Development and psychometric validation of a novel health literacy scale for family caregivers of preschool children

Background: Health literacy among family caregivers has been found to be strongly correlated with health exposures and outcomes for their children. Accurate assessment of their health literacy contributes to improving child health outcomes. Given the limited evidence on health literacy measures for family caregivers, the study aimed to develop and validate a novel Health Literacy Scale for Family Caregivers of Preschool Children (HLSFC). Methods: The HLSFC was developed in 4 phases: 1) using Nutbeam’s conceptual framework of health literacy as a guide to clarify the content to be measured; 2) generating an item pool; 3) providing feedback on the initial items; 4) psychometric analyses. A cross-sectional survey of 443 family caregivers of preschoolers was conducted in Northwest China. Construct validity was assessed using exploratory factor analysis (n = 213) and confirmatory factor analysis (n = 230). Reliability was assessed using internal consistency, split-half reliability, and test–retest reliability. Results: Thirty-Three items were included in the final instrument. Principal component analysis yielded a three-factor structure explaining 70.013% of the total variance. All fitting indices met the standard based upon confirmatory factor analysis. The composite reliability values of the factors ranged from 0.928 to 0.944 (> 0.7), and the average variance extracted values ranged from 0.552 to 0.590 (> 0.5), indicating acceptable convergent validity. The Cronbach’s alpha value was 0.963. The test–retest reliability was good, with an intraclass correlation coefficient of 0.909. Sociodemographic factors, such as caregiver education, occupation, residence, and monthly household income per person, were significantly associated with health literacy scores. Conclusion: The HLSFC demonstrated adequate reliability and validity, and can measure a wide range of health literacy skills: from functional to interactive and critical health literacy. It could be potentially applied as an effective tool for the health literacy assessment among family caregivers of preschoolers.