The CHLSQ, as compiled by the China Health Education Center (36 (link)), was used to measure health literacy. The questionnaire has strong internal consistency and split-half reliability (23 (link)), which consists of two parts: sociodemographic characteristics and health literacy content (a total of 50 items). The 50 items include eight true-or-false questions, 23 single-choice questions, 15 multiple-choice questions, and four situational questions (including three single and one multiple-choice questions). The 50-item health literacy is further categorized into three aspects and six dimensions. Based on the knowledge, attitude, practice (KAP) theory, the three aspects of literacy are basic knowledge and concept literacy, healthy lifestyles and behavior literacy, and health skill literacy (25 (link)). Guided by public health problems, the six dimensions of literacy are scientific views of health, infectious disease literacy, chronic disease literacy, safety and first aid literacy, medical care literacy, and health information literacy (24 (link)).
The total score of 50 items ranged from 0 to 66 points, with one point for every true-or-false and every single-choice question and two points for every multiple-choice question. Moreover, every wrong or missing choice received 0 points. The total scores of the three aspects were 28 (basic knowledge and concepts literacy, 22 items), 22 (healthy lifestyles and behavior literacy, 16 items), and 16 (health skill literacy, 12 items) points. The maximum total scores for the six dimensions of literacy were 11 points (scientific views of health, eight items), seven points (infectious disease literacy, six items), 12 points (chronic disease literacy, nine items), 14 points (safety and first aid literacy, ten items), 14 points (medical care literacy, 11 items), and eight points (health information literacy, six items).
Adequate health literacy is defined as when participants achieve more than 80% of the total score (53–66 points), and limited health literacy is defined as when participants score <80% of the total score (0–52 points) (24 (link), 25 (link)). The judgment criterion for adequate health literacy in each aspect or dimension was ≥80% of the total score for the aspect or dimension. Health literacy level was defined as the proportion of participants who had adequate health literacy out of the total number of participants, as was the health literacy level of the three aspects and six dimensions (37 (link)).
The total score of 50 items ranged from 0 to 66 points, with one point for every true-or-false and every single-choice question and two points for every multiple-choice question. Moreover, every wrong or missing choice received 0 points. The total scores of the three aspects were 28 (basic knowledge and concepts literacy, 22 items), 22 (healthy lifestyles and behavior literacy, 16 items), and 16 (health skill literacy, 12 items) points. The maximum total scores for the six dimensions of literacy were 11 points (scientific views of health, eight items), seven points (infectious disease literacy, six items), 12 points (chronic disease literacy, nine items), 14 points (safety and first aid literacy, ten items), 14 points (medical care literacy, 11 items), and eight points (health information literacy, six items).
Adequate health literacy is defined as when participants achieve more than 80% of the total score (53–66 points), and limited health literacy is defined as when participants score <80% of the total score (0–52 points) (24 (link), 25 (link)). The judgment criterion for adequate health literacy in each aspect or dimension was ≥80% of the total score for the aspect or dimension. Health literacy level was defined as the proportion of participants who had adequate health literacy out of the total number of participants, as was the health literacy level of the three aspects and six dimensions (37 (link)).
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