Revision of brief health literacy assessment scale among the older adults and its reliability and validity test.

Abstract

The development and validation of the specific health literacy assessment tool for older adults is the basis for conducting the research on health literacy among older adults. The existing health literacy assessment scale for older adults in Chinese mainland has some limitations, such as too many items and poor compliance during the survey. It is necessary to develop or introduce simplified assessment tools to support large-scale surveys in the future. This study aims to modify the brief health literacy assessment scale compiled by Taiwan scholars, and to conduct the test for the reliability, validity and the measurement equivalence across gender in the older population in mainland China. From March to April 2021, 508 older adults from Jinan, Shandong Province, China were selected by cluster sampling method to conduct a questionnaire survey using the brief health literacy assessment scale and health-promoting lifestyle profile. After 4 weeks, 83 of them were selected for retesting. SPSS 25.0 statistical software was used for descriptive analysis, item analysis, exploratory factor analysis, correlation analysis, and reliability test, and Mplus 8.0 was used for confirmatory factor analysis and gender measurement equivalence test. Each item of the scale had good discrimination, and there were significant differences in the scores of each item between high score and low score groups (P<0.05), and the coefficient of correlation between the scores of each item and the total score was between 0.721 and 0.891. Exploratory factor analysis extracted a factor with a characteristic root greater than 1, and the cumulative variance interpretation amount was 67.94%. The confirmatory factor analysis showed that the single factor structure fit was good [χ2/df was 2.260, the Tucker-Lewis index was 0.973, the comparison fit index (CFI) was 0.982, and the root mean square error of approximation (RMSEA) was 0.071]. The multi-group confirmatory factor analysis results showed that the brief health literacy assessment scale's configural equivalence, weak equivalence, and strong equivalence models were all accepted. The comparison results of measurement equivalence models showed that the changes of RMSEA were less than 0.015, and the changes of CFI were less than 0.01, indicating that the brief health literacy assessment scale had measurement equivalence between different gender groups. Cronbach's α coefficient was 0.945, and the test-retest reliability was 0.946. The correlation coefficient between health literacy and health-promotion lifestyles was 0.557 (P<0.05). The brief health literacy assessment scale has good reliability, validity, and measurement equivalence across gender, and can be used as an effective measurement tool for the health literacy of the older people in Chinese mainland.