「中文健康識能評估量表」簡式量表的發展與效度檢測

Development and Validation of the Short-form Mandarin Health Literacy Scale

10.6288/TJPH2012-31-02-10

李守義(Shoou-Yih D. Lee)；蔡慈儀(Tzu-I Tsai)；蔡憶文(Yi-Wen Tsai)；郭耿南(Ken N. Kuo)

功能性健康識能 ； 中文健康識能評估量表 ； 簡式量表發展 ； functional health literacy ； Mandarin Health Literacy Scale ； short-form scale development

台灣公共衛生雜誌

31卷2期（2012 / 04 / 01）

184 - 194

繁體中文

目標：目前國內已發展出一套中文健康識能評估表，用以評估成年民眾的功能性健康識能，瞭解民眾閱讀、理解及應用健康資訊之能力。本研究的目的是根據「中文健康識能評估表」來發展出簡式量表，檢驗原始量表和簡式量表測量模式的適配性，並進行簡式量表的信度及效度檢核。方法：本研究為橫斷性研究設計，以面訪方式進行資料收集。樣本對象為全國成年民眾，採三階段分層、抽取率與單位大小成比例之等機率抽樣設計，有效樣本共計3,491。測量模式的檢驗是以AMOS 19.0統計軟體進行驗證性因素分析。結果：簡式量表的題目是選擇與原始總量表之間的皮爾森相關係數最高的兩題組，題目由原始量表的33題文字性題目減少成8題，17題數字性題目減少到3題。驗證性因素分析結果支持簡式量表為單一構面的模式。適配度測量結果顯示，簡式量表的增值適配度及精簡適配度指標均比原始量表有更好的配適性表現，有達到模式的簡約原則。簡式量表與原始量表間的相關達0.97，簡式量表的內在一致信度係數為0.94。以「教育程度」、「閱讀健康訊息的能力」、「他人協助讀寫的需求」、「健康知識」、「自覺健康狀態」進行簡式量表的幅合性效度和已知群組效度檢定，所有相關係數均達到顯著。結論：綜合各種心理計量方法分析，結果確認這份中文健康識能簡式量表可取代原始健康識能評估表，應用於使用華文的族群，進行功能性健康識能相關研究或臨床評估。

Objectives: A Mandarin Health Literacy Scale (MHLS) has been developed and validated to assess Taiwanese adults' functional health literacy in terms of their ability to read, comprehend, and utilize basic health information in making personal health decisions. The purpose of this study was to develop a shortened version of the MHLS, the short-form Mandarin Health Literacy Scale (s-MHLS), and to examine the psychometric qualities of the shortened instrument. Methods: The study sample consisted of 3491 Taiwanese adults who were randomly selected using the threestage stratified sampling design with a sampling rate proportional-to-size within each stage. The measurement models were examined using AMOS 19.0. Results: Item selection was determined by the correlation between the question sets and the total scores on the MHLS. The MHLS was reduced from 33 text-reading items to 8 and 17 numerical items to 3. Confirmatory factor analysis supported the unidimensionality of s-MHLS. Measurement model analysis revealed that s-MHLS yielded a better fit than MHLS. The Cronbach's correlation between the MHLS and s-MHLS was 0.97, and the s-MHLS had satisfactory internal reliability (Cronbach's alpha=0.94). The s-MHLS was significantly correlated with education, reading ability, need for reading assistance, health knowledge, and perceived health status, suggesting that the shortened instrument had good convergent and known-group validity. Conclusions: The s-MHLS is valid and reliable. It could be employed in clinical and research settings to assess functional health literacy in the Mandarinspeaking population. (Taiwan J Public Health. 2012;31(2):184-194)

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