Validation and Psychometric Testing of the Chinese Version of the Mental Health Literacy Scale Among Nurses.

Anni Wang,Yuan Zhu,Xiaomin Sun,Shoumei Jia,Zhongying Shi,Miaoli Shen

doi:10.3389/fpsyg.2021.791883

Abstract

The Mental Health Literacy Scale (MHLS) is the most widely used and strong theory-based measurement tool to gain an understanding of mental health knowledge and ability. This study aimed to test the psychometric properties of the Chinese version of the Mental Health Literacy Scale (MHLS-C) and to document the norm and its influential factors of mental health literacy among nurses. The MHLS was translated following Brislin’s translation model and tested with a sample of 872 clinical registered nurses. The Jefferson Scale of Empathy-Health Professionals (JSE-HP), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder-2 (GAD-2) were administered to assess convergent validity. The minimum average partial test, parallel analysis and confirmatory factor analysis supported 4 first-order 2 second-order structure. The 4 factors were named “knowledge of mental disorder,” “ability to seek information and help,” “recognition of mental disorder,” and “acceptance of patients with mental illness,” with factor 1-3 were summarized into MHLS-Core (Core literacy subscale) and factor 4 as MHLS-SA (Social acceptance subscale). The MHLS-C was moderately negatively correlated with the PHQ-2 and GAD-2 (-0.111, -0.081) and highly positively correlated with JSE-HP (0.492). The Cronbach’s α was 0.85 for the overall scale and 0.89 and 0.93 for two subscales. The test-retest reliability was good, with intraclass correlation coefficients (ICCs) of 0.80 for the whole scale, and 0.79 and 0.94 for two subscales. As an approximately normal distribution, the 50th percentile for the MHLS-C was 99, with 50th percentiles of 74 and 20 for MHLS-Core and MHLS-SA. Higher position, higher professional credentials, higher hospital hierarchy, other specialist hospital, psychiatric hospital and unmarried status were positive predictors. The 29-item MHLS-C, with two subscales of MHLS-Core and MHLE-SA, is a stable and validated tool to measure mental health literacy. MHLS-Core could be used independently to measure the core content of mental health literacy. It may be applicable for Chinese health professionals, but need further validation among the general public. MHL curriculum and a targeted culturally appropriate program for acceptance for health professionals, especially for those in general hospitals and with less working tenure, may be recommended.

Highlights

In the past three decades, mental disorders have become more prevalent and one of the top causes of diseases worldwide (World Health Organization at https://www.who.int/healthtopics/mental-health#tab=tab_2)
Three items were deleted for poor item information: I-10 “men are more likely to experience an anxiety disorder compared to women,” I15 “a mental health professional can break confidentiality if your problem is not life-threatening and they want to assist others to better support you,” I-20 “People with a mental illness could snap out if it if they wanted,” I-21 “A mental illness is a sign of personal weakness,” I-22 “A mental illness is not a real medical illness”
I-20 refers to recognition of mental disorders, but it seems to be too absolute because mental illness could be self-cured in some cases, such as self-practiced mindfulness therapy (Parsons et al, 2017), and I-21, I-22 conveyed vogue content in Chinese context, and they had poor performance

Summary

Introduction

In the past three decades, mental disorders have become more prevalent and one of the top causes of diseases worldwide (World Health Organization at https://www.who.int/healthtopics/mental-health#tab=tab_2). The general public’s MHL is generally low even in developed countries (Jorm et al, 1997; Jorm, 2012; Kutcher et al, 2016) and developing countries such as China (Jiang et al, 2020), and enhancing MHL is of great significance. This issue has been taken seriously by China Health Commission in its “Healthy China Action (2019–2030),” which took the improvement of mental health literacy as an important national strategic goal for improving the level of mental health of the people (accessible at: http://www.gov.cn/zhengce/2019-07/ 16/content_5410295.html)

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Discussion

Conclusion