Construct Validity of Health Literacy Scales and Causal Model of Sufficient Health among NCDs Risk Adults

Background: Over 75% of Thai people’s deaths are caused by non-communicable diseases (NCDs), which is higher than all deaths worldwide at 71%.

Objective: To develop a health literacy (HL) and sufficient health behavior (SHB) scale and examine the causal relationship model of SHB.

Materials and Methods: The present study was a cross-sectional exploratory study among adults aged 20 to 60 at NCD risks. Six hundred thirty-six participants were sampled through stratified random sampling. The participants consisted of employees in public and private organizations and local people in urban and semi-urban communities. The research was done between August 2021 and March 2022. Confirmatory Factor analysis (CFA), and structural equation modeling (SEM) were used to analyze the data.

Results: 1) In respect of construct validity, the 28-item HL Scale achieved an overall Cronbach’s alpha of 0.94 and a factor loading ranging between 0.67 to 0.84. Similarly, the 30-item SHB Scale achieved an overall Cronbach’s alpha of 0.94 and a factor loading ranging between 0.40 to 0.82. 2) The causal relationship model of SHB was consistent with the empirical data. In addition, HL positively influenced SHB (direct effect=0.82, p<0.001), and HL was a key factor that could predict SHB by 67.00%.

Conclusion: Both developed scales are high-quality assessment instruments that can be used by healthcare providers in assessing NCD risks and predicting SHB to organize activities enhancing people’s HL and knowledge for decreasing NCD risk behaviors.

Keywords: Health literacy; Sufficient health behavior; Non-communicable diseases; NCDs Risk; Construct Validity