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Development and Validation of Chinese Health Literacy Scale for Low Salt Consumption-Hong Kong Population (CHLSalt-HK).

Chau PH, Leung AY, Li HL, Sea M, Chan R, Woo J - PLoS ONE (2015)

Bottom Line: The mean CHLSalt-HK score among those who were aware of the public education slogan about nutrition labels and sodium intake was higher by 3.928 points (95% confidence interval: 1.742 to 6.115) than that among those who were not aware of the slogan, which supports adequate discriminant validity.The validated CHLSalt-HK had acceptable content validity, acceptable construct validity, good internal consistency, good test-retest reliability, and adequate discriminant validity.The scale could be completed in 10-15 minutes and is easy to administer compared with the collection of biomarkers or food diaries.

View Article: PubMed Central - PubMed

Affiliation: School of Nursing, The University of Hong Kong, Hong Kong, China.

ABSTRACT
Globally, sodium intake far exceeds the level recommended by the World Health Organization. Assessing health literacy related to salt consumption among older adults could guide the development of interventions that target their knowledge gaps, misconceptions, or poor dietary practices. This study aimed to develop and validate the Chinese Health Literacy Scale for Low Salt Consumption-Hong Kong population (CHLSalt-HK). Based on previous studies on salt intake and nutrition label reading in other countries, we developed similar questions that were appropriate for the Chinese population in Hong Kong. The questions covered the following eight broad areas: functional literacy (term recognition and nutrition label reading), knowledge of the salt content of foods, knowledge of the diseases related to high salt intake, knowledge of international standards, myths about salt intake, attitudes toward salt intake, salty food consumption practices, and nutrition label reading practices. Eight professionals, including doctors, nurses, and dietitians, provided feedback on the scale. The psychometric properties of the scale were assessed based on data collected from a convenience sample of 603 Chinese elderly adults recruited from Elderly Health Centres in Hong Kong. The 49-item CHLSalt-HK had a possible score range of 0 to 98, with a higher score indicating higher health literacy related to salt intake. The CHLSalt-HK had acceptable content validity; the item-level Content Validity Index ranged from 0.857 to 1.000, and the scale-level Content Validity Index was 0.994. Additionally, it had good internal consistency (Cronbach's alpha of 0.799) and good test-retest reliability (intraclass correlation coefficient of 0.846). The mean CHLSalt-HK score among those who were aware of the public education slogan about nutrition labels and sodium intake was higher by 3.928 points (95% confidence interval: 1.742 to 6.115) than that among those who were not aware of the slogan, which supports adequate discriminant validity. The validated CHLSalt-HK had acceptable content validity, acceptable construct validity, good internal consistency, good test-retest reliability, and adequate discriminant validity. The scale could be completed in 10-15 minutes and is easy to administer compared with the collection of biomarkers or food diaries. Further research should investigate its concurrent validity and predictive validity. The development of this scale supports the first step in salt intake reduction among older Chinese adults in Hong Kong by enabling the assessment of their health literacy related to salt consumption in health screenings or health assessments, and it can be used to evaluate salt reduction interventions.

No MeSH data available.


Factor structure of the Chinese Health Literacy Scale for Low Salt Consumption—Hong Kong population (CHLSalt-HK).
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pone.0132303.g002: Factor structure of the Chinese Health Literacy Scale for Low Salt Consumption—Hong Kong population (CHLSalt-HK).

Mentions: A factor structure with 54 items in eight first-order factors and one second-order factor was examined. However, the structure did not show adequate fit (RMSEA = 0.033, 90% confidence interval [CI]: 0.031 to 0.036; SRMR = 0.088; CFI = 0.871). Thus, the items with insignificant loading or with a loading of less than 0.2 in the first-order factors were removed from the model, leaving 49 items. The eight first-order factors were functional literacy (3 items), salty food knowledge (13 items), disease knowledge (8 items), knowledge of international standards (2 items), myths about salt intake (4 items), salt intake attitudes (7 items), salty food consumption (9 items), and nutrition label practices (3 items). Table 2 shows the 49 items in the eight first-order factors. The second-order factor was health literacy related to low salt intake. Model modification was driven by the modification index, which suggested that there was a correlation between the salt intake attitudes and the salty food consumption factors. The final model had a RMSEA of 0.033 (90% CI: 0.030 to 0.035) and a SRMR of 0.085, which indicates adequate fit.[24] The CFI was 0.901, which also indicates acceptable fit. This structure confirmed that all 49 of the items were measuring the same health literacy domain. Fig 2 shows the factor structure and the standardized estimates of the model.


Development and Validation of Chinese Health Literacy Scale for Low Salt Consumption-Hong Kong Population (CHLSalt-HK).

Chau PH, Leung AY, Li HL, Sea M, Chan R, Woo J - PLoS ONE (2015)

Factor structure of the Chinese Health Literacy Scale for Low Salt Consumption—Hong Kong population (CHLSalt-HK).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492982&req=5

pone.0132303.g002: Factor structure of the Chinese Health Literacy Scale for Low Salt Consumption—Hong Kong population (CHLSalt-HK).
Mentions: A factor structure with 54 items in eight first-order factors and one second-order factor was examined. However, the structure did not show adequate fit (RMSEA = 0.033, 90% confidence interval [CI]: 0.031 to 0.036; SRMR = 0.088; CFI = 0.871). Thus, the items with insignificant loading or with a loading of less than 0.2 in the first-order factors were removed from the model, leaving 49 items. The eight first-order factors were functional literacy (3 items), salty food knowledge (13 items), disease knowledge (8 items), knowledge of international standards (2 items), myths about salt intake (4 items), salt intake attitudes (7 items), salty food consumption (9 items), and nutrition label practices (3 items). Table 2 shows the 49 items in the eight first-order factors. The second-order factor was health literacy related to low salt intake. Model modification was driven by the modification index, which suggested that there was a correlation between the salt intake attitudes and the salty food consumption factors. The final model had a RMSEA of 0.033 (90% CI: 0.030 to 0.035) and a SRMR of 0.085, which indicates adequate fit.[24] The CFI was 0.901, which also indicates acceptable fit. This structure confirmed that all 49 of the items were measuring the same health literacy domain. Fig 2 shows the factor structure and the standardized estimates of the model.

Bottom Line: The mean CHLSalt-HK score among those who were aware of the public education slogan about nutrition labels and sodium intake was higher by 3.928 points (95% confidence interval: 1.742 to 6.115) than that among those who were not aware of the slogan, which supports adequate discriminant validity.The validated CHLSalt-HK had acceptable content validity, acceptable construct validity, good internal consistency, good test-retest reliability, and adequate discriminant validity.The scale could be completed in 10-15 minutes and is easy to administer compared with the collection of biomarkers or food diaries.

View Article: PubMed Central - PubMed

Affiliation: School of Nursing, The University of Hong Kong, Hong Kong, China.

ABSTRACT
Globally, sodium intake far exceeds the level recommended by the World Health Organization. Assessing health literacy related to salt consumption among older adults could guide the development of interventions that target their knowledge gaps, misconceptions, or poor dietary practices. This study aimed to develop and validate the Chinese Health Literacy Scale for Low Salt Consumption-Hong Kong population (CHLSalt-HK). Based on previous studies on salt intake and nutrition label reading in other countries, we developed similar questions that were appropriate for the Chinese population in Hong Kong. The questions covered the following eight broad areas: functional literacy (term recognition and nutrition label reading), knowledge of the salt content of foods, knowledge of the diseases related to high salt intake, knowledge of international standards, myths about salt intake, attitudes toward salt intake, salty food consumption practices, and nutrition label reading practices. Eight professionals, including doctors, nurses, and dietitians, provided feedback on the scale. The psychometric properties of the scale were assessed based on data collected from a convenience sample of 603 Chinese elderly adults recruited from Elderly Health Centres in Hong Kong. The 49-item CHLSalt-HK had a possible score range of 0 to 98, with a higher score indicating higher health literacy related to salt intake. The CHLSalt-HK had acceptable content validity; the item-level Content Validity Index ranged from 0.857 to 1.000, and the scale-level Content Validity Index was 0.994. Additionally, it had good internal consistency (Cronbach's alpha of 0.799) and good test-retest reliability (intraclass correlation coefficient of 0.846). The mean CHLSalt-HK score among those who were aware of the public education slogan about nutrition labels and sodium intake was higher by 3.928 points (95% confidence interval: 1.742 to 6.115) than that among those who were not aware of the slogan, which supports adequate discriminant validity. The validated CHLSalt-HK had acceptable content validity, acceptable construct validity, good internal consistency, good test-retest reliability, and adequate discriminant validity. The scale could be completed in 10-15 minutes and is easy to administer compared with the collection of biomarkers or food diaries. Further research should investigate its concurrent validity and predictive validity. The development of this scale supports the first step in salt intake reduction among older Chinese adults in Hong Kong by enabling the assessment of their health literacy related to salt consumption in health screenings or health assessments, and it can be used to evaluate salt reduction interventions.

No MeSH data available.