| Objective(1)To explore the concept and connotation of parents’ health literacy of asthmatic children by using conceptual analysis method.(2)To develop the scale of parents’ health literacy of asthmatic children aged 4-11 years of China in line with China’s national conditions and cultural background and examine the reliability and validity of the scale.MethodsThe concept and connotation of parents’ health literacy of children with asthma were discussed by using conceptual analysis method.On this basis,the item pool of this scale was determined by referring to the domestic and foreign guidelines for children’s bronchial asthma and relevant assessment tools and then the initial scale was formed.Two rounds of Delphi expert consultation method were used to evaluate the items of initial scale,and then pretest scale was formed on the basis of revising the initial scale according to the expert opinions and the results of the research group’s discussion.A total of 481 parents of asthmatic children were selected from 7 hospitals in Beijing,Guangdong,Gansu and Xinjiang by using convenience sampling method,and the data were statistically analyzed.Critical ratio method,Pearson correlation coefficient method and Cronbach’s a coefficient method were used to analyze and select the items of the scale,and expert evaluation content validity index method was used to examine the content validity of the scale.Exploratory factor analysis was used to examine the structure validity of the scale.Cronbach’s αcoefficient method and split half reliability method were used to examine the reliability of the scale.Results(1)The concept of parents’ health literacy of asthmatic children refers to the parents had related knowledge of asthmatic disease and management,who can initiative to access,understand,judge,communicate and use asthma related health information,and the ability to help asthmatic children take full advantage of health care services and manage asthma by themselves,when they in care of their children.The connotation includes three dimensions named health knowledge,health information ability and health behavior.(2)The results of Delphi expert consultation:18 experts from Beijing,Guangdong,Chongqing and Gansu provinces or regions,their major cover clinical medicine and nursing of childhood asthma,chronic health literacy and maternal and child health and other fields,with good representativeness.Regarding the degree of expert positivity:the effective recovery rate of the first round was 100%,and the effective recovery rate of the second round was 88.9%,which are both exceeding 70%,indicating a high degree of expert positivity.The rate of expert opinions in the second round was significantly lower than that in the first round,indicating that the experts have a high degree of recognition for the items.Regarding the degree of expert authority:the coefficient of the degree of expert authority in the two rounds is 0.80 and 0.79,both greater than 0.7,indicating that the degree of expert authority is relatively high.Regarding the concentration degree of expert opinions:according to the selection criteria of items,the importance degree of all items in the second round is higher after removing 6 items,indicating the high concentration degree of expert opinions.Regarding the coordination coefficient of expert opinions,the second round Kendall harmony coefficient is 0.444 and closing to 0.5,indicating a high degree of consistency of expert opinions.According to the two rounds of expert opinions and the results of the research group’s discussion,the dimensions and items of the scale were revised.Regarding the item adjustment:a total of 12 items were deleted,the expression and attribution of 14 items were modified,2 items were combined and adjusted,and 3 items were added(the evaluation content and inducing factor items of health belief were added in the dimension of ’health knowledge’,and the evaluation content of self-efficacy was added in the dimension of ’health behavior ability’).(3)Item Analysis and selection:Critical ratio method,Pearson correlation coefficient method and Cronbach’s a coefficient method were used to analyze and select the scale items,a total of 7 items were deleted from the 45 items pretest scale.The final scale of parents’health literacy scale of asthmatic children was developed which including 3 dimensions and 38 items:health knowledge(11 items),health skills(19 items)and health behavior ability(8 items).The scale adopted Likert 5-point scoring method,and the answer setting of the scale ranged from ’completely inconsistent’ to’completely consistent’.(4)Validity test:① Content Validity.Examine the content validity of the scale was used the Delphi method by assessing level of item-content validity index(I-CVI)and levels of scale-content validity index(S-CVI),the results showed that this scale includes 38 items,I-CVI values were between 0.81～1.00,S-CVI value was 0.842,which showed high content validity of the scale.②Construct Validity.Pearson correlation coefficient method was used to analyze the correlation between items and each dimension,between each dimension,and between each dimension and the total score of the scale.The results showed that the correlation coefficient between each item of the scale and each dimension was 0.438～0.777,the correlation coefficient between each dimension was 0.772～0.834,and the correlation coefficient between each dimension and the total table was 0.904～0.962,all of which were statistically significant(P<0.001).Exploratory factor analysis was conducted on individual levels.After each round of factor analysis,some items and factors were deleted,and a total of 38 items were retained in the three dimensions.Finally,the explanatory variables of factor concepts in each dimension are 59.33%,62.90%and 62.51%,and all dimensions can explain more than 50%of the variance,indicating that the scale has good structure validity.Confirmatory factor analysis results showed that the chi-square and freedom ratio was 2.473,SRMR was 0.078,less than 0.08,RMSEA was 0.078,less than 0.08,NNFI,IFI and CFI values were all greater than 0.8,and GFI and NFI values were close to 0.8,indicating that the model was acceptable and could basically explain the internal structure of the parental health literacy scale of asthmatic children.(4)Reliability test:①Cronbach’s a coefficient method:The degree of internal consistency of the scale was measured by calculating the Cronbach’s a coefficient of each dimension and the total scale.The results showed that the total Cronbach’s a coefficients were 0.956 and 0.870,0.924 and 0.828 for each dimension.②Split coefficient method:The split reliability coefficient of the total scale was 0.887,and that of each dimension were 0.806,0.814 and 0.708,respectively.Internal consistency reliability and split half reliability were both greater than 0.7,which could be seen that this scale had good reliability.ConclusionThis study completed the development of the parents’health literacy scale of asthmatic children,including 38 items from 3 dimensions.The scale has good validity and reliability after examination.It can be used as a scientific and effective evaluation tool to evaluate the parents’ health literacy of asthmatic children which provides reference for medical staff to understand the health literacy level of parents of asthmatic children and further develop targeted health education programs. |
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