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已发表论文
中国版糖尿病健康素养量表在2型糖尿病成人中的心理测量学验证：因子分析和项目反应理论的应用
Authors Li Y , Wang C, Yang L , Zhang L
Received 14 November 2025
Accepted for publication 30 December 2025
Published 21 January 2026 Volume 2026:19 581591
DOI https://doi.org/10.2147/DMSO.S581591
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Ernesto Maddaloni
Yao Li, Congzhi Wang, Liu Yang, Lin Zhang
Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, People’s Republic of China
Correspondence: Lin Zhang, Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu, Anhui, People’s Republic of China, Email yaoran2008@163.com
Background: Diabetes health literacy is a critical determinant of a patient’s ability to effectively self-manage the condition, and its accurate assessment is paramount for developing targeted interventions. This study aims to translate and validate the reliability and validity of the Chinese version of the Diabetes Health Literacy Scale (DHLS) among Chinese patients with type 2 diabetes mellitus based on factor analysis and item response theory (IRT) models.
Methods: The cross-sectional study was conducted among 251 adult patients with type 2 diabetes mellitus admitted to a tertiary hospital in Wuhu City. The 14-item DHLS was administered to all participants. Reliability was evaluated using Cronbach’s alpha. The three-factor structure of the scale was assessed through both exploratory and confirmatory factor analysis (EFA/CFA). Furthermore, the Graded Response Model from IRT was employed to analyze item discrimination, difficulty parameters, and the scale information function.
Results: The Chinese version of the DHLS demonstrated excellent overall reliability (Cronbach’s alpha = 0.938). Both EFA and CFA strongly supported the original three-factor structure (informational, computational, and communicative literacy). Convergent validity was satisfactory, with all subscales achieving the average variance extracted (AVE) > 0.50, and composite reliability values > 0.70. Discriminant validity was also confirmed, as the square roots of the AVE for each subscale exceeded the inter-construct correlations. IRT analysis confirmed that all 14 items had satisfactory discrimination parameters and exhibited monotonic increasing difficulty patterns. Importantly, the total information curve revealed that the scale provides the most precise measurement for individuals with moderate levels of health literacy.
Conclusion: The Chinese version of the DHLS is a valid and reliable instrument with robust psychometric properties. Its application can facilitate the development of targeted interventions, ultimately improving diabetes management outcomes.
Keywords: diabetes health literacy scale, type 2 diabetes mellitus, reliability, validity, item response theory
Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, People’s Republic of China
Correspondence: Lin Zhang, Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu, Anhui, People’s Republic of China, Email yaoran2008@163.com
Background: Diabetes health literacy is a critical determinant of a patient’s ability to effectively self-manage the condition, and its accurate assessment is paramount for developing targeted interventions. This study aims to translate and validate the reliability and validity of the Chinese version of the Diabetes Health Literacy Scale (DHLS) among Chinese patients with type 2 diabetes mellitus based on factor analysis and item response theory (IRT) models.
Methods: The cross-sectional study was conducted among 251 adult patients with type 2 diabetes mellitus admitted to a tertiary hospital in Wuhu City. The 14-item DHLS was administered to all participants. Reliability was evaluated using Cronbach’s alpha. The three-factor structure of the scale was assessed through both exploratory and confirmatory factor analysis (EFA/CFA). Furthermore, the Graded Response Model from IRT was employed to analyze item discrimination, difficulty parameters, and the scale information function.
Results: The Chinese version of the DHLS demonstrated excellent overall reliability (Cronbach’s alpha = 0.938). Both EFA and CFA strongly supported the original three-factor structure (informational, computational, and communicative literacy). Convergent validity was satisfactory, with all subscales achieving the average variance extracted (AVE) > 0.50, and composite reliability values > 0.70. Discriminant validity was also confirmed, as the square roots of the AVE for each subscale exceeded the inter-construct correlations. IRT analysis confirmed that all 14 items had satisfactory discrimination parameters and exhibited monotonic increasing difficulty patterns. Importantly, the total information curve revealed that the scale provides the most precise measurement for individuals with moderate levels of health literacy.
Conclusion: The Chinese version of the DHLS is a valid and reliable instrument with robust psychometric properties. Its application can facilitate the development of targeted interventions, ultimately improving diabetes management outcomes.
Keywords: diabetes health literacy scale, type 2 diabetes mellitus, reliability, validity, item response theory