Ambient Air Pollution Health Literacy Instrument

Abstract

The Ambient Air Pollution Health Literacy Instrument (AAPHL Instrument), developed by Chen et al. in 2023, is a specialized inventory designed to quantitatively assess an individual’s competency regarding Ambient Air Pollution (AAP) information. The creation of the AAPHL Instrument addressed a significant gap in existing tools, which lacked measures specifically tailored for Ambient Air Pollution Health Literacy (AAPHL).

The development methodology was rigorously grounded in the integrated conceptual model of health literacy (Sørensen et al., 2012) and derived structure from the European Health Literacy Survey Questionnaire (HLS-EU-Q). The initial pool of 24 items was formulated to capture 12 distinct constructs, representing the intersection of four information competencies (Accessing, Understanding, Appraising, Applying) across three health domains (Healthcare, Disease Prevention, Health Promotion).

Validation procedures included expert evaluations to ensure content validity and cognitive interviews to confirm item comprehension among adult participants in Taiwan. The instrument’s underlying theoretical structure was supported by Confirmatory Factor Analysis (CFA), which endorsed the hypothesized 12-factor model. The study confirmed the instrument’s strong reliability and validity for assessing AAPHL in adult populations.

Keywords

Ambient Air Pollution, Health Literacy, Health Psychology Assessment, Environmental Measures, Accessing in Disease Prevention, Understanding in Health Promotion, Appraising in Healthcare, Applying in Disease Prevention, Pollution, 12-Factor Model.

Authors

Chen, I-Chen; Li, Chung-Yi; Lu, Chien-Yeh; Huang, Yi-Chin; Lee, Pei-Chen; Lin, Ming-Yeng; Wang, Yu-Chen; Chen, Long-Sheng; Kuo, Chia-Lun; Hou, Wen-Hsuan.

Purpose

The primary objective of the Ambient Air Pollution Health Literacy Instrument (AAPHL Instrument) is to provide a quantitative, psychometrically sound measure for assessing an individual’s health literacy skills specifically concerning ambient air pollution. This assessment is vital for public health interventions and environmental health education programs.

The instrument aims to capture the complexity of health literacy, moving beyond simple knowledge recall to evaluate the practical competencies required for individuals to manage their health risks associated with environmental factors, particularly pollution exposure.

Construct

The AAPHL Instrument measures Ambient Air Pollution Health Literacy (AAPHL), which is conceptualized as a multi-dimensional construct based on the integrated model proposed by Sørensen et al. (2012). This model views health literacy as the competence to meet the complex demands of health in modern society.

The scale operationalizes AAPHL through a 12-factor structure, which systematically crosses four core information processing competencies with three crucial domains of the health continuum:

• Information Processing Competencies: Accessing (finding information), Understanding (comprehending information), Appraising (evaluating credibility), and Applying (using information to make decisions).

• Health Domains: Healthcare, Disease Prevention, and Health Promotion.

The 12 resulting factors, such as Accessing in Healthcare or Applying in Disease Prevention, provide a detailed profile of an individual’s ability to navigate and act upon information related to the health risks and preventative measures associated with ambient air pollution.

Validity

The validity of the AAPHL Instrument was primarily established through robust assessment of its content validity, ensuring that the items accurately and comprehensively represent the defined construct of AAPHL.

Expert evaluations yielded exceptionally high content validity indices (CVI). The index for relevance was 0.97, confirming a strong theoretical alignment between the scale items and the measured construct. Furthermore, the importance index reached 0.99, demonstrating the critical nature of the information being conveyed by the instrument. Finally, an unambiguity index of 0.94 indicated that the items were clearly phrased and easily comprehensible to the target population, minimizing measurement error due to misunderstanding.

Reliability

The reliability of the Ambient Air Pollution Health Literacy Instrument was assessed using internal consistency measures, confirming the coherence and homogeneity of the 24 items.

Internal consistency reliability was quantified using Cronbach’s alpha. The results demonstrated a high degree of internal consistency, with a Cronbach’s alpha coefficient of 0.93 for the entire 24-item scale. This high value suggests that the items within the instrument are highly interrelated and consistently measure the same underlying construct of ambient air pollution health literacy.

Factor Analysis

A Confirmatory Factor Analysis (CFA) was performed to test the fit of the theoretically derived 12-factor structure against the collected data. This structure, which links four competencies across three domains, was strongly supported.

The CFA results indicated a good model fit, with the following key indices reported: Root Mean Square Error of Approximation (RMSEA) = 0.068, Comparative Fit Index (CFI) = 0.039, Standardized Root Mean Square Residual (SRMR) = 0.934, Normed Fit Index (NFI) = 0.914, and Tucker-Lewis Index (TLI) = 0.902. While some indices suggest room for improvement, the overall structure was deemed adequate to represent the complex theoretical framework.

Crucially, all 24 items were retained in the final instrument because the standardized factor loadings ranged strongly between 0.61 and 0.88. These values exceed the ideal threshold of 0.7 for strong relationships between items and their respective latent factors, and none fell below 0.5, confirming the robust empirical support for the 12-factor theoretical model.

Instrument

Test Type: Original Inventory/Questionnaire.

Format: The instrument contains 24 items, each rated on a 4-point scale: 1 (“very difficult”), 2 (“fairly difficult”), 3 (“fairly easy”), and 4 (“very easy”). Responses of “I do not know” or “I have no experience” were treated as missing values during analysis.

Language Available: Chinese. The study was conducted using both Chinese and English materials, but the primary language of administration was Chinese.

Population Group: Human population, specifically targeting male and female adults.

Age Group: Suitable for all adult age groups, including Young Adulthood (18-29 years), Thirties (30-39 years), Middle Age (40-64 years), and Aged (65 years and older).

Population Details: The development and validation study for the AAPHL Instrument were conducted among adult individuals residing in Taiwan.

Test Methodology: The validation included Test Validity, Content Validity, Test Reliability, Internal Consistency, Factor Analysis, and Confirmatory Factor Analysis. The administration method was via telephone interviews.

Authors (Detailed)

Author ORCID Identifier: No data is Available.

Affiliation:

• Chen, I-Chen: Da-Yeh University, Department of Occupational Therapy, College of Nursing and Health Sciences.

• Li, Chung-Yi: National Cheng Kung University, Department of Public Health, College of Medicine.

• Lu, Chien-Yeh: Taipei Medical University, School of Gerontology Health Management, College of Nursing.

• Huang, Yi-Chin: National Cheng Kung University, Department of Public Health, College of Medicine.

• Lee, Pei-Chen: National Cheng Kung University, Department of Public Health, College of Medicine.

• Lin, Ming-Yeng: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University.

• Wang, Yu-Chen: National Cheng Kung University, Department of Law, College of Social Science.

• Chen, Long-Sheng: Surveillance, Research and Health Education Division, Health Promotion Administration, Ministry of Health and Welfare.

• Kuo, Chia-Lun: National Cheng Kung University, Department of Public Health, College of Medicine.

• Hou, Wen-Hsuan: National Cheng Kung University, Department of Public Health, College of Medicine.

Affiliation Email addresses:

• Kuo, Chia-Lun: [email protected]

• Hou, Wen-Hsuan: [email protected]

Correspondence Address:

• Kuo, Chia-Lun: [email protected]

Permissions & Fee and Test Year

Permissions: To obtain authorization and permissions for the use of the Ambient Air Pollution Health Literacy Instrument, interested parties must contact the Corresponding Author directly.

Fee: This instrument is not a commercial product, and there is no fee associated with its use.

Test Year: The Ambient Air Pollution Health Literacy Instrument was developed, validated, and published in 2023.

Reference’s

Chen, I. -C., Li, C.-Y., Lu, C.-Y., Huang, Y.-C., Lee, P.-C., Lin, M.-Y., Wang, Y.-C., Chen, L.-S., Kuo, C.-L., & Hou, W.-H. (2023). Psychometric properties of novel instrument for evaluating ambient air pollution health literacy in adults. PLoS ONE, 18(6), Article e0285001. doi:10.1371/journal.pone.0285001

Sørensen, K., Broucke, S. V., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12(1), 1–13.

Sørensen, K., Broucke, S. V., Pelikan, J. M., Fullam, J., Doyle, G., Slonska, Z., & Brand, H. (2013). Measuring health literacy in Europe: The European Health Literacy Survey Questionnaire (HLS-EU-Q)—a synthesis of results from the HLS-EU project. Journal of Public Health, 21(6), 663–673.

Items of the Ambient Air Pollution Health Literacy Instrument

The Ambient Air Pollution Health Literacy Instrument comprises 24 items. These items are designed to assess 12 distinct factors, which are further categorized into four information competencies across three health domains. The factors and subscales include:

• Accessing in Healthcare: Items related to the ability to find and access information about ambient air pollution in healthcare settings.

• Understanding in Healthcare: Items related to the comprehension of information about ambient air pollution provided in healthcare contexts.

• Appraising in Healthcare: Items related to the ability to evaluate the credibility and relevance of ambient air pollution information from healthcare sources.

• Applying in Healthcare: Items related to the capacity to use ambient air pollution information obtained in healthcare settings to make informed decisions.

• Accessing in Disease Prevention: Items related to the ability to find and access information on ambient air pollution for disease prevention.

• Understanding in Disease Prevention: Items related to the comprehension of information concerning ambient air pollution for disease prevention.

• Appraising in Disease Prevention: Items related to the ability to evaluate the quality and applicability of ambient air pollution information for disease prevention.

• Applying in Disease Prevention: Items related to the capacity to utilize ambient air pollution information for effective disease prevention strategies.

• Accessing in Health Promotion: Items related to the ability to find and access information about ambient air pollution for health promotion.

• Understanding in Health Promotion: Items related to the comprehension of information concerning ambient air pollution for health promotion.

• Appraising in Health Promotion: Items related to the ability to evaluate the reliability and utility of ambient air pollution information for health promotion.

• Applying in Health Promotion: Items related to the capacity to apply ambient air pollution information to enhance personal and community health.