上海市社区卫生服务中健康素养量表的开发和评价

 目的 开发适用于上海市社区卫生服务情景的具有较高信效度的健康素养量表。方法 通过文献评价、深度访谈发展题库及德尔菲法审定条目,结合上海市社区卫生服务环境的实际情况开发量表。采用方便抽样的方法,在上海市某区3家社区卫生服务中心抽取300名候诊者进行问卷调查。采用同质性信度、重测信度和分半信度、内容效度、区分效度等方法进行信效度评价,采用验证性因子分析进行模型验证。结果  获得有效问卷297份(99%)。量表的Cronbach’s α为0.901,各维度的Cronbach’s α分别为0.911、0.861、0.855和0.753;重测信度和分半信度分别为0.637和0.756。因子分析的KMO值为0.891,生成4个公因子可解释65.96%的方差变异。高分组和低分组、不同文化水平、是否从事过医疗行业的人群的得分差异均有统计学意义(P<0.05),说明量表具有区分效度。验证性因子分析得到χ2/df =3.067,近似误差均方根(root mean square error of approximation,RMSEA)为0.054,残差均方根(root of the mean square residual,RMR)为0.082,拟合优度指数(goodness-of-fit index,GFI)、校正拟合优度指数(adjusted goodness-of-fit index,AGFI)、比较拟合指数(comparative fit index,CFI)、规范拟合指数( normed fit index,NFI )、增量拟合指数(incremental fit index,IFI)均接近1,显示模型拟合较好。结论 该健康素养量表在此次调查中显示具有较好的信效度,可应用于上海市社区卫生服务工作。

Development and assessment of health literacy scale in community health service in Shanghai

Objective  To develop and validate a scale on health literacy that is suitable for community health service in Shanghai,China.Methods  Based on the situation of community health service in Shanghai,we developed a scale and checked its items through systematic literature reviews,in-depth interviews and the Delphi technique.A convenient sample of 300 patients in 3 community health service centers in Shanghai was investigated.The internal consistent reliability,test-retest reliability,split-half reliability,content validity and construct validity of the scale were examined.Confirmatory factor analysis was also used for model validation.Results  A total of 297 (99%) effective questionnaires were collected.The total Cronbach’s α coefficient was 0.901,and the Cronbach’s α of each dimension was 0.911,0.861,0.855 and 0.753,respectively.Test-retest reliability and split-half reliability were 0.637 and 0.756,respectively.KMO statistic in factor analysis was 0.891 and 4 factors predicted 65.96% of total variance.Significant differences were found among different score groups,education levels and jobs related to health care (P<0.05),indicating that the discriminate validity was suitable.The indicators of confirmatory factor analysis were well:χ2/df was 3.067;root mean square error of approximation (RMSEA) was 0.054;root of the mean square residual (RMR) was 0.082;goodness-of-fit index (GFI),adjusted goodness-of-fit index (AGFI),comparative fit index (CFI),normed fit index (NFI) and incremental fit index (IFI) were close to 1.Conclusions  The health literacy scale presents acceptable reliability and validity in the surveyed sample,which may be used as a valid measure of health literacy in community health service centers in Shanghai.