| ObjectiveThe National Residents Health Literacy Survey has been widely used in the national resident’s health literacy survey,but the number of questions and the time is too long,leading to the implementation and promotion of health literacy survey work being very difficult.Therefore,this study simplified the National Residents’ Health Literacy Survey,and conducted a validation study on the effectiveness of the simplified version of the questionnaire,in order to effectively promote the monitoring of health literacy,improve the response rate and improve work efficiency.MethodsBased on the data of health literacy survey in Suzhou in 2018,a structural equation model(Structural Equation Modeling,SEM)was constructed using confirmatory factor analysis(Confirmatory Factor Analysis,CFA)to evaluate the structural validity of the National Questionnaire on Health Literacy.Pearson correlation coefficient method,confirmatory factor analysis and independent sample T-test were used to screen the original questionnaires,and three versions of the initial simplified questionnaires were formed.The structural equation model was constructed to fit and modify the initial simplified version of the questionnaire,and three simplified versions of the questionnaire were formed.Based on the health literacy survey data of Suzhou in 2019 and 2020,the health literacy scores of the complete questionnaire and the simplified questionnaire were calculated,and the correlation coefficients were calculated to verify the simplified questionnaire.Results1.Evaluation of the original questionnaireBased on the total sample,the CFA of the 3-factor structure of the original questionnaire shows that the 3-factor structure is poorly fitted(χ2/df=6.781,RMSEA=0.043,IFI=0.720,TLI=0.708,CFI=0.719).2.Questionnaire simplification2.1 The correlation coefficient method was used to simplify the questionnaire and assessmentThe Pearson correlation coefficient method was used to eliminate 40 questions at one time to form a 3-factor simplified questionnaire containing 16 questions.The overall adaptation index of the questionnaire was χ2/df=9.501,RMSEA=0.052,IFI=0.918,TLI=0.900,CFI=0.918.Cronbach’s a coefficient of the questionnaire was 0.825.The health literacy rates of residents from 2018 to 2020 measured by the original questionnaire were 34.3%,28.1%,and 49.2%,while the health literacy rates of residents from 2018 to 2020 measured by the simplified version were 30.2%,27.1%,and 48.3%.The total score of the original questionnaire was significantly positively correlated with that of the simplified version(r=0.937,P<0.05).2.2 Simplified questionnaire and assessment based on stepwise correlation coefficient methodUsing the Pearson correlation coefficient method,the original questionnaire was gradually simplified into a 3-factor simplified version containing 31 questions.The overall adaptation index of the questionnaire was χ2/df=5.361,RMSEA=0.038,IFI=0.914,TLI=0.902,CFI=0.914.Cronbach’s a coefficient of the questionnaire was 0.872.The health literacy rate of residents from 2018 to 2020 measured by the original questionnaire was 34.3%,28.1%,and 49.2%,while the health literacy rate of residents from 2018 to 2020 measured by the simplified version was 31.2%,27.4%,and 51.3%.The total score of the original questionnaire was significantly positively correlated with that of the simplified version(r=0.968,P<0.05).2.3 Simplify and evaluate the questionnaire based on the combination of various methods51 questions were eliminated by the Pearson correlation coefficient method,con firmatory factor analysis method,and independent sample t-test,and a 2-factor mini malist questionnaire containing 5 questions was formed.The overall adaptation inde x of the questionnaire was χ2/df=6.289,RMSEA=0.041,IFI=0.996.TLI=0.979,CFI=0.996.Cronbach’s a coefficient of the questionnaire was 0.665.The health literacy r ates of residents from 2018 to 2020 measured by the original questionnaire were 34.3%,28.1%,and 49.2%,while the health literacy rates of residents from 2018 to 2020 measured by the simplified version were 31.7%,28.7%,and 42.3%.There was a significant positive correlation between the total score of the original questionnaire and the total score of the simplified questionnaire(r=0.804,P<0.05).ConclusionIn this study,the Questionnaire of National Residents’ Health Literacy(56 questions)was systematically sorted out,evaluated,and simplified,and a total of 3 versions were simplified,including 31 questions,16 questions,and 5 questions respectively.The results show that the basic fit and overall fit of the model of the three versions of the Simplified National Residents Health Literacy Questionnaire are good,the dimension division is basically reasonable,and the model has good structural validity.The simplified version with 31 items has the highest reliability coefficient and better internal consistency.The overall reliability of the 5-item minimalist questionnaire reached an acceptable level,and the health literacy rate was closer to that of the complete questionnaire,with the shortest time in use. |
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