Multiple-choice version of Chinese Health Literacy Scale for Diabetes (CHLSD): a validation study

Abstract

BACKGROUND: Chinese Health Literacy Scale for Diabetes (CHLSD) has been well received by practitioners and researchers and has been adopted as a tool for assessing patients’ health literacy in different clinical settings in Chinese society. The original scale consists of four subscales: remembering, understanding, applying and analyzing. The last three subscales were developed in open-ended question format. Some practitioners comment that it takes time for them to code the answers of these open-ended questions and calculate the total score. In view of the extensive use of this scale in clinical practice, the research team proposed to change these open-ended (OE) questions to multiple-choice (MC) format. This study aims to validate the MC version of CHLSD with the original OE version, and assess its relationship with medication adherence and glycaemic control. METHOD: This is a cross-sectional study. Recruitment was made in Special Out-patient Clinic in a public hospital from November 2013 to April 2014. Inclusion criteria were: aged 18 or above, diagnosed with type 2 diabetes, receiving regular follow up in this clinic, taking at least one type of diabetic drug, and able to communicate in Cantonese. The exclusion criteria were: living in nursing homes, and those who could not read the sample drug label. The open-ended questions were converted to multiple-choice version, and then commented by a panel of three. Pilot test of the MC version was run with 10 patients. Comments were collected to revise the options in the MC. Kappa statistics was calculated to compare the consistency between the individual items of the MC version and OE version. Paired t-test was used to compare the overall score of the MC version and the OE version. The MC version was tested by two batches of patients. Further modification of the options in the MC version was made based on the Kappa coefficients of each item and the feedback collected from the participants. RESULTS: A total of 254 patients were approached. Out of these, 179 patients (115 patients in batch A and 64 in batch B) agreed to participate in the study. The Kappa coefficients of the items in batch A ranged from 0.321 to 0.982 while the kappa coefficients of the items in batch B ranged from 0.499 to 1.000. All items of the MC version reached acceptable or good level in consistency. The mean score of MC version was 10.57 (S.D. 3.40) and that of the OE version was 10.65 (S.D. 3.60) and there was no significant difference (p=0.458). CONCLUSION: The MC version of the CHLSD is comparable to the original OE version. This version provides an alternative for practitioners to use CHLSD in clinical assessment. Future study can review the relationship between this MC version and health outcomes such as medication adherence and glycemic control.