Background
What is health literacy?
The role of health literacy on tuberculosis and critical reasons to measure it
Available measurements of health literacy
Aims of the study
Methods
Scale development
Phase 1: Theoretical framework
Phase 2: development of an item pool
Phase 3: item selection
Pilot study
Assessing the psychometric properties of the scale
Study design
Participants
Ethics statement
Data collection
Statistical analysis
Results
Scale development
Phase 1: Theoretical framework
Phase 2: development of an item pool
Phase 3: item selection
Pilot study
Assessing the psychometric properties of the scale
Participants demographic characteristics
Characteristics | Total sample (n = 498) | Sample of EFA (n1 = 253) | Sample of CFA (n2 = 245) | x2/z | P |
---|---|---|---|---|---|
n (%) or mean ± SD | n (%) or mean ± SD | n (%) or mean ± SD | |||
Age (range: 18–78 years) | 37.25 ± 15.31 | 37.40 ± 15.45 | 37.09 ± 15.19 | − 0.103 | 0.918 |
Gender | 3.762 | 0.052 | |||
Male | 300 (60.2%) | 163(64.4) | 137(55.9) | ||
Female | 198 (39.8) | 90(35.6) | 108(44.1) | ||
Education | −1.827 | 0.068 | |||
Less than primary school | 81 (16.3) | 38(15.0) | 43(17.6) | ||
Junior high school | 122 (24.5) | 55(21.7) | 67(27.3) | ||
Senior high school | 227 (45.6) | 123(48.6) | 104(42.5) | ||
College/university diploma or higher | 68 (13.6) | 37(14.6) | 31(12.7) | ||
Marital status | 2.543 | 0.468 | |||
Single | 194 (39.0) | 100(39.5) | 94(38.4) | ||
Married | 270 (54.2) | 132(52.2) | 138(56.3) | ||
Divorced | 21 (4.2) | 12(4.7) | 9(3.7) | ||
Widowed | 13 (2.6) | 9(3.6) | 4(1.6) | ||
Patient type | 1.266 | 0.261 | |||
Outpatient | 278 (55.8) | 135(53.4) | 143(58.4) | ||
Inpatient | 220 (44.2) | 118(46.6) | 102(41.6) | ||
Medical history | 1.404 | 0.495 | |||
Initial treatment | 358 (71.9) | 177(70.0) | 181(73.9) | ||
Re-treatment | 117 (23.5) | 65(25.7) | 52(21.2) | ||
Drug-resistant | 23 (4.6) | 11(4.3) | 12(4.9) | ||
Treatment time | −0.671 | 0.502 | |||
1–2 months | 306 (61.4) | 152(60.1) | 154(62.9) | ||
3–8 months | 176 (35.3) | 92(36.4) | 84(34.4) | ||
> 8 months | 16 (3.2) | 9(3.6) | 7(2.9) | ||
Occupation | 12.010 | 0.100 | |||
Factory worker | 71 (14.3) | 34(13.4) | 37(15.1) | ||
Agriculture | 106 (21.3) | 58(22.9) | 48(19.6) | ||
Professional and technical personnel | 48 (9.6) | 30(11.9) | 18(7.3) | ||
Office worker | 11 (2.2) | 5(2.0) | 6(2.4) | ||
Business/service staff | 49 (9.8) | 17(6.7) | 32(13.1) | ||
Student | 74 (14.9) | 44(17.4) | 30(12.2) | ||
Retired | 21 (4.2) | 9(3.6) | 12(4.9) | ||
Laid-off worker | 48 (9.6) | 20(7.9) | 28(11.4) | ||
Others | 70 (14.1) | 36(14.2) | 34(13.9) | ||
Census | 2.591 | 0.274 | |||
Permanent residents | 398 (79.9) | 209(82.6) | 189(77.1) | ||
Temporary residents | 70 (14.1) | 32(12.6) | 38(15.5) | ||
Floating population | 30 (6) | 12(2.0) | 18(7.3) | ||
Personal monthly income (RMB yuan) | −0.200 | 0.842 | |||
< 1999 | 192 (38.6) | 95(37.5) | 97(39.6) | ||
2000–2999 | 223 (44.8) | 121(47.8) | 102(41.6) | ||
3000–3999 | 70 (14.1) | 32(12.6) | 38(15.5) | ||
> 4000 | 13 (2.6) | 5(2.0) | 18(7.3) |
Content validity
Construct validity by EFA
Items | Factors | ||||
---|---|---|---|---|---|
1 | 2 | 3 | 4 | ||
Factor 1 (F1): Remembering 1 (Words for TB-related drug names and main symptoms, 10 items) | |||||
A11 | Rifampicin | .742 | |||
A3 | Cough with blood | .727 | |||
A2 | Expectoration | .709 | |||
A12 | Bloody sputum | .673 | |||
A4 | Fever | .640 | |||
A14 | Respiratory infectious disease | .629 | |||
A10 | Isoniazid | .626 | |||
A9 | Tuberculosis | .549 | |||
A16 | Chemotherapy of tuberculosis | .513 | |||
A1 | Cough | .453 | |||
Factor 2 (F2): Remembering 2 (Words for TB-related treatment and care adherence, 6 items) | |||||
A8 | Follow up | .755 | |||
A7 | Reexamination | .743 | |||
A13 | Sputum examination | .723 | |||
A15 | Close contact check | .676 | |||
A6 | Misses a dose | .568 | |||
A5 | Night sweats | .497 | |||
Factor 3 (F3): Understanding and Applying (Contexts for TB-related treatment and follow-up, 6 items) | |||||
B14 | If you go for the follow-up on April 16, 2017, what time should you leave your night sputum? | .608 | |||
B10 | If there is a confirmed smear-positive pulmonary tuberculosis patients, what should he do with his own sputum? | .603 | |||
B8 | If a patient receiving an anti-tuberculosis chemotherapy has nausea and vomiting during the medication, but has not yet reviewed the time, what should the patient do? | .556 | |||
B5 | If you run out of drugs on April 12, 2017, what time should you go to the hospital to review and receive the medicine? | .541 | |||
B7 | If a patient who has received anti-tuberculosis chemotherapy for two months, his tuberculosis symptoms have basically disappeared, may he be able to reduce or disable the drug? | .539 | |||
B9 | Assume a smear-positive tuberculosis patients, his family appears the symptoms of coughing, sputum, etc., do you think his family should go to the hospital for further examination? | .463 | |||
Factor 4 (F4): Analysing (Ability for TB patients to calculate and analyze, 7 items) | |||||
B2 | How many times should you take your medication every day? | .667 | |||
B4 | How long this drug could be taken? | .643 | |||
B1 | If you have a breakfast at 7:00 and should take the medication before a meal, what time do you have to take the medication? | .575 | |||
B11 | Assume a patient who is in an infectious phase, could you tell me which of the following is wrong with him? | .570 | |||
B12 | How many times do you need to check your sputum during the treatment of tuberculosis? | .564 | |||
B3 | If your weight is 60 kg, how many tablets should you take each time? | .550 | |||
B13 | If you are the first treatment of tuberculosis patients, what first time should you send sputum to review? | .447 | |||
Eigenvalues | 4.672 | 3.894 | 3.185 | 2.898 | |
% of variance | 15.070 | 12.562 | 10.274 | 9.347 | |
Cumulative% | 15.070 | 27.632 | 37.906 | 47.254 |
Construct validity by CFA
Discriminant validity
Variables | Range of scores | Mean ± SD | Mean ± SD | t | |
---|---|---|---|---|---|
Scores of PH | Scores of PL | ||||
F1:Remembering 1 | 0–10 | 8.68 ± 2.18 | 9.77 ± 0.54 | 9.05 ± 1.39 | 6.84* |
F2:Remembering 2 | 0–6 | 3.52 ± 2.23 | 5.45 ± 0.95 | 3.34 ± 2.05 | 13.20* |
F3:Understanding and Applying | 0–18 | 11.11 ± 4.97 | 15.95 ± 2.94 | 10.05 ± 3.92 | 16.56* |
F4:Analysing | 0–21 | 14.06 ± 5.85 | 19.39 ± 2.20 | 14.11 ± 4.35 | 15.33* |
Total: CHLS-TB | 0–55 | 37.37 ± 11.34 | 50.55 ± 3.03 | 36.54 ± 4.78 | 34.43* |
Reliability
Variables | No. of items | Cronbach’s α(n = 498) | Test-retest reliability (n = 50) |
---|---|---|---|
F1:Remembering 1 | 10 | 0.856 | 0.843* |
F2:Remembering 2 | 6 | 0.857 | 0.899* |
F3:Understanding and Applying | 6 | 0.755 | 0.968* |
F4:Analysing | 7 | 0.722 | 0.955* |
Total: CHLS-TB | 29 | 0.820 | 0.958* |