Academic journal article Journal of Nursing Measurement

Measuring Maternal Health Literacy in Adolescents Attending Antenatal Care in Uganda: Exploring the Dimensionality of the Health Literacy Concept Studying a Composite Scale

Academic journal article Journal of Nursing Measurement

Measuring Maternal Health Literacy in Adolescents Attending Antenatal Care in Uganda: Exploring the Dimensionality of the Health Literacy Concept Studying a Composite Scale

Article excerpt

Background and Purpose: The purpose of this article is to test the requirement of "local independence" in the newly developed "Maternal Health Literacy" (MaHeLi) composite scale measuring health literacy in pregnant adolescents attending antenatal care. Methods: The 20-item scale was administered to 384 adolescents aged 15-19 years attending antenatal care in Uganda during the period July-December 2013. Rasch analysis was conducted using RUMM2030. Results: Differential item functioning was observed for 3 items. One item had disordered response categories. One subscale brought substantial multidimensionality into the MaHeLi scale. Conclusions: Results support the use of a 12-item version of the MaHeLi scale. The article shows how Rasch analyses help us to identify violations of local independence in scales.

Keywords: Rasch analysis; violations of local independence in composite scales; maternal health literacy; antenatal care; pregnant adolescents

(ProQuest: ... denotes formulae omitted.)

Scales constructed in the field of caring sciences are intended to characterize more or less of some construct. Such scales are usually claimed to be unidimensional and as a consequence, all items are summed.

To increase the validity of a scale beyond the validity that could be achieved if only one aspect was measured, some scales operationalize different aspects of the construct being measured, with a subscale identified with each aspect. When a scale is constructed by a composition of subscales with the aim of increasing validity, some multidimensionality is expected in the data. Therefore, some violations of "strict" unidimensionality might be seen as an acceptable property of the scale rather than evidence of some fault.

The newly developed "Maternal Health Literacy" (MaHeLi) scale, explored in this study, consists of 20 polytomous items with 6 response categories. Seven of the items cover the health-seeking behavior (HSB) aspect, six items cover the competence and coping skills (CCS) aspect, and seven items cover the appraisal of health information (AHI) aspect. Hence, the MaHeLi scale is constructed as a conceptually balanced scale where the different aspects are equally weighted in the entire scale. The aim of this article is to test the following sixfolded hypothesis:

Applied to adolescents aged 15-19 years attending antenatal care in the Jinja and Iganga districts of Uganda, the MaHeLi scale represent (a) a well-targeted scale with (b) acceptable person separation that consists of (c) locally independent items that (d) have ordered response categories, (e) are functioning in the same way for different levels of relevant person factors, and (f) show acceptable individual fit to the unidimensional polytomous Rasch model.

This article contributes to the international knowledge base on the motivations and abilities of pregnant adolescents to gain access to, understand, and use information in ways that promote and maintain their health and that of their children. This issue is of great international interest and concern and relevant to a wide spectre of clinical practice.

Applying the unidimensional polytomous Rasch model, this article aims to advance the quality of clinical health research methods by showing how violations of local independence can be identified in the data from composite questionnaire scales where items are deliberately developed to assess different aspects of a construct, with a subscale identified with each aspect.

The article makes an important contribution to the discussion of the dimensionality of the "health literacy" concept in general, an issue of great interest to researchers in the whole health profession community and with important implications for measurement and the use of questionnaires in numerous clinical samples around the world also beyond the health-related professions.

BACKGROUND AND CONCEPTUAL FRAMEWORK

Realms of Health Literacy From an Antenatal Perspective

The cognitive and social skills which determine the motivation and ability of women to gain access to, understand, and use information in ways to promote and maintain their health and that of their children are collectively referred to as maternal health literacy (MHL; Renkert & Nutbeam, 2001). …

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