The Chinese Resident Health Literacy Scale was developed based on a manual published by the Chinese Ministry of Health in 2008—“Basic Knowledge and Skills of People’s Health Literacy” (trial edition) [1 ]. The scale was designed by experts in public health, health education and promotion, and clinical medicine using the Delphi method. Details of the development procedure have been described in a previous paper [44 ]. The scale contains 80 items and three dimensions: (1) knowledge and attitudes; (2) behavior and lifestyle; and (3) health-related skills. The questions cover six aspects: scientific views of health; infectious diseases; chronic diseases; safety and first aid; medical care; and health information. As indicated in Table 1 , there are four types of questions in the scale: true-or-false; single-answer (only one correct answer in multiple-choice questions); multiple-answer (more than one correct answer in multiple-choice questions); and situation questions. With multiple-answer questions, a correct response had to contain all the correct answers and no wrong ones. Situation questions were given following a paragraph of instruction or medical information.
Written informed consent was obtained from all participants before the survey. The scale was self-administered. However, if a participant was unable to complete the scale owing to impaired vision or other such reasons, an interview was used as an alternative. In that situation, the investigators would complete the questions in a neutral fashion on behalf of the participants.
Examples of items
| Type of items | Examples | Dimension | Scope |
|---|---|---|---|
| True-or-false | • A01 - Antibiotic is effective in preventing influenza. | Knowledge and attitude | Infectious disease |
| • A07 - Nutrients in vegetables and fruits are similar; so vegetables can be replaced by fruits. | Behavior and lifestyle | Chronic disease | |
| Single-answer | • B01 - The integrated conception of health is: (1) Complete physical well-being without disease. (2) Physical and mental well-being. (3) A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. (4) I do not know. | Knowledge and attitude | Scientific views of health |
| • B36 - When the fire emergency occurs, the correct way to escape is: (1) Encase your head with your arms or cloths and rush out the fire. (2) Wet your cloths and head, or cover yourself with a wet towel and rush out the fire. (3) Flap the fire with you cloths and escape simultaneously. (4) I do not know. | Health-related skills | Safety and first aid | |
| Multiple-answer | • C06 - Which of the following strategies can prevent chronic disease: (1) Quit smoking and limit the intake of alcohol. (2) Balance the nutrition. (3) Exercise moderately. (4) Be in good mood. (5) I do not know. | Knowledge and attitude | Chronic disease |
| • C15 - Which descriptions about health management service for patients with type 2 diabetes are correct: (1) Only patients above 60 years old can receive the service. (2) All diagnosed patients in a community can receive the service. (3) Patients can receive four times of FBG testing for free. (4) Free FBG testing are unlimited, depending on the severity of disease. (5) I do not know. | Behavior and lifestyle | Medical care | |
| Situation questions | • D03 - (A paragraph of instruction book for amoxicillin is given before the question) The drug may cause which of the following adverse reactions: (1) Nausea. (2) Depression. (3) Insomnia. (4) I do not know. | Health-related skills | Health information |
| • D04 - (A paragraph of introduction to body mass index is given before the question) Mr. Li is 45 years old and 27.7 in BMI (kg/m2). Which of the following categories does he belong to, according to the Chinese adult BMI reference: (1) Obese. (2) Normal. (3) Overweight. (4) I do not know. | Health-related skills | Health information |
Written informed consent was obtained from all participants before the survey. The scale was self-administered. However, if a participant was unable to complete the scale owing to impaired vision or other such reasons, an interview was used as an alternative. In that situation, the investigators would complete the questions in a neutral fashion on behalf of the participants.
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