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Study on the development of an infectious disease-specific health literacy scale in the Chinese population
  1. Xiangyang Tian1,
  2. Zeqing Di2,
  3. Yulan Cheng1,
  4. Xuefeng Ren1,
  5. Yan Chai1,
  6. Fan Ding3,
  7. Jibin Chen2,
  8. Jodi L Southerland4,
  9. Zengwei Cui2,
  10. Xiuqiong Hu1,
  11. Jingdong Xu5,
  12. Shuiyang Xu6,
  13. Guohong Qian7,
  14. Liang Wang8
  1. 1Chinese Center for Health Education, Beijing, China
  2. 2Chinese Association of Preventive Medicine, Beijing, China
  3. 3Office for Public Health Hazard Response Public Health Emergency Center, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
  4. 4Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
  5. 5Health Education Institute, Hubei Provincial CDC, Wuhan City, Hubei Province, China
  6. 6Health Education Institute, Zhejiang Provincial CDC, Hangzhou, Zhejiang Province, China
  7. 7Gansu Provincial Center for Health Education, Lanzhou, Gansu Province, China
  8. 8Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
  1. Correspondence to Dr Liang Wang; WANGL2{at}


Objectives To develop a scale to assess infectious disease-specific health literacy (IDSHL) in China and test its initial psychometric properties.

Methods Item pooling, reduction and assessment of psychometric properties were conducted. The scale was divided into 2 subscales; subscale 1 assessed an individual's skills to prevent/treat infectious diseases and subscale 2 assessed cognitive ability. In 2014, 9000 people aged 15–69 years were randomly sampled from 3 provinces and asked to complete the IDSHL questionnaire. Cronbach's α was calculated to assess reliability. Exploratory factor analysis, t-test, correlations, receiver operating characteristic (ROC) curve and logistic regression were used to examine validity.

Results Each of the 22 items in subscale 1 had a content validity index >0.8. In total, 8858 people completed the scale. The principal components factor analysis suggested a 5-factor solution. All factor loadings were >0.40 (p<0.05). The IDSHL score was 22.07±7.91 (mean±SD; total score=38.62). Significant differences were observed across age (r=−0.276), sex (males: 21.65±8.03; females: 22.47±7.78), education (14.16±8.19 to 26.55±6.26), 2-week morbidity (present: 20.62±8.17, absent: 22.35±7.83; p<0.001) and health literacy of the highest and lowest 27% score groups (all p<0.05). The ROC curve indicated that 76.2% of respondents were adequate in IDSHL. Binary logistic regression analysis revealed 12 predictors of IDSHL adequacy (p<0.05). Among the 22 remaining items, Corrected Item-Total Correlation ranged from 0.316 to 0.504 and Cronbach's α values ranged from 0.754 to 0.810 if the items were deleted. The overall α value was 0.839 and the difficulty coefficient ranged from 1.19 to 4.08. For subscale 2, there were statistically significant differences between the mean scores of those with a correct/incorrect answer (all p<0.001).

Conclusions The newly developed 28-item scale provides an efficient, psychometrically sound and user-friendly measure of IDSHL in the Chinese population.

  • Infectious disease
  • Health literacy
  • Psychometric analysis
  • China

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