简版健康素养量表的开发:基于经典测量理论和项目反应理论  

Development of a Short Version of the Health Literacy Scale Based on Classical Test Theory and Item Response Theory

作　　者：孙小楠 陈珂 武运筹 汤靖琪 王飞 孙昕霙[6] 贺苗[7] 吴一波 SUN Xiaonan;CHEN Ke;WU Yunchou;TANG Jingqi;WANG Fei;SUN Xinying;HE Miao;WU Yibo(Public Health College of Harbin Medical University,Harbin 150081,China;School of Philosophy,Anhui University,Hefei 230039,China;School of Psychology,Southwest University,Chongqing 400715,China;School of Psychology and Cognitive Science,East China Normal University,Shanghai 200062,China;State Key Laboratory of Cognition and Learning,Department of Psychology,Beijing Normal University,Beijing 100875,China;School of Public Health,Peking University,Beijing 100191,China;Department of Social Science and Humanities of Harbin Medical University,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学公共卫生学院,黑龙江省哈尔滨市150081 [2]安徽大学哲学学院,安徽省合肥市230039 [3]西南大学心理学部,重庆市400715 [4]华东师范大学心理与认知科学学院,上海市200062 [5]北京师范大学心理学部认知与学习国家重点实验室,北京市100875 [6]北京大学公共卫生学院,北京市100191 [7]哈尔滨医科大学人文社会科学学院,黑龙江省哈尔滨市150081

出　　处：《中国全科医学》2024年第23期2931-2940,共10页Chinese General Practice

基　　金：2021年度黑龙江省哲学社会科学研究规划项目(21SHB106);2023年教育部人文社会科学研究一般项目(23YJA840006)。

摘　　要：背景健康素养与健康状况密切相关,目前国内研究多倾向于运用多维度、多条目的健康素养测评工具,尚缺少简便且有效的健康素养测评工具。目的简化健康素养量表并在中国人群中进行心理测量学检验。方法从“中国家庭健康指数调查(2021年)”数据中选择18岁及以上人群作为本研究的调查对象,依据纳入与排除标准,最终纳入7449份数据,并随机分为2个样本集,其中样本集1共3680份,样本集2共3769份。对调查对象进行一般资料问卷、12条目健康素养量表(HLS-SF12)、领悟社会支持量表(PSSS)、家庭健康量表(FHS-SF)调查。应用经典测量理论以及项目反应理论中的Mokken模型对HLS-SF12原条目进行筛选,并对精简后的量表进行信效度等验证性分析。结果使用经典测量理论和Mokken模型分别简化出1个9条目版本的量表(HLS-SF9)和1个4条目版本的量表(HLS-SF4)。HLS-SF9与HLS-SF4均无天花板效应、地板效应,二者的Cronbach'sα系数分别为0.913和0.842,折半信度分别为0.871和0.815。HLS-SF4经探索性因子分析提取出1个公因子,累积方差贡献率为67.813%,各条目的因子载荷量均>0.81。HLS-SF9经验证性因子分析结果显示χ^(2)/df=10.844、拟合优度指数(GFI)=0.985、调整拟合优度指数(AGFI)=0.971、规范拟合指数(NFI)=0.986、比较拟合指数(CFI)=0.987和近似误差均方根(RMSEA)=0.051。相关性分析结果显示,HLS-SF9、HLS-SF4与PSSS呈正相关(r=0.367、0.292,P<0.001),与FHS-SF呈正相关(r=0.340、0.237,P<0.001)。HLS-SF9对HLS-SF12的效标效度的一致性水平(ICC)(95%CI)为0.989(0.988~0.999),HLS-SF4效标效度的ICC(95%CI)为0.892(0.886~0.899)。结论简化后的健康素养量表具有良好的信效度,是能够快速测评中国人群健康素养的有效工具,研究者可根据研究精度(HLS-SF9)或测评时间(HLS-SF4)的需求采取针对性选择。Background Health literacy is closely associated with health status,most domestic studies tend to use multidimensional and multi-item tools for assessing health literacy,lacking simple and effective assessment methods.Objective To simplify health literacy scale and conduct psychometric test within the Chinese population.Methods Adults aged 18 years and above were selected from the"China Family Health Index Survey(2021)"for this investigation.Based on inclusion and exclusion criteria,a total of 7449 participants were selected and randomly divided into two sample sets,including 3680 cases in sample set 1 and 3769 cases in sample set 2.The general information questionnaire,Short-form Health Literacy Questionnaire(HLS-SF12),Perception Social Support Scale(PSSS),and Family Health Scale Short-form(FHS-SF)were administered to the respondents.Classical test theory(CTT)and the Mokken model in item response theory(IRT)were used to screen the original items,and validation analyses such as reliability and validity of the simplified scales were also conducted.Results A 9-item version(HLS-SF9)and a 4-item version(HLS-SF4)were simplified by using CTT and the Mokken model,respectively.Both the HLS-SF9 and the HLS-SF4 had no ceiling effect or floor effect,and the Cronbach'sαcoefficients for both were 0.913 and 0.842,with split-half reliabilities of 0.871 and 0.815,respectively.The exploratory factor analysis of HLS-SF4 revealed one common factor,accounting for 67.813%of the cumulative variance,with factor loadings exceeding 0.81 for each item.The confirmatory factor analysis of HLS-SF9 showed thatχ^(2)/df was 10.844,goodness of fit index(GFI)was 0.985,adjusted goodness of fit index(AGFI)was 0.971,normative fit index(NFI)was 0.986,comparative fit index(CFI)was 0.987,and root mean squared error of approximation(RMSEA)was 0.051.The correlation analysis demonstrated positive correlation of HLS-SF9 and HLS-SF4 with PSSS(r=0.367,0.292,P<0.001),as well as FHS-SF(r=0.340,0.237,P<0.001),respectively.The intraclass correlation coefficien

关 键 词：健康素养 条目筛选 经典测量理论 Mokken模型 12条目健康素养量表 

分 类 号：R193[医药卫生—卫生事业管理]