Development Of Medication Literacy Scale For Elderly Patients With Chronic Diseases

ObjectiveTo develop a medication literacy scale for elderly patients with chronic diseases suitable for the context of aging in China and to test the reliability of the scale.In order to provide a reliable evaluation tool for medical practitioners in China to identify and assess the medication literacy of elderly patients with chronic diseases.Methods1.Preliminary formulation of the scale: Based on the literature review,semistructured interviews and expert group discussions,the conceptual model of medication literacy was used as the basis,and the existing medication literacy assessment tools at home and abroad were combined to initially establish the connotation of medication literacy in elderly patients with chronic diseases,formulate a pool of medication literacy scale dimensions and entries for elderly patients with chronic diseases,and form a draft medication literacy scale for elderly patients with chronic diseases.2.Preliminary construction of the scale: The Delphi method was used to conduct two rounds of expert consultation,inviting domestic experts engaged in the care and management of chronic diseases of the elderly,medication research and other related fields,adjusting and modifying the scale dimensions and entry pools based on expert feedback,defining the connotation of medication literacy in elderly patients with chronic diseases,and forming the first draft of the medication literacy scale for elderly patients with chronic diseases.3.Pre-survey of the scale: using the preliminary draft of the medication literacy scale for elderly patients with chronic diseases,a small sample of 20 elderly patients with chronic diseases in three tertiary-level general hospitals in Lanzhou City was selected for a pre-survey between May 2022 and September 2022 to debug the language;then 204 elderly patients with chronic diseases were selected for a questionnaire survey,and the preliminary draft of the scale was screened for entries using the critical ratio method,reliability testing method,correlation coefficient method,and exploratory factors analysis to form a pre-survey version of the medication literacy scale for elderly patients with chronic diseases.4.Formal investigation of the scale: Using the pre-survey version of the medication literacy scale for elderly patients with chronic diseases,215 elderly patients with chronic diseases in three tertiary-level A general hospitals and three elderly institutions in Lanzhou City were selected for the questionnaire survey using the convenience sampling method from October 2022 to January 2023,and the scale was analyzed for reliability using Cronbach’s α coefficient,split-half reliability,and retest reliability,and validity tests were conducted using content validity,structural validity,convergent validity,and discriminant validity to form the official medication literacy scale for elderly patients with chronic diseases.Results1.Interviews were conducted with 10 elderly patients with chronic diseases,and a total of 5 themes were extracted.After literature research and group discussions,the initial dimensions included: information acquisition ability,medication knowledge reserve,communication and interaction ability,critical ability and numeracy,and the draft medication literacy scale for elderly patients with chronic diseases was formed with 5 dimensions and 38 entries.2.Sixteen experts from six cities across China were invited to conduct expert correspondence,after two rounds of consultation,the positive coefficients of experts were 100% and 93.8%,and the effective recall rates were 100%,the authority coefficients were 0.904 and 0.934,and the Kendall harmony coefficients were 0.389 and 0.167,respectively.The first draft of the medication literacy scale for elderly patients with chronic diseases containing 4 dimensions and 27 items was formed by making modifications and adjustments according to the experts’ opinions.3.The scale was screened by entries to form a pre-survey version of the medication literacy scale for elderly patients with chronic diseases containing 4dimensions and 23 entries.One entry was removed by the critical ratio method,correlation coefficient method,and Cronbach’s alpha coefficient method,and 26 entries were retained for exploratory factor analysis.The exploratory factor results showed that the KMO value was 0.922 and the Bartlett’s spherical test chi-square value was 5591.728(P < 0.001),and a total of 4 factors were extracted with a cumulative variance contribution of 77.912%,3 entries were deleted,and 23 entries were finally retained.4.The results of the pre-survey reliability test of the scale showed that the reliability,the Cronbach’s alpha coefficient of the overall scale was 0.958,and the Cronbach’s alpha coefficients of each dimension were 0.956,0.945,0.876,and 0.942,respectively;the overall fold-half reliability was 0.858,and the fold-half coefficients of each dimension were 0.903,0.900,0.743,and 0.848;the retest reliability was 0.954,and the internal consistency of the scale was good with good reliability.In terms of validity,the validation factor analysis showed that the model fit all met the criteria,the chi-square to degrees of freedom ratio(χ2/df)was 2.838,the Root-Mean-Square Error of Approximation(RMSEA)was 0.093,the Normed Fit Index(NFI)was 0.901,the Incremental Index(IFI)was 0.934,the Tucker-Lewis Index(TFI)was 0.922,and the Comparative Fit Index(CFI)was 0.933.The average variance extracted(AVE)in the aggregation validity ranged from 0.597 to 0.818,and the combined reliability(CR)ranged from 0.881 to 0.957,all of which were >0.7,indicating that the scale had good convergent validity;the discriminant validity showed that each significant variable was significant(P < 0.05).The content validity index(I-CVI)for each entry level of the scale ranged from 0.87 to 1.00,and the content validity index(S-CVI)for the scale level was 0.983,indicating that the content validity of the scale was good.ConclusionsThis study established the meaning of medication literacy in elderly patients with chronic diseases,and the developed medication literacy scale for elderly patients with chronic diseases has good reliability and feasibility.The medication literacy scale for elderly patients with chronic diseases is a scientific and reliable medication literacy measurement tool,which can provide a valid reference basis for medical personnel to measure medication literacy in elderly patients with chronic diseases in the future,and help medical personnel to formulate effective and targeted interventions to improve medication literacy in elderly patients with chronic diseases,thus promoting the health and disease recovery of elderly patients with chronic diseases and improving their quality of life.