Objective: To develop a suitable scale for assessing the public health safety literacy in residents in China. Methods: The initial scale of Chinese public health safety literacy was developed through theoretical conceptualization, item pooling, field verifying and item inclusion and exclusion. Then the initial scale was converted into an electronic questionnaire. A total of 2 809 residents from 4 provinces were randomly selected for field testing. Classical test theory (CTT) and item response theory (IRT) were used for item reduction. SPSS 23.0 was used for exploratory factor analysis (EFA) and unidimensional testing. Package R 4.1.1 ltm and mirt were used for the analysis of the psychometric properties of items and generate the ICC, IIC and TIF. Results: The initial scale had 30 items (B1-B30), and the test took 9.8 s to complete one item averagely. According to the CTT, B2 was deleted due to coefficient of total correlation (CITC) <0.3 and the item-dimension correlation coefficient (IDCC) <0.4. B23 was deleted due to CITC<0.3, IDCC<0.4 and difficulty index (W) <0.2. B30 was deleted due to CITC<0.3 and W<0.2. The total Cronbach's α of the scale was 0.923 after deletion. EFA indicated that 14 items should be deleted due to lower factor loadings <0.7. EFA was conducted for remaining 13 items and 2 common factors were extracted, the factor loadings of all items were >0.7, the accumulated variance contribution of the 2 common factors was 63.361%, and the total Cronbach's α was 0.891, showing unidimensionality, IRT was used to test the remaining items. B14 and B20 were deleted due to discrimination coefficient (a) <0.3, difficulty threshold coefficient (b) ∉[-3,3], the small amount of information and the flat, crowded, non-monotonic ICC, and IIC. Finally, the Cronbach's α of the 11-itemed scale was 0.936 with TLI=0.97, CFI=0.99, and RMSEA=0.03. Conclusion: The final scale has good reliability, validity, discrimination, difficulty level and feasibility, and can be applied for the rapid assessment of public health safety literacy in China.

ObjectiveTo explore the status and influencing factors of public health safety literacy (PHSL) among residents in four provinces of China for providing references to the development of appropriate intervention strategies. MethodsWe recruited 2 809 urban and rural residents aged 15 – 69 years in three provinces (Hubei, Guangdong and Sichuan) and Beijing municipality using stratified multistage cluster sampling and conducted an on-site self-administered electronic questionnaire survey among the residents during April – June, 2021. A scale with three domains (each with a maximum score of 40) was designed to assess the PHSL of the residents. T-test, one-way analysis of variance (ANOVA), and χ2 test were adopted in univariate analysis and logistic regression in multivariate analysis. Results For all the participants, the mean overall PHSL score was 81.61 ± 13.71 and the mean domain scores were 29.21 ± 5.89 for PHS perception, 25.10 ± 5.10 for PHS knowledge, and 27.30 ± 4.87 for PHS skills. There were 80.85% of the participants being assessed with basic PHSL (with the overall scale score of ≥ 72) and there were 86.69%, 61.05%, and 78.96% of the participants being assessed with basic PHS perception, knowledge, and skills (with the domain scores of ≥ 24); also based on the scale of overall score of ≥ 96 and domain scores of ≥ 32, the proportion of the participants with good PHSL was 15.70% and the proportions of participants with good PHS perception, knowledge and skills were 35.32%, 14.03% and 20.15%, respectively. Multivariate logistic regression analysis showed that PHSL was associated with residential region, sex, education and household income. The participants residing in Hubei, Sichuan, and Guangdong province were less likely to have basic/good PHSL, with the odds ratios (OR) of 0.485/0.422, 0.488/0.699, and 0.389/0.566 in contrast to those residing in Beijing municipality. The participants being female (versus male: OR = 1.336/1.283), with the education of higher than primary school education or below (junior high school: OR = 1.786/1.205; senior high or vocational or technical secondary school: OR = 2.204/2.013; college and above: OR = 2.932/3.710), with the annual household income of more than 30 000 RMB yuan (30 000 – 60 000: OR = 1.660/1.648; ≥ 120 000: OR = 1.865/2.145) were more likely to have basic/good PHSL. ConclusionFor 15 – 69 years old residents in four provincial administrative regions of China, the PHSL still needs to be improved and the residents′ PHSL is influenced mainly by gender, education, annual household income and residential region.

目的 分析"中国公众公共卫生安全素养自制量表"的项目功能差异(DIF),检验量表题项质量,为开发公共卫生安全素养(PHSL)调查工具提供依据.方法 通过经典测试理论和项目反应理论相结合的方法编制了单维的中国公众公共卫生安全素养量表.使用自制的初始量表(30个题项),于2021年4—6月随机抽取湖北、广东、北京和四川省的2809名常住居民进行调查.利用SPSS 23.0进行PHSL得分分析,两组间比较采用t检验,多组间比较采用单因素方差分析.利用R4.1.2软件mirt和scDIF test包对量表题项进行不同人口学特征的DIF检验.结果 调查对象PHSL的平均得分为(34.44±7.59)(满分44分).不同性别、年龄、文化程度、职业、地区、城乡、家庭年均总收入的公众PHSL得分差异均有统计学意义(P<0.001).其中,女性高于男性,文化程度较高人群高于较低人群,农民低于其他职业人群,湖北地区高于其他地区,城镇居民高于农村居民.所有题项均不存在性别、收入和城乡的DIF(P>0.05);8个题项存在年龄的DIF(P<0.05);8个题项存在文化程度的DIF(P<0.05);6个题项存在职业的DIF(P<0.05);4个题项存在地区的DIF(P<0.05).结论 中国公众公共卫生安全素养自制量表题项稳定性较好,适合推广使用.

Background The changing disease spectrum of Chinese residents poses great challenges to the healthcare delivery. Understanding patients' health literacy and influencing factors is helpful to improve doctor-patient communication, promote patients' health and alleviate the pressure of healthcare delivery. However, the number of studies on patients' health literacy is insufficient, and most of them focus on those with a special illness. Objective To understand the status of health literacy and its influencing factors among Chinese outpatients, providing a scientific basis for improving patients' health status and self-management ability, and for medical workers to perform patient education and instruction, disease management and relevant improvement. Methods A systematic sampling method was used to select 14 secondary or tertiary general hospitals in eight regions in eastern, central and western China as survey settings, and outpatients (≥15 years old) of them during January to May 2021 were randomly selected and surveyed using the Patient Health Literacy Scale (PHLS) 〔those with scores <41 were deemed unlikely to have health literacy; those with scores ≥55 were judged as having high level of health literacy; those with scores between 41 and 54 were regarded as having moderate level of health literacy〕. The health literacy level of outpatients was compared by various personal factors. Ordinal and multinomial Logistic regression analyses were used to analyze the influencing factors of health literacy. Results Altogether, 2 808 cases who handed in responsive questionnaires were included for final analysis. The average score of PHLS in the respondents was (43.38±6.25) . The prevalence of health literacy, and high level of health literacy was 68.38% (1 920/2 808) , and 6.93% (133/2 808) , respectively. The level of health literacy varied obviously by age, education level, occupation, average household monthly income per person, prevalence of a family member working as a healthcare worker, and prevalence of using the way of acquiring health information (from medical workers, family members, friends or coworkers, activities conducted by the work unit or the community, listening to the radio, watching television, reading a newspaper/book, searching the Internet, or other approaches) (P<0.001) . Higher educational level and average household monthly income per person were associated with higher level of health literacy (P<0.001) . Being a student, worker of an industrial/mining enterprise, retailer or server was associated with higher level of health literacy (P<0.05) . Acquiring heath information from healthcare workers and searching the Internet were associated with higher level of health literacy (P<0.05) . Conclusion On the whole, the health literacy was moderate in outpatients of the 14 general hospitals. To improve the health literacy level in this population, it is suggested to improve the levels of health education and guidance for them by strengthening the key role of healthcare workers in health information delivery, giving more concerns to the low educated or low-income earners, and increasing the ways of acquiring health information.

Objective: To develop a measurement scale for the public health and safety literacy of university freshmen. Methods: Item pooling was conducted through literature review and in-depth interview with public health experts, and a nominal group was organized to develop the initial items to form the questionnaire. A total of 250 freshmen were randomly selected to complete the questionnaire, and the assessment of psychometric properties were performed to carry out item reduction by using classical test theory and item response theory. Exploratory factor analysis method (EFA) was employed to calculate the item-factor loadings. The data collected from another 318 freshmen were analyzed using confirmatory factor analysis method (CFA). Results: The scale contained 3 dimensions and 9 items with all content validity index ≥0.8. The difficulty coefficient of 9 items was 1.18-2.43. The discriminative validity analysis showed that the difficulty index was 0.41-0.78, and the discrimination index was 0.38-0.64. Each of the remaining items had a statistically significant difference in the score value between the top 27% and lowest 27% of respondents (t>3, P<0.05). The item's Cronbach's α was 0.72-0.77, corrected item-total correlation was 0.33-0.60 and the overall α of the scale was 0.77. EFA indicated all item-factor loading were higher than 0.680, and the accumulated variance contribution of the 3 factors was 62.484%. Results of CFA showed that the overall fitness index of the model reached the fitness standard except for the χ2 value. There was no statistical significance in the total score of the scale and the scores of each item among groups with different demographic characteristics (P>0.05). Conclusions: The newly developed public health safety literacy scale had a good reliability,validity,stability and item constancy.It can be used in measurement of the public health and safety literacy of university freshmen.

目的 了解某高校新生公共卫生安全意识、知识与技能现状,为在高校开展有针对性的公共卫生安全教育提供依据.方法 于2020年9-11月,在北京市某所全国招生的综合性大学抽取2020年入学的3 204名本、硕、博新生,采用高校新生公共卫生安全意识、知识和技能调查表开展调查,采用SPSS 19.0进行统计分析.结果 调查对象信息甄别意识的回答正确率最低,为20.29％(650/3 204);其次为心理调适技能,回答正确率为52.68％(1 688/3 204).公共卫生安全意识得分(0.25±0.32)分,知识得分(0.75±0.21)分,技能得分(0.74±0.26)分,总分(1.74±0.52)分;48.85％(1 565/3 204)的人具备公共卫生安全意识、知识与技能.女生的公共卫生安全技能得分(0.76±0.25)高于男生(0.73±0.26)(t=-2.588,P=0.010),而男生的知识得分(0.76±0.20)高于女生(0.74±0.21)(t=2.710,P=0.007),本科及以下学历学生总分相对较高(1.76±0.50;t=3.596,P=0.028),城市学生具备公共卫生安全意识、知识和技能情况优于农村学生(OR=1.405,95％CI=1.213～1.628).结论 高校新生公共卫生安全意识、知识与技能处于中等水平,健康教育可有效提高学生的公共卫生安全素养.开展健康教育工作时,应注重信息甄别意识和心理调适技能的培养,同时注意区分不同性别、学历,并更多地关注农村地区学生.