title: Study on the development of an infectious disease-specific health literacy scale in the Chinese population.
abstract: To develop a scale to assess infectious disease-specific health literacy (IDSHL) in China and test its initial psychometric properties.
  
  
  
  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.
  
  
  
  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).
  
  
  
  The newly developed 28-item scale provides an efficient, psychometrically sound and user-friendly measure of IDSHL in the Chinese population.
authors: Chinese Center for Health Education, Beijing, China.
authors: Xiangyang
authors: X
authors: Tian
authors: Chinese Association of Preventive Medicine, Beijing, China.
authors: Zeqing
authors: Z
authors: Di
authors: Chinese Center for Health Education, Beijing, China.
authors: Yulan
authors: Y
authors: Cheng
authors: Chinese Center for Health Education, Beijing, China.
authors: Xuefeng
authors: X
authors: Ren
authors: Chinese Center for Health Education, Beijing, China.
authors: Yan
authors: Y
authors: Chai
authors: Office for Public Health Hazard Response Public Health Emergency Center, Chinese Center for Disease Control and Prevention (CDC), Beijing, China.
authors: Fan
authors: F
authors: Ding
authors: Chinese Association of Preventive Medicine, Beijing, China.
authors: Jibin
authors: J
authors: Chen
authors: Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.
authors: Jodi L
authors: JL
authors: Southerland
authors: Chinese Association of Preventive Medicine, Beijing, China.
authors: Zengwei
authors: Z
authors: Cui
authors: Chinese Center for Health Education, Beijing, China.
authors: Xiuqiong
authors: X
authors: Hu
authors: Health Education Institute, Hubei Provincial CDC, Wuhan City, Hubei Province, China.
authors: Jingdong
authors: J
authors: Xu
authors: Health Education Institute, Zhejiang Provincial CDC, Hangzhou, Zhejiang Province, China.
authors: Shuiyang
authors: S
authors: Xu
authors: Gansu Provincial Center for Health Education, Lanzhou, Gansu Province, China.
authors: Guohong
authors: G
authors: Qian
authors: Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.
authors: Liang
authors: L
authors: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D003071:Cognition; D003141:Communicable Diseases / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D057220:Health Literacy / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000379:methods; D012372:ROC Curve; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: China; Health literacy; Infectious disease; Psychometric analysis