How to measure critical health competences: development and validation of the Critical Health Competence Test (CHC Test)

Abstract

Consumers' autonomy regarding health increasingly requires competences to critically appraise health information. Critical health literacy refers to the concept of evidence-based medicine. Instruments to measure these competences in curriculum evaluation and surveys are lacking. We aimed to develop and validate an instrument to measure critical health competences (CHC test). Development and testing of the questionnaire covered three phases: (1) test construction (and feasibility, (2) first field test of scalability and items revision (3) second field test to validate the instrument. Model fit analyses were performed for both field tests for Rasch-, Mixed Rasch- and Hybrid model. Participants were secondary school and university students with and without prior training in evidence-based medicine (1. field test n = 322; with training n = 87; 2. field test n = 107; with training n = 13). The second field test resulted in Rasch scalability of all items in one person class. Mean values (+/-SD) of person parameters were 716.14 (+/-53.74) for trained students and 470.11 (+/-59.63) for untrained students. Reliability of the instrument was 0.91 (WINMIRA ANOVA). In conclusion the CHC instrument is a feasible, reliable and valid instrument to measure critical health literacy. The generalizability of the instrument is to be explored in ongoing studies in different educational settings.

Health literacy in childhood and youth: a systematic review of definitions and models

“…understand health issues in deeper way, make sound choices, participate as active member of society)Self-awareness (ability to self-reflect on oneself, own decisions, and oneself as learner;Citizenship (ability to act in an ethically-responsible way and take social responsibility; consider health matters beyond one’s own perspective (the ones of others and of the collective)Cross-sectional skills: Basic reading, writing and speech skills social skills, communication skills, and information-gathering skillsHealth literacy is defined as a learning outcomes of the school health education subject in Finland. It focusses on a health promoting and empowerment perspective with effects for the personal and societal health.7Rask, Uusiautti, Määttä, 2013 [29]Basic/Functional literacy (basic ability to read and write)Communicative/interactive literacy (ability to participate in daily activities and communicationCritical literacy (person’s potential to evaluate information)Extended with fourth dimension:Holistic health literacy, with four sub dimensions:- tolerance,- understanding culture as wide and multidimensional phenomena,- environmental consciousness,analysis of the state of the world from various points of viewBased on author’s understanding of Nutbeam’s typology (2000), complemented with own holistic health literacy models (adapted from Stewart et al 2008), dimensions are elaborated from students’ perspectives & point of views, based on their answers from the Finnish Matriculation Examination8Steckelberg et al, 2009 a&b [22, 41]Principles of critical health literacy related to evidence-based medicine (EBM):Understanding medical concepts (e.g. informed choice in diagnostic tests; appraising patient information)Skills of searching literature (e.g.…”

Effects of School-Based Educational Interventions for Enhancing Adolescents Abilities in Critical Appraisal of Health Claims: A Systematic Review

“…Students’ competences in terms of knowledge and skills were assessed using a multiple-choice and short-answer open-response tests that measured competences in subareas such as basic statistics and experimental design [49]. The intervention group had higher competences than the control group at post-test (mean difference in person parameters of 114, 95% CI: 86 to 142, p < 0.01).…”

“…There is also a need for comparable, reliable, and validated outcome measures to permit firm conclusions about the effects of interventions. Notably, the instrument used in one of the studies (Critical Health Competence Test) has been further validated and improved after the specific intervention was tested [49]. …”

Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q)

“…As they are often used in clinical settings, these tools are necessarily short and quick and easy to use. Other tools aim at measuring a broader concept of health literacy, with a view to provide an in-depth assessment of the dimensions of health literacy, or to explore its relationships with social determinants, health behavior, health status or healthy service use such as the National Assessment of Adult Literacy survey (NAAL) [13], the Critical Health Competence Test (CHC) [14], the Swiss Health Literacy Survey [15], the Health Literacy Management Scale (HeLMS) [16] and the Health Literacy Questionnaire (HLQ) [17]. Furthermore, existing health literacy measurement tools differ in terms of their administration style and their focus on specific aspects, such as the recognition and pronunciation of medical terms, numeracy, comprehension, and decision-making competencies.…”