Development of a Health Literacy Assessment Tool for the Working-Age Population at Risk of Type 2 Diabetes in Thailand

Abstract

This study aimed to develop a health literacy assessment tool for the working-age population at risk of type 2 diabetes in Thailand. The study was conducted in five phases: (1) defining the concep tual framework, (2) item generation, (3) content validity assessment by nine experts, (4) pilot testing, and (5) field application. Data analysis included the content validity index (CVI), item discrimination power analysis using t-test, reliability testing using Cronbach’s alpha coefficient, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). The sample consisted of 858 working-age individuals at risk of diabetes, selected via multi-stage sampling. The results indicated that the developed assessment tool met the criteria for the item-level content validity index (I-CVI) for all items, with a scale-level content validity index (S-CVI) of 1.00. The overall reliability of the scale was 0.955, and all items demonstrated significant discrimination power (p<0.05). EFA results yielded a five-domain structure comprising 15 items. CFA results confirmed that the measurement model fitted the empirical data well. The goodness-of-fit indices were: likelihood ratio ( ) = 5,786.19 (p = 0.07), root mean square error of approximation (RMSEA) = 0.035 (p = 0.99), CFI = 0.99, TLI = 0.98, SRMR = 0.017, and coefficient of determination (R2) = 0.96. In conclusion, the health literacy assessment tool for the working-age population at risk of type 2 diabetes in Thailand consists of five components: access, understanding, decision making, communication with healthcare personnel, and application, totaling 15 items. This tool can effectively identify the health literacy status of at-risk groups at both individual and population levels.