中医养生健康信息素养量表编制及其信效度检验
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摘要
背景健康信息素养不仅关注个体对健康信息的掌握情况和获取途径,更注重个体对信息评价与应用的能力。中医在治病防病、养生保健方面发挥了不可替代作用,评估个体中医养生健康信息素养水平可有效促进我国社区居民健康。目的编制中医养生健康信息素养量表,并检测其信效度。方法 2017年9月,在健康信息素养基本概念的基础上,查阅国内外相关文献、量表及《中国公民中医养生保健素养》和《中国公民健康素养——基本知识与技能(2015年版)》等中医养生权威问卷形成条目池,编制中医养生健康信息素养量表初稿(包括5个维度45个条目)。2018年1—2月,经过专家咨询形成中医养生健康信息素养量表初稿1(包括5个维度40个条目),2018年3月经过预调查及项目分析形成中医养生健康信息素养量表(包括5个维度36个条目)。2018年4—5月,采用便利抽样法选取南大和园、赛世香樟园、亚东城、西岗社区、仙林新村5个社区的220例社区居民进行正式调查,分析中医养生健康信息素养量表的信效度。结果中医养生健康信息素养量表初稿1条目1～21、条目23～35、条目38～39得分与其总分的相关系数均>0.300,条目22、36、37、40得分与其总分的相关系数均<0.300。通过区分度法将调查对象分为高分组(由中医养生健康信息素养量表总分最高27%的个体组成,n=32)和低分组(由中医养生健康信息素养量表总分最低的27%的个体组成,n=32);高分组中医养生健康信息素养量表初稿1条目1～21、条目23～35、条目38、条目39得分高于低分组(P<0.05);高分组中医养生健康信息素养量表初稿1条目22、36、37、40得分与低分组比较,差异无统计学意义(P>0.05)。综上,删除条目22、36、37、40,形成中医养生健康信息素养量表。中医养生健康信息素养量表各条目水平的内容效度指数(I-CVI)为0.79～1.00,量表水平的内容效度指数(S-CVI)为0.911。中医养生健康信息素养量表的KMO值为0.858,Bartlett's球形检验的χ2=4 432.383,P<0.001,符合探索性因子分析条件。采用主成分分析法,共提取特征根>1.000的公因子5个,分别命名为对中医养生健康信息的认知能力、对中医养生健康信息的获取能力、对中医养生健康信息的评价能力、对中医养生健康信息的应用能力和信息道德,其累积方差贡献率为65.293%,各条目的因子负荷为0.423～0.860,均>0.400。中医养生健康信息素养量表的Cronbach'sα系数为0.922,各维度Cronbach'sα系数为0.839～0.882。结论本研究编制的中医养生健康信息素养量表包括对中医养生健康信息的认知能力(5个条目)、对中医养生健康信息的获取能力(11个条目)、对中医养生健康信息的评价能力(11个条目)、对中医养生健康信息的应用能力(7个条目)和信息道德(2个条目)共5个维度36个条目,其在社区居民中具有良好的信效度和适用性,且易于理解,有利于研究者评估我国社区居民中医养生健康信息素养。
Background The health information literacy(HIL)focuses on not only the ability to acquire health information but also the ability of evaluation and application.Traditional Chinese medicine(TCM)plays an irreplaceable role in preventing and combating disease as well as maintaining health status for Chinese residents.Evaluating HIL in TCM helps to improve residents' health status effectively.Objective To develop an instrument for measuring the health information literacy in TCM and test its reliability and validity.Methods Based on the concept of HIL,the item pool was completed by reviewing relevant literature and scales as well as authoritative questionnaires in health preserving of TCM,including Chinese Citizens' Health Preserving Literacy and Basic Knowledge and Skills of Chinese Citizens' Health Literacy(2015 Edition)at September 2017.After revising in accordance with the expert consultation performed from January to February,2018,the draft of the HIL Scale in TCM 1 consisting of 5 dimensions and 40 items was developed.In March 2018,a pilot study and item analysis with the first version of the scale were performed and then the HIL Scale in TCM was accomplished with 5 dimensions and 36 items.From April to May 2018,220 citizens were selected from 5 communities(Ntu and Garden,Saishi Camphr Garden,Yadong City,Xigang Community and Xianlin Village)for investigation by using convenience sampling to test the validity and reliability of the HIL Scale in TCM.Results Item analysis of the first draft of HIL Scale in TCM showed that the correlation coefficient between the separate score for each of the following items from 1 to 21,23 to 35,items 38 and 39,and the total score of 40 items was >0.300.The correlation coefficient between the separate score for each of the rest items 22,36,37,40 and total score of 40 items was <0.300.The subjects were categorized into a high-score group(composed of 27% of individuals with the highest total score of the first draft of the HIL Scale in TCM,n=32)and a low-score group(composed of 27% individuals with the lowest total score,n=32)by using item discrimination analysis.The scores in each of the following items from 1 to 21,23 to 35,items 38 and 39 in the high-score group were higher than those of the low-score group(P<0.05).There were no significant differences in the scores of the rest items 22,36,37 and 40 between the high-score group and the lower-score group(P>0.05).In summary,the HIL Scale in TCM was finally formed by deleting items 22,36,37 and 40.The item content validity index ranged from 0.79 to 1.00,and the scale content validity index was 0.911.The KMO of the testing version scale was 0.858,and Bartlett's test showed that χ2=4 432.383,P<0.001,indicating that factor analysis could be performed.Using principal component analysis,according to the principle that Eigen value should be over 1.000,five factors were extracted and named as cognitive ability of health preserving information in TCM,retrieving ability of health preserving information in TCM,evaluation ability of health preserving information in TCM,application ability of health preserving information in TCM,and information morality,respectively,which explained 65.293% of the total variance.The factor load of each item ranged from 0.423 to 0.860,all of which were over 0.400.The Cronbach's α of the scale was 0.922.Cronbach's α of each dimension ranged from 0.839 to 0.882.Conclusion The HIL Scale in TCM consists of 5 domains covering 36 items,including the cognitive ability of health preserving information in TCM(5 items),retrieving ability of health preserving information in TCM(11 items),evaluation ability of health preserving information in TCM(7 items),application ability of health preserving information in TCM(11 items)and information morality(2 items).The HIL scale in TCM has good validity and reliability and it is also very comprehensible.The scale can be used to evaluate the community citizens' HIL in TCM.
Background The health information literacy(HIL)focuses on not only the ability to acquire health information but also the ability of evaluation and application.Traditional Chinese medicine(TCM)plays an irreplaceable role in preventing and combating disease as well as maintaining health status for Chinese residents.Evaluating HIL in TCM helps to improve residents' health status effectively.Objective To develop an instrument for measuring the health information literacy in TCM and test its reliability and validity.Methods Based on the concept of HIL,the item pool was completed by reviewing relevant literature and scales as well as authoritative questionnaires in health preserving of TCM,including Chinese Citizens' Health Preserving Literacy and Basic Knowledge and Skills of Chinese Citizens' Health Literacy(2015 Edition)at September 2017.After revising in accordance with the expert consultation performed from January to February,2018,the draft of the HIL Scale in TCM 1 consisting of 5 dimensions and 40 items was developed.In March 2018,a pilot study and item analysis with the first version of the scale were performed and then the HIL Scale in TCM was accomplished with 5 dimensions and 36 items.From April to May 2018,220 citizens were selected from 5 communities(Ntu and Garden,Saishi Camphr Garden,Yadong City,Xigang Community and Xianlin Village)for investigation by using convenience sampling to test the validity and reliability of the HIL Scale in TCM.Results Item analysis of the first draft of HIL Scale in TCM showed that the correlation coefficient between the separate score for each of the following items from 1 to 21,23 to 35,items 38 and 39,and the total score of 40 items was >0.300.The correlation coefficient between the separate score for each of the rest items 22,36,37,40 and total score of 40 items was <0.300.The subjects were categorized into a high-score group(composed of 27% of individuals with the highest total score of the first draft of the HIL Scale in TCM,n=32)and a low-score group(composed of 27% individuals with the lowest total score,n=32)by using item discrimination analysis.The scores in each of the following items from 1 to 21,23 to 35,items 38 and 39 in the high-score group were higher than those of the low-score group(P<0.05).There were no significant differences in the scores of the rest items 22,36,37 and 40 between the high-score group and the lower-score group(P>0.05).In summary,the HIL Scale in TCM was finally formed by deleting items 22,36,37 and 40.The item content validity index ranged from 0.79 to 1.00,and the scale content validity index was 0.911.The KMO of the testing version scale was 0.858,and Bartlett's test showed that χ2=4 432.383,P<0.001,indicating that factor analysis could be performed.Using principal component analysis,according to the principle that Eigen value should be over 1.000,five factors were extracted and named as cognitive ability of health preserving information in TCM,retrieving ability of health preserving information in TCM,evaluation ability of health preserving information in TCM,application ability of health preserving information in TCM,and information morality,respectively,which explained 65.293% of the total variance.The factor load of each item ranged from 0.423 to 0.860,all of which were over 0.400.The Cronbach's α of the scale was 0.922.Cronbach's α of each dimension ranged from 0.839 to 0.882.Conclusion The HIL Scale in TCM consists of 5 domains covering 36 items,including the cognitive ability of health preserving information in TCM(5 items),retrieving ability of health preserving information in TCM(11 items),evaluation ability of health preserving information in TCM(7 items),application ability of health preserving information in TCM(11 items)and information morality(2 items).The HIL scale in TCM has good validity and reliability and it is also very comprehensible.The scale can be used to evaluate the community citizens' HIL in TCM.
引文
[1]朱光祥,徐勤勇,吕艳.中医养生研究概况及展望[J].中医研究,2017,30(12):77-80.DOI:10.3969/j.issn.1001-6910.2017.12.33.ZHU G X,XU Q Y,LYU Y.Survey and prospect of health preservation research in traditional Chinese medicine[J].Traditional Chinese Medicinal Research,2017,30(12):77-80.DOI:10.3969/j.issn.1001-6910.2017.12.33.
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[6]解亚宁.心理统计学[M].北京:人民出版社,2007:302-311.
[7]DE VELLIS R F.量表编制:理论与应用[M].魏勇刚,龙长权,宋武,译.2版.重庆:重庆大学出版社,2010.
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[9]尉敏琦,余峰,周热娜,等.职业人群健康素养量表编制及其信度、效度评价[J].环境与职业医学,2015,32(3):233-239.DOI:10.13213/j.cnki.jeom.2015.14502.WEI M Q,YU F,ZHOU R N,et al.Development of health literacy scale for occupational population and assessment on reliability and validity[J].Journal of Environmental&Occupational Medicine,2015,32(3):233-239.DOI:10.13213/j.cnki.jeom.2015.14502.
[10]金瑜.心理测量[M].上海:华东师范大学出版社,2005:169-245.
[11]毛婷,李春玉,魏保建.青少年健康素养量表的编制及信效度检验[J].护理学杂志,2016,31(7):75-77.DOI:10.3870/j.issn.1001-4152.2016.07.075.MAO T,LI C Y,WEI B J.Development and psychometric analysis of Adolescent Health Literacy scale[J].Journal of Nursing Science,2016,31(7):75-77.DOI:10.3870/j.issn.1001-4152.2016.07.075.
[12]胡雁.护理研究[M].4版.北京:人民卫生出版社,2012.
[13]STANTON K,WATSON D.An examination of the structure and construct validity of the Wender Utah Rating Scale[J].J Pers Assess,2016,98(5):545-552.DOI:10.1080/00223891.2016.1152579.
[14]COOK D A,BECKMAN T J.Current concepts in validity and reliability for psychometric instruments:theory and application[J].Am J Med,2006,119(2):166.e7-16.DOI:10.1016/j.amjmed.2005.10.036.
[15]许清安,常履华,万崇华,等.基于健康调查量表的脑卒中患者报告结局与临床客观指标的相关性研究[J].中国全科医学,2018,21(6):643-647.DOI:10.3969/j.issn.1007-9572.2017.00.193.XU Q A,CHANG L H,WAN C H,et al.Association analysis on clinical objective indicators and patient-reported outcomes in patients with stroke based on the SF-36 scale[J].Chinese General Practice,2018,21(6):643-647.DOI:10.3969/j.issn.1007-9572.2017.00.193.2018081420181127
[2]王辅之,罗爱静,谢文照,等.健康信息素养自评量表的编制及其信效度检验[J].中国现代医学杂志,2013,23(30):89-93.DOI:10.3969/j.issn.1005-8982.2013.30.022.WANG F Z,LUO A J,XIE W Z,et al.Development of health information literacy self-rating scale and its reliability and validity test[J].China Journal of Modern Medicine,2013,23(30):89-93.DOI:10.3969/j.issn.1005-8982.2013.30.022.
[3]中国公民中医养生保健素养[N].中国中医药报,2014-06-06(003).Chinese Citizens'Health Preserving Literacy[N].China News of Traditional Chinese Medicine,2014-06-06(003).
[4]中华人民共和国国家卫生和计划生育委员会.中国公民健康素养--基本知识与技能(2015年版)[J].中国实用乡村医生杂志,2016,23(10):35-36.DOI:10.3969/j.issn.1672-7185.2016.10.011.
[5]吴明隆.问卷统计分析实务--SPSS操作与应用[M].重庆:重庆大学出版社,2010:29-36.
[6]解亚宁.心理统计学[M].北京:人民出版社,2007:302-311.
[7]DE VELLIS R F.量表编制:理论与应用[M].魏勇刚,龙长权,宋武,译.2版.重庆:重庆大学出版社,2010.
[8]丘皓政.量化研究与统计分析--SPSS中文视窗版数据分析范例解析[M].重庆:重庆大学出版社,2009.
[9]尉敏琦,余峰,周热娜,等.职业人群健康素养量表编制及其信度、效度评价[J].环境与职业医学,2015,32(3):233-239.DOI:10.13213/j.cnki.jeom.2015.14502.WEI M Q,YU F,ZHOU R N,et al.Development of health literacy scale for occupational population and assessment on reliability and validity[J].Journal of Environmental&Occupational Medicine,2015,32(3):233-239.DOI:10.13213/j.cnki.jeom.2015.14502.
[10]金瑜.心理测量[M].上海:华东师范大学出版社,2005:169-245.
[11]毛婷,李春玉,魏保建.青少年健康素养量表的编制及信效度检验[J].护理学杂志,2016,31(7):75-77.DOI:10.3870/j.issn.1001-4152.2016.07.075.MAO T,LI C Y,WEI B J.Development and psychometric analysis of Adolescent Health Literacy scale[J].Journal of Nursing Science,2016,31(7):75-77.DOI:10.3870/j.issn.1001-4152.2016.07.075.
[12]胡雁.护理研究[M].4版.北京:人民卫生出版社,2012.
[13]STANTON K,WATSON D.An examination of the structure and construct validity of the Wender Utah Rating Scale[J].J Pers Assess,2016,98(5):545-552.DOI:10.1080/00223891.2016.1152579.
[14]COOK D A,BECKMAN T J.Current concepts in validity and reliability for psychometric instruments:theory and application[J].Am J Med,2006,119(2):166.e7-16.DOI:10.1016/j.amjmed.2005.10.036.
[15]许清安,常履华,万崇华,等.基于健康调查量表的脑卒中患者报告结局与临床客观指标的相关性研究[J].中国全科医学,2018,21(6):643-647.DOI:10.3969/j.issn.1007-9572.2017.00.193.XU Q A,CHANG L H,WAN C H,et al.Association analysis on clinical objective indicators and patient-reported outcomes in patients with stroke based on the SF-36 scale[J].Chinese General Practice,2018,21(6):643-647.DOI:10.3969/j.issn.1007-9572.2017.00.193.2018081420181127