Ambient Air Pollution Health Literacy Instrument

Abstract

The Ambient Air Pollution Health Literacy Instrument (AAPHL Instrument), developed by Chen et al. (2023), is a comprehensive inventory/questionnaire designed to evaluate health literacy specifically related to ambient air pollution. The creation of this measure was driven by the absence of existing tools tailored for assessing ambient air pollution health literacy (AAPHL). The development process of the AAPHL instrument was grounded in an integrated conceptual model of health literacy (Sørensen et al., 2012) and drew inspiration from the European Health Literacy Survey Questionnaire (HLS-EU-Q; Sørensen et al., 2013). The initial phase involved formulating a pool of 24 items, which encompassed 12 distinct constructs, representing four information competencies across three health domains. To ensure content validity, expert evaluations were conducted, and cognitive interviews were performed to ascertain interviewees’ comprehension of the items. This instrument was administered through telephone interviews to adult participants in Taiwan. A theoretically derived 12-factor model received support from confirmatory factor analysis. The study also reported findings regarding the instrument’s reliability and validity.

Keywords

Accessing in Disease Prevention; Accessing in Health Promotion; Accessing in Healthcare; Ambient Air Pollution; Applying in Disease Prevention; Applying in Health Promotion; Applying in Healthcare; Appraising in Disease Prevention; Appraising in Health Promotion; Appraising in Healthcare; Health Literacy; Understanding in Disease Prevention; Understanding in Health Promotion; Understanding in Healthcare; Pollution; Health Literacy; Health Psychology Assessment; Environmental Measures.

Authors

Chen, I-Chen; Li, Chung-Yi; Lu, Chien-Yeh; Huang, Yi-Chin; Lee, Pei-Chen; Lin, Ming-Yeng; Wang, Yu-Chen; Chen, Long-Sheng; Kuo, Chia-Lun; Hou, Wen-Hsuan.

Purpose

The primary purpose of the Ambient Air Pollution Health Literacy Instrument (AAPHL Instrument) is to quantitatively assess an individual’s health literacy specifically in the context of ambient air pollution.

Validity

Content Validity: The content validity of the AAPHL Instrument was thoroughly assessed, yielding high content validity indices. For relevance, the index was 0.97, indicating a strong alignment of the items with the construct being measured. The importance index was 0.99, underscoring the critical nature of the information conveyed by the items. Furthermore, the unambiguity index was 0.94, suggesting that the items were clearly phrased and easily understood by respondents.

Reliability

Internal Consistency: The internal consistency reliability of the Ambient Air Pollution Health Literacy Instrument was evaluated using Cronbach’s alpha. The instrument demonstrated a high level of internal consistency, with a Cronbach’s alpha of 0.93 for the entire scale. This indicates that the items within the instrument are highly correlated and consistently measure the same underlying construct of ambient air pollution health literacy.

Factor Analysis

Confirmatory Factor Analysis: A confirmatory factor analysis (CFA) was conducted to assess the fit of the theoretically conceived 12-factor model to the 24 items of the Ambient Air Pollution Health Literacy Instrument. The results of the CFA indicated a good fit for the 12-factor model, with the following fit indices: RMSEA = 0.068, CFI = 0.039, SRMR = 0.934, NFI = 0.914, and TLI = 0.902. These values generally suggest that the model adequately represents the underlying factor structure of the instrument. The 12-factor structure of the developed AAPHL instrument strongly supports the hypothesis derived from the integrated conceptual model of health literacy, which posits that health literacy comprises four information competencies distributed across three domains of the health continuum. In this 12-factor model, all standardized factor loadings ranged between 0.61 and 0.88, which are greater than the ideal value of 0.7, indicating strong relationships between the items and their respective factors. Notably, none of the factor loadings fell below 0.5, leading to the inclusion of all 24 items in the final instrument.

Instrument: Ambient Air Pollution Health Literacy Instrument (AAPHL Instrument)

Test Type: Original Inventory/Questionnaire.

Format: The items of the Ambient Air Pollution Health Literacy Instrument are rated on a 4-point scale, where 1 signifies “very difficult,” 2 indicates “fairly difficult,” 3 represents “fairly easy,” and 4 denotes “very easy.” If an interviewee’s response was “I do not know” or “I have no experience,” the item was coded as a missing value. The instrument contains 24 items.

Language Available: Chinese. The language present in the study was Chinese and English.

Population Group: The instrument is designed for the human population, specifically targeting both male and female adults.

Age Group: The instrument is suitable for individuals across various adult age groups, including Young Adulthood (18-29 years), Thirties (30-39 years), Middle Age (40-64 years), and Aged (65 years and older).

Population Details: The study for the development and validation of the AAPHL Instrument was conducted in Taiwan. The respondents were adult individuals from the Taiwanese population.

Test Methodology: The methodology employed in the development and validation of the AAPHL Instrument included: Test Validity, Content Validity, Test Reliability, Internal Consistency, Factor Analysis, and Confirmatory Factor Analysis. The administration method for the instrument was via interview, specifically telephone interviews.

Authors Including

Author ORCID Identifier: No data is Available.

Affiliation:

• Chen, I-Chen: Da-Yeh University, Department of Occupational Therapy, College of Nursing and Health Sciences.

• Li, Chung-Yi: National Cheng Kung University, Department of Public Health, College of Medicine.

• Lu, Chien-Yeh: Taipei Medical University, School of Gerontology Health Management, College of Nursing.

• Huang, Yi-Chin: National Cheng Kung University, Department of Public Health, College of Medicine.

• Lee, Pei-Chen: National Cheng Kung University, Department of Public Health, College of Medicine.

• Lin, Ming-Yeng: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University.

• Wang, Yu-Chen: National Cheng Kung University, Department of Law, College of Social Science.

• Chen, Long-Sheng: Surveillance, Research and Health Education Division, Health Promotion Administration, Ministry of Health and Welfare.

• Kuo, Chia-Lun: National Cheng Kung University, Department of Public Health, College of Medicine.

• Hou, Wen-Hsuan: National Cheng Kung University, Department of Public Health, College of Medicine.

Email Addresses:

• Kuo, Chia-Lun: [email protected]

• Hou, Wen-Hsuan: [email protected]

Correspondence Address:

• Kuo, Chia-Lun: [email protected]

Files

No file is available.

Permissions & Fee and Test Year

Permissions: To obtain permissions for the use of the Ambient Air Pollution Health Literacy Instrument, please contact the Corresponding Author.

Fee: There is no fee associated with the use of this instrument, and it is not a commercial product.

Test Year: The Ambient Air Pollution Health Literacy Instrument was developed and published in 2023.

References

Chen, I. -C., Li, C.-Y., Lu, C.-Y., Huang, Y.-C., Lee, P.-C., Lin, M.-Y., Wang, Y.-C., Chen, L.-S., Kuo, C.-L., & Hou, W.-H. (2023). Psychometric properties of novel instrument for evaluating ambient air pollution health literacy in adults. PLoS ONE, 18(6), Article e0285001. doi:10.1371/journal.pone.0285001

Sørensen, K., Broucke, S. V., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12(1), 1–13.

Sørensen, K., Broucke, S. V., Pelikan, J. M., Fullam, J., Doyle, G., Slonska, Z., & Brand, H. (2013). Measuring health literacy in Europe: The European Health Literacy Survey Questionnaire (HLS-EU-Q)—a synthesis of results from the HLS-EU project. Journal of Public Health, 21(6), 663–673.

Items of the Ambient Air Pollution Health Literacy Instrument (AAPHL Instrument)

The Ambient Air Pollution Health Literacy Instrument comprises 24 items. These items are designed to assess 12 distinct factors, which are further categorized into four information competencies across three health domains. The factors and subscales include:

• Accessing in Healthcare: Items related to the ability to find and access information about ambient air pollution in healthcare settings.

• Understanding in Healthcare: Items related to the comprehension of information about ambient air pollution provided in healthcare contexts.

• Appraising in Healthcare: Items related to the ability to evaluate the credibility and relevance of ambient air pollution information from healthcare sources.

• Applying in Healthcare: Items related to the capacity to use ambient air pollution information obtained in healthcare settings to make informed decisions.

• Accessing in Disease Prevention: Items related to the ability to find and access information on ambient air pollution for disease prevention.

• Understanding in Disease Prevention: Items related to the comprehension of information concerning ambient air pollution for disease prevention.

• Appraising in Disease Prevention: Items related to the ability to evaluate the quality and applicability of ambient air pollution information for disease prevention.

• Applying in Disease Prevention: Items related to the capacity to utilize ambient air pollution information for effective disease prevention strategies.

• Accessing in Health Promotion: Items related to the ability to find and access information about ambient air pollution for health promotion.

• Understanding in Health Promotion: Items related to the comprehension of information concerning ambient air pollution for health promotion.

• Appraising in Health Promotion: Items related to the ability to evaluate the reliability and utility of ambient air pollution information for health promotion.

• Applying in Health Promotion: Items related to the capacity to apply ambient air pollution information to enhance personal and community health.