中国患者健康素养量表修订及改进

陈颖; 董建; 田向阳; 孙桐; 韦国峰; 张红; 吴宗辉

doi:10.11847/zgggws1136236

中国患者健康素养量表修订及改进

doi: 10.11847/zgggws1136236

陈颖¹,
董建²,
田向阳^3, ,,
孙桐⁴,
韦国峰⁵,
张红⁶,
吴宗辉^7, ,

1.
安徽医科大学公共卫生学院营养与食品卫生学系，安徽合肥 230032
2.
首都医科大学宣武医院
3.
中国健康教育中心培训部
4.
山东省疾病预防控制中心
5.
甘肃省卫生健康宣传教育中心
6.
山西省眼科医院
7.
西南大学医院

详细信息

作者简介:
陈颖（1996 – ），女，安徽宿州人，硕士在读，研究方向：健康教育与健康促进

通讯作者:
田向阳，E-mail：healthtian@163.com

吴宗辉，E-mail：wuzh@swu.edu.cn

中图分类号: R 183
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- 被引次数: 0
出版历程
- 接收日期: 2021-09-22
- 网络出版日期: 2022-05-31
- 刊出日期: 2022-08-31

Revision and an empirical evaluation of the Chinese Patient Health Literacy Scale

1.
Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, Anhui Province 230032, China

摘要

摘要: 目的改进和完善《中国患者健康素养量表》，为中国患者健康素养测评提供适宜工具。方法使用经初步修订的《中国患者健康素养量表》电子问卷，于2021年1 — 5月抽取中国东、中、西部地区14所医院的2 808例门诊患者进行调查；运用SPSS 23.0软件进行探索性因子分析，对修订后的量表进行进一步改进；运用AMOS 23.0进行结构方程模型分析，检验量表结构效度。结果经初步修订的患者健康素养量表Cronbach′s α系数为0.841，5个维度的α系数分别为0.751、0.787、0.568、0.725、0.412，累积方差贡献率为62.538 %。修订后量表探索性因子分析提取3个公因子，提示量表压缩为自我效能、疾病自我管理技能和医学常识3个维度，删除4个题项，量表整体Cronbach′s α系数为0.845，3个维度的α系数分别为0.926、0.831、0.753，累积方差贡献率为67.228 %。结构方程模型分析结果显示，改进后量表各条目在所属维度的因子载荷量均 > 0.53（0.53～0.90）。残差均方和平方根（RMR）0.083、适配度指标渐进残差均方和平方根（RMSEA）0.086、适配度指数（GFI）0.926、调整后适配度指数（AGFI）0.891、规准适配指数（NFI）0.928、相对适配指数（RFI）0.909、增值拟合指数（IFI）0.931、Tacker-lewis指数（TLI/NNFI）0.913、比较适配指数（CFI）0.931、简约调整适配度指数（PGFI）0.631、简约调整规准适配指数（PNFI）0.737、简约调整比较适配指数（PCFI）0.740、临界样本数（CN）171。结论改进后的患者健康素养量表具有良好的内部一致性信度和结构效度，更易于在患者中推广应用。
- 患者健康素养量表 /
- 探索性因子分析 /
- 结构方程模型
Abstract: Objective To modify the Chinese Patient Health Literacy Scale (CPHLS) for improving the reliability and validity of the scale. Methods From January to May 2021, t he CPHLS was preliminarily revised by expert consultation and the revised electronic scale was employed to measure the health literacy of 2 808 outpatients randomly selected at 14 hospitals in eastern, central and western China. SPSS 23.0 was utilized for Cronbach′s α calculation and exploratory factor analysis (EFA) to further improve the revised scale; AMOS 23.0 was applied to build a structural equation model (SEM) to test the validity of the scale. Results The Cronbach′s α coefficient of the preliminarily revised CPHLS was 0.841 and the α coefficients of the scale′s five dimensions were 0.751 for concept of medical science, 0.787 for disease self-management skills, 0.568 for medical common sense, 0.725 for self-efficacy , and 0.412 for medical information cognition, respectively, with an overall cumulative proportion of variance of 62.538%. Three common factors of the revised scale (e.g. self-efficacy, disease self-management skills and medical common sense) were extracted according to the results of EFA. After deleting four original items, the α coefficient of the revised scale was raised to 0.845, the α coefficients of the three dimensions were 0.926, 0.831, and 0.753 and the cumulative proportion of variance was 67.228%. The SEM analysis on the revised scale demonstrated that the dimension-specific factor load capability ranged 0.53 – 0.90 and the constructed SEM is of good overall goodness of fit, with the root mean square residual (RMR) of 0.083, root mean square error of approximation (RMSEA) of 0.086, goodness-of-fit index (GFI) of 0.926, adjusted goodness-of-fit index (AGFI) of 0.891, normed fit index (NFI) of 0.928, relative fit index (RFI) of 0.909, incremental fit index (IFI) of 0.931, the Tacker-Lewis index/non-normed fit index (TLI/NNFI) of 0.913, comparative fit index (CFI) of 0.931, parsimony goodness-of-fit index (PGFI) of 0.631, parsimony-adjusted normed fit index (PNFI) of 0.737, parsimony-adjusted comparative fit index (PCFI) of 0.740, and the critical number (CN) of 171, respectively. Conclusion The revised Chinese Patient Health Literacy Scale is of good internal consistency reliability and construct validity, indicating a potential application in the evaluation on patients' health literacy.
- Patient Health Literacy Scale /
- exploratory factor analysis /
- structural equation model

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图 1 改进后患者健康素养量表的结构方程模型标准化路径图

注：图中 3个维度之间的路径系数、每个维度与各题项之间的路径系数为标准化参数估计值（因子载荷量λ）；各题项右上角的系数为λ²，表示观测变量（题项）可被相应的潜变量（维度）解释的变异量；e1～e13为观测变量相应的残差变量。

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表 1 患者健康素养量表修订前后题项删除对量表信度影响及各维度信度

维度	题项	删除该题项总量表的信度变化	修订前各维度 Cronbach′s α系数	修订后量表各维度 Cronbach′s α系数
医学科学观念	B9：戒烟的关键是有人提醒和帮助	– 0.010	0.666	0.751
	B10：吃的多、喝的多、尿的多、体重下降说明身体好	– 0.005
	B12：得了高血压病，不必持续服药，只要在感到不适时服　　药就可以了	– 0.003
	B15：糖尿病治疗的最终目的是控制血糖	– 0.010
	B20：持续性精神紧张压力是糖尿病的危险因素	– 0.015
疾病自我管理技能	B3：肥胖、持续性精神紧张、压力大、缺乏身体活动的人　更容易得高血压	– 0.011	0.656	0.787
	B4：身高体重指数是诊断肥胖症的参考指标	– 0.012
	B8：心脏骤停，可施行胸外心脏按压，进行急救	– 0.012
医学常识	B13：控制血压是糖尿病治疗的关键	– 0.013	0.610	0.568
	B14：积极规范治疗高血压可有效预防心脏病、肾病以及　　脑血管疾病	– 0.014
	B18：突然出现一侧身体、躯干无法移动，说话不流利、意　　识障碍，说明可能患有脑卒中	– 0.010
自我效能	A16：清楚自己所患疾病的病因、症状、治疗措施和注意　　事项?	– 0.016	0.562	0.725
	A17：清楚自己的病情或治疗方案	– 0.015
	A18：与医护人员之间的沟通情况	0.001
医学信息认知	A13：清楚自己得的是什么疾病	– 0.014	0.715	0.412
	A14：清楚自己的病是什么时候确诊的	– 0.015
	C21：平均每天上网时间	0.021
总量表			0.785	0.841

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表 2 患者健康素养量表改进前后整体模型适配指标

统计检验量	适配的标准或临界值	改进前	改进后
绝对适配度统计量
χ² 值	χ²显著性检验P > 0.05	2 410.421（P < 0.05）	1 336.514（P < 0.05）
RMR 值	< 0.05	0.085	0.083
RMSEA 值	< 0.08（若 < 0.05优良， < 0.08良好， < 0.1普通）	0.087	0.086
GFI 值	> 0.9	0.897	0.926
AGFI 值	> 0.9	0.856	0.891
增值适配统计量
NFI 值	> 0.9	0.886	0.928
RFI 值	> 0.9	0.858	0.909
IFI 值	> 0.9	0.891	0.931
TLI 值	> 0.9	0.864	0.913
CFI 值	> 0.9	0.891	0.931
简约适配统计量
PGFI 值	> 0.5	0.639	0.631
PNFI 值	> 0.5	0.710	0.737
PCFI 值	> 0.5	0.714	0.740
CN 值	> 200	157.000	171.000
χ²/df	< 2（良好）， < 3（普通）， < 5（可以接受）	22.114	21.557

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参考文献(25)

[1]	Institute of Medicine (US) Committee on Health Literacy. Health literacy: a prescription to end confusion[M]. Washington (DC): National Academies Press (US), 2004: 4.
[2]	Berkman ND, Sheridan SL, Donahue KE, et al. Low health literacy and health outcomes: an updated systematic review[J]. Annals of Internal Medicine, 2011, 155(2): 97 – 107. doi: 10.7326/0003-4819-155-2-201107190-00005
[3]	White S, Chen J, Atchison R. Relationship of preventive health practices and health literacy: a national study[J]. American Journal of Health Behavior, 2008, 32(3): 227 – 242.
[4]	Miller TA. Health literacy and adherence to medical treatment in chronic and acute illness: a meta-analysis[J]. Patient Education and Counseling, 2016, 99(7): 1079 – 1086. doi: 10.1016/j.pec.2016.01.020
[5]	胡佳. 患者健康素养量表研制与评价[D]. 北京: 中国疾病预防控制中心, 2019.
[6]	Morgado FFR, Meireles JFF, Neves CM, et al. Scale development: ten main limitations and recommendations to improve future research practices[J]. Psicologia:Reflexã o e Crítica, 2017, 30(1): 3.
[7]	吴明隆. 结构方程模型 – AMOS的操作与应用[M]. 重庆: 重庆大学出版社, 2010: 37 – 68, 486 – 490.
[8]	国家卫生健康委员会. 2020中国卫生健康统计年鉴[M]. 北京: 中国协和医科大学出版社, 2020: 119.
[9]	Griva K, Yoong RKL, Nandakumar M, et al. Associations between health literacy and health care utilization and mortality in patients with coexisting diabetes and end - stage renal disease: a prospective cohort study[J]. British Journal of Clinical Psychology, 2020, 25(3): 405 – 427.
[10]	O'Conor R, Muellers K, Arvanitis M, et al. Effects of health literacy and cognitive abilities on COPD self - management behaviors: a prospective cohort study[J]. Respiratory Medicine, 2019: 160.
[11]	Lu MM, Ma JY, Lin Y, et al. Relationship between patient's health literacy and adherence to coronary heart disease secondary prevention measures[J]. Journal of Clinical Nursing, 2019, 28(15/16): 2833 – 2843.
[12]	Caldwell EP. The influence of health literacy on emergency department utilization and hospitalizations in adolescents with sickle cell disease[J]. Public Health Nursing, 2019, 36(6): 765 – 771. doi: 10.1111/phn.12643
[13]	Fabbri M, Yost K, Finney Rutten LJ, et al. Health literacy and outcomes in patients with heart failure: a prospective community study[J]. Mayo Clinic Proceedings, 2018, 93(1): 9 – 15. doi: 10.1016/j.mayocp.2017.09.018
[14]	Jaffee EG, Arora VM, Matthiesen MI, et al. Health literacy and hospital length of stay: an inpatient cohort study[J]. Journal of Hospital Medicine, 2017, 12(12): 969 – 973. doi: 10.12788/jhm.2848
[15]	Davis TC, Crouch MA, Long SW, et al. Rapid assessment of literacy levels of adult primary care patients[J]. Family Medicine, 1991, 23(6): 433 – 435.
[16]	Parker RM, Baker DW, Williams MV, et al. The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills[J]. Journal of General Internal Medicine, 1995, 10(10): 537 – 541. doi: 10.1007/BF02640361
[17]	Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the newest vital sign[J]. The Annals of Family Medicine, 2005, 3(6): 514 – 522. doi: 10.1370/afm.405
[18]	黄亚阳, 宋娟, 庄丽丽, 等. 校内青少年生活技能评价量表初步修订及信、效度评价[J]. 中国公共卫生, 2017, 33(12): 1685 – 1689. doi: 10.11847/zgggws2017-33-12-03
[19]	郝元涛, 孙希凤, 方积乾, 等. 量表条目筛选的统计学方法研究[J]. 中国卫生统计, 2004, 21(4): 209 – 211. doi: 10.3969/j.issn.1002-3674.2004.04.006
[20]	胡佳, 田向阳, 任学锋, 等. 中国居民传染病健康素养测评量表验证性因子分析[J]. 中国公共卫生, 2019, 35(3): 313 – 316. doi: 10.11847/zgggws1120400
[21]	温忠麟, 侯杰泰, 马什赫伯特. 结构方程模型检验: 拟合指数与卡方准则[J]. 心理学报, 2004, 36(2): 186 – 194.
[22]	黄芳铭. 结构方程模式: 理论与应用[M]. 北京: 中国税务出版社, 2005: 141 – 170.
[23]	吴明隆. 结构方程模型 – AMOS实务进阶[M]. 重庆: 重庆大学出版社, 2013: 79 – 95.
[24]	Schumacker RE, Lomax RG. A beginner's guide to structural equation modeling[M]. 3rd ed. Mahwah: Taylor and Francis Group, 2010: 91.
[25]	Hair JF Jr, Black WC, Babin BJ, et al. Multivariate data analysis[M]. 7th ed. New York: Pearson Education, 2009: 627 – 777.