Article(id=1325503432412496617, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325502070660407522, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025145, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733068800000, receivedDateStr=2024-12-02, revisedDate=1744041600000, revisedDateStr=2025-04-08, acceptedDate=null, acceptedDateStr=null, onlineDate=1793954244949, onlineDateStr=2026-11-06, pubDate=1748102400000, pubDateStr=2025-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793954244949, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793954244949, creator=13701087609, updateTime=1793954244949, updator=13701087609, issue=Issue{id=1325502070660407522, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='5', pageStart='609', pageEnd='760', issueExtLink='null', onlineDate='null', pubDate='1748102400000', pubDateStr='2025-05-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793953920283, creator='13701087609', updateTime=1793953920283, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=676, endPage=680, ext={EN=ArticleExt(id=1325503433251357418, articleId=1325503432412496617, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Preliminary development of Health Literacy Evaluation Scale for Chinese High School Students, columnId=1259565859148804482, journalTitle=Chinese Journal of School Health, columnName=Health Education and Promotion, runingTitle=null, highlight=null, articleAbstract=
Objective

To develop a health literacy evaluation scale for Chinese high school students, providing a tool for dynamic monitoring of health literacy among high school students and evaluating the effectiveness of health school construction.

Methods

Through theoretical research, an evaluation index system for health literacy of Chinese high school students was constructed. Two rounds of Delphi expert consultations were conducted to quantitatively screen the items, and the item pool was revised based on expert opinions to compile the health literacy evaluation scale for Chinese students. Two focus group interviews were held to collect suggestions from health educators, high school teachers, and high school students regarding optimized scale length, question types, difficulty and wording of the scale. The scale was revised accordingly. A pilot survey was conducted in Beijing and Tianjin in November 2024, and the reliability and validity of the scale were evaluated based on the pilot survey data.

Results

The response rate in both rounds of Delphi expert consultations was over 80%, and the expert authority coefficient was over 0.70. The expert opinions were highly concentrated, and the dispersion was small. The revised item pool based on expert opinions contained 39 items. The revised scale based on the suggestions and opinions collected from the focus group interviews had a moderate number of questions and difficulty level. The pilot survey obtained 800 valid responses, with the response rate of 89.39%. The Cronbach α coefficient of the scale was 0.911, χ2/df=3.321, the root mean square error of approximation was 0.054, the adjusted goodness-of-fit index was 0.991, and the factor loadings of some items were less than 0.40.

Conclusion

The health literacy evaluation scale for Chinese high school students demonstrates scientific rigor and practical applicability, with good internal consistency and structural validity.

, authors=Shihao GUO1, Fan ZHU1, Guiyin ZHU1, Tiantian QI1, Shuang YANG1, Bin HU2, Huiyun WU2, He JIANG2, Yinghua MA*, 1, authorsList=Shihao GUO, Fan ZHU, Guiyin ZHU, Tiantian QI, Shuang YANG, Bin HU, Huiyun WU, He JIANG, Yinghua MA, authorCompany=null, correspAuthors=Yinghua MA, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325503437454050027, articleId=1325503432412496617, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=中国高中生健康素养评价量表的初步编制, columnId=1259565859903779205, journalTitle=中国学校卫生, columnName=健康教育与健康促进, runingTitle=null, highlight=null, articleAbstract=
目的

编制中国高中生健康素养评价量表,为开展高中生健康素养动态监测、健康学校建设效果评价提供工具。

方法

通过理论研究,构建中国高中生健康素养评价指标体系。通过2轮德尔菲专家咨询定量筛选条目,根据专家意见修订条目池,并编制中国高中生健康素养评价量表。通过2次专题小组访谈,收集健康教育专家、高中教师及高中生对量表题量、题型、难度、语言表述等的建议,据此修订量表。于2024年11月在北京市和天津市开展预调查,基于预调查数据评价量表的信度与效度。

结果

2轮德尔菲专家咨询的专家积极性均>80%,专家权威系数均>0.70,专家意见集中程度较高,专家意见分散程度较小,根据专家意见修订后的条目池包含39个条目。根据专题小组访谈收集的意见和建议修订后的量表题量、难度适中。预调查获得800份有效答卷,问卷有效率为89.39%。量表的Cronbach α系数为0.911,χ2值与自由度比值(χ2/df)为3.321,渐近残差均方和平方根为0.054,调整适配度指数为0.991,部分条目的因子负荷小于0.40。

结论

初步编制出兼具科学性与适用性的中国高中生健康素养评价量表,量表内部一致性良好,结构效度尚可。

, authors=郭世豪1, 朱璠1, 朱桂因1, 祁甜甜1, 杨爽1, 胡滨2, 吴慧云2, 姜贺2, 马迎华*, 1, authorsList=郭世豪, 朱璠, 朱桂因, 祁甜甜, 杨爽, 胡滨, 吴慧云, 姜贺, 马迎华, authorCompany=null, correspAuthors=马迎华, authorNote=

郭世豪(2000-),男,河南周口人,在读硕士,主要研究方向为儿童青少年生长发育及其影响因素

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马迎华,E-mail:
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(in Chinese), articleTitle=null, refAbstract=null), Reference(id=1325503457691566919, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325503432412496617, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=21, rfOrder=25, authorNames=null, journalName=null, refType=null, unstructuredReference=余小鸣, 郭帅军, 王璐, 等. 高中生健康素养评价问卷的结构框架及信效度分析[J]. 中国学校卫生, 2014, 35(5): 672-674, 678., articleTitle=null, refAbstract=null), Reference(id=1325503457976779592, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325503432412496617, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=21, rfOrder=26, authorNames=null, journalName=null, refType=null, unstructuredReference=YU X M, GUO S J, WANG L, et al. Structural framework and reliability and validity analysis of Health Literacy Evaluation Questionnaire for High School Students[J]. Chin J Sch Health, 2014, 35(5): 672-674, 678. (in Chinese), articleTitle=null, refAbstract=null), Reference(id=1325503458048082762, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325503432412496617, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=22, rfOrder=27, authorNames=null, journalName=null, refType=null, unstructuredReference=王媛媛. 医学量表的编制与评价: 理论、方法与实例操作[M]. 北京: 北京大学医学出版社, 2020: 66-69, 84-115., articleTitle=null, refAbstract=null), Reference(id=1325503458127774539, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325503432412496617, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=22, rfOrder=28, authorNames=null, journalName=null, refType=null, unstructuredReference=WANG Y Y. Development and evaluation of medical scale: theory, method and instance operation[M]. Beijing: Peking University Medical Press, 2020: 66-69, 84-115. (in Chinese), articleTitle=null, refAbstract=null), Reference(id=1325503458438153036, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325503432412496617, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=23, rfOrder=29, authorNames=null, journalName=null, refType=null, unstructuredReference=孙昕霙. 健康调查问卷设计原理与实践[M]. 北京: 北京大学医学出版社, 2020: 41-61, 74-167., articleTitle=null, refAbstract=null), Reference(id=1325503458509456206, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325503432412496617, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=23, rfOrder=30, authorNames=null, journalName=null, refType=null, unstructuredReference=SUN X Y. The principles and practices of designing health questionnaires[M]. Beijing: Peking University Medical Press, 2020: 41-61, 74-167. (in Chinese), articleTitle=null, refAbstract=null), Reference(id=1325503458845000528, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325503432412496617, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=24, rfOrder=31, authorNames=null, journalName=null, refType=null, unstructuredReference=中华人民共和国国家卫生健康委办公厅关于印发中国公民健康素养——基本知识与技能(2024年版)的通知[EB/OL]. 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The factor loading of each item in Scale 2.0(n=800)

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各因子条目内容因子负荷
因子1
  了解获取健康相关信息的可靠渠道0.58
  理解不良饮食习惯、缺乏运动、吸烟、饮酒等会增加高血压、糖尿病、高血脂等慢性非传染性疾病发生的可能性0.53
  了解高度近视引发的眼底病变及其预防措施0.05
  了解睡眠时间和质量对身心健康的影响0.02
  了解反式脂肪酸的危害及其食物来源0.11
  了解《14~17岁学龄儿童平衡膳食宝塔》的内容0.05
  了解食源性疾病的原因和预防措施0.09
  认同保持健康生活方式的重要性,树立“每个人都是自己健康第一责任人”的意识0.62
  能够通过睡前放松训练、营造良好睡眠环境等方法提高睡眠质量0.47
  自觉抵制吸烟行为0.50
  坚持科学、规律的体育锻炼0.55
  坚持合理作息,保证睡眠时间和质量0.44
因子2
  了解青春期不同阶段的生长发育特点0.10
  认同“体态以健康自然为美”0.78
  树立健康的异性交往观念0.15
  能够识别导致性骚扰和性侵害的危险因素0.13
  遇到性骚扰和性侵害时,采取适当的自我保护措施0.17
因子3
  了解竞争存在利弊两面性0.57
  能够客观认识自身的优势、劣势、兴趣、目标等0.71
  认同焦虑症和抑郁症患者需要接受药物治疗、心理治疗等0.67
  能够分析压力的来源并能正确应对压力0.58
  能够识别自身出现的焦虑、抑郁等不良情绪0.64
  能够有效地疏解焦虑、抑郁情绪,主动寻求帮助0.71
  遭遇校园欺凌和校园暴力时,及时寻求师长的帮助0.71
  正确应对失败和挫折0.77
因子4
  了解艾滋病病毒感染者与艾滋病患者的区别0.03
  树立接纳、平等对待传染病患者的意识0.70
  认同国家在传染病流行时采取的必要措施0.68
  能够识别可能感染性传播疾病的危险行为,提高防范能力-0.03
  主动关注公共卫生信息,提高关于疫情信息的识别能力0.74
  传染病发生时,采取正确措施做好个人防护0.71
因子5
  了解家庭药箱中的常用药品及其使用方法0.10
  了解药物误用、滥用对身体的危害0.13
  了解预防网络成瘾的方法0.11
  树立自觉主动报告突发应急事件的意识0.67
  能够在遇险时准确、有效地传递信息0.76
  能够根据现场情况判断触电的种类,在保证自身安全的情况下,对触电者进行科学、及时的急救处置0.76
  能够正确实施心肺复苏、正确使用自动体外除颤仪0.68
  在医生指导下正确使用抗生素,遵医嘱正确使用镇静催眠药和镇痛药等成瘾性药物0.68
), ArticleFig(id=1325503448837391146, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325503432412496617, language=CN, label=表1, caption=

《量表2.0》各条目因子负荷(n=800)

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各因子条目内容因子负荷
因子1
  了解获取健康相关信息的可靠渠道0.58
  理解不良饮食习惯、缺乏运动、吸烟、饮酒等会增加高血压、糖尿病、高血脂等慢性非传染性疾病发生的可能性0.53
  了解高度近视引发的眼底病变及其预防措施0.05
  了解睡眠时间和质量对身心健康的影响0.02
  了解反式脂肪酸的危害及其食物来源0.11
  了解《14~17岁学龄儿童平衡膳食宝塔》的内容0.05
  了解食源性疾病的原因和预防措施0.09
  认同保持健康生活方式的重要性,树立“每个人都是自己健康第一责任人”的意识0.62
  能够通过睡前放松训练、营造良好睡眠环境等方法提高睡眠质量0.47
  自觉抵制吸烟行为0.50
  坚持科学、规律的体育锻炼0.55
  坚持合理作息,保证睡眠时间和质量0.44
因子2
  了解青春期不同阶段的生长发育特点0.10
  认同“体态以健康自然为美”0.78
  树立健康的异性交往观念0.15
  能够识别导致性骚扰和性侵害的危险因素0.13
  遇到性骚扰和性侵害时,采取适当的自我保护措施0.17
因子3
  了解竞争存在利弊两面性0.57
  能够客观认识自身的优势、劣势、兴趣、目标等0.71
  认同焦虑症和抑郁症患者需要接受药物治疗、心理治疗等0.67
  能够分析压力的来源并能正确应对压力0.58
  能够识别自身出现的焦虑、抑郁等不良情绪0.64
  能够有效地疏解焦虑、抑郁情绪,主动寻求帮助0.71
  遭遇校园欺凌和校园暴力时,及时寻求师长的帮助0.71
  正确应对失败和挫折0.77
因子4
  了解艾滋病病毒感染者与艾滋病患者的区别0.03
  树立接纳、平等对待传染病患者的意识0.70
  认同国家在传染病流行时采取的必要措施0.68
  能够识别可能感染性传播疾病的危险行为,提高防范能力-0.03
  主动关注公共卫生信息,提高关于疫情信息的识别能力0.74
  传染病发生时,采取正确措施做好个人防护0.71
因子5
  了解家庭药箱中的常用药品及其使用方法0.10
  了解药物误用、滥用对身体的危害0.13
  了解预防网络成瘾的方法0.11
  树立自觉主动报告突发应急事件的意识0.67
  能够在遇险时准确、有效地传递信息0.76
  能够根据现场情况判断触电的种类,在保证自身安全的情况下,对触电者进行科学、及时的急救处置0.76
  能够正确实施心肺复苏、正确使用自动体外除颤仪0.68
  在医生指导下正确使用抗生素,遵医嘱正确使用镇静催眠药和镇痛药等成瘾性药物0.68
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中国高中生健康素养评价量表的初步编制
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郭世豪 1 , 朱璠 1 , 朱桂因 1 , 祁甜甜 1 , 杨爽 1 , 胡滨 2 , 吴慧云 2 , 姜贺 2 , 马迎华 *, 1
中国学校卫生 | 健康教育与健康促进 2025,46(5): 676-680
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中国学校卫生 |健康教育与健康促进 2025 , 46 (5) : 676 -680
中国高中生健康素养评价量表的初步编制
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郭世豪1, 朱璠1, 朱桂因1, 祁甜甜1, 杨爽1, 胡滨2, 吴慧云2, 姜贺2, 马迎华*, 1
作者信息
  • 1北京大学公共卫生学院儿童青少年卫生研究所,北京 100191
  • 2人民教育出版社体育与健康编辑室
通讯作者:
马迎华,E-mail:
作者简介:

郭世豪(2000-),男,河南周口人,在读硕士,主要研究方向为儿童青少年生长发育及其影响因素

Preliminary development of Health Literacy Evaluation Scale for Chinese High School Students
Shihao GUO1, Fan ZHU1, Guiyin ZHU1, Tiantian QI1, Shuang YANG1, Bin HU2, Huiyun WU2, He JIANG2, Yinghua MA*, 1
Affiliations
  • 1Institute of Child and Adolescent Health, School of Public Health of Peking University, Beijing (100191), China
出版时间: 2025-05-25 doi: 10.16835/j.cnki.1000-9817.2025145
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目的

编制中国高中生健康素养评价量表,为开展高中生健康素养动态监测、健康学校建设效果评价提供工具。

方法

通过理论研究,构建中国高中生健康素养评价指标体系。通过2轮德尔菲专家咨询定量筛选条目,根据专家意见修订条目池,并编制中国高中生健康素养评价量表。通过2次专题小组访谈,收集健康教育专家、高中教师及高中生对量表题量、题型、难度、语言表述等的建议,据此修订量表。于2024年11月在北京市和天津市开展预调查,基于预调查数据评价量表的信度与效度。

结果

2轮德尔菲专家咨询的专家积极性均>80%,专家权威系数均>0.70,专家意见集中程度较高,专家意见分散程度较小,根据专家意见修订后的条目池包含39个条目。根据专题小组访谈收集的意见和建议修订后的量表题量、难度适中。预调查获得800份有效答卷,问卷有效率为89.39%。量表的Cronbach α系数为0.911,χ2值与自由度比值(χ2/df)为3.321,渐近残差均方和平方根为0.054,调整适配度指数为0.991,部分条目的因子负荷小于0.40。

结论

初步编制出兼具科学性与适用性的中国高中生健康素养评价量表,量表内部一致性良好,结构效度尚可。

健康教育  /  问卷调查  /  德尔菲技术  /  学生
Objective

To develop a health literacy evaluation scale for Chinese high school students, providing a tool for dynamic monitoring of health literacy among high school students and evaluating the effectiveness of health school construction.

Methods

Through theoretical research, an evaluation index system for health literacy of Chinese high school students was constructed. Two rounds of Delphi expert consultations were conducted to quantitatively screen the items, and the item pool was revised based on expert opinions to compile the health literacy evaluation scale for Chinese students. Two focus group interviews were held to collect suggestions from health educators, high school teachers, and high school students regarding optimized scale length, question types, difficulty and wording of the scale. The scale was revised accordingly. A pilot survey was conducted in Beijing and Tianjin in November 2024, and the reliability and validity of the scale were evaluated based on the pilot survey data.

Results

The response rate in both rounds of Delphi expert consultations was over 80%, and the expert authority coefficient was over 0.70. The expert opinions were highly concentrated, and the dispersion was small. The revised item pool based on expert opinions contained 39 items. The revised scale based on the suggestions and opinions collected from the focus group interviews had a moderate number of questions and difficulty level. The pilot survey obtained 800 valid responses, with the response rate of 89.39%. The Cronbach α coefficient of the scale was 0.911, χ2/df=3.321, the root mean square error of approximation was 0.054, the adjusted goodness-of-fit index was 0.991, and the factor loadings of some items were less than 0.40.

Conclusion

The health literacy evaluation scale for Chinese high school students demonstrates scientific rigor and practical applicability, with good internal consistency and structural validity.

Health education  /  Questionnaires  /  Delphi technique  /  Students
郭世豪, 朱璠, 朱桂因, 祁甜甜, 杨爽, 胡滨, 吴慧云, 姜贺, 马迎华. 中国高中生健康素养评价量表的初步编制. 中国学校卫生, 2025 , 46 (5) : 676 -680 . DOI: 10.16835/j.cnki.1000-9817.2025145
Shihao GUO, Fan ZHU, Guiyin ZHU, Tiantian QI, Shuang YANG, Bin HU, Huiyun WU, He JIANG, Yinghua MA. Preliminary development of Health Literacy Evaluation Scale for Chinese High School Students[J]. Chinese Journal of School Health, 2025 , 46 (5) : 676 -680 . DOI: 10.16835/j.cnki.1000-9817.2025145
健康素养是个人获取和理解基本健康信息和服务,并运用这些信息和服务做出正确决策,以维护和促进自身健康的能力[1]。健康素养较高的青少年,会践行更多健康促进行为[2-6],规避健康不利行为[7],出现不良健康结局的风险更低[8-10]。我国高度重视青少年健康素养水平的提升与评价,陆续发布多个文件对提升青少年健康素养、完善青少年健康素养评价机制提出要求[11-13]。高中生即将步入成年期,科学评价与提高其健康素养对提升当下和成年期健康水平至关重要。学校健康教育在不同学段有不同内容安排[12],且高中生与成人健康教育内容、途径有所不同[14]。目前国内多数健康素养评价工具并非高中生专用[15-20],已有高中生专用工具的指标体系[21]未依据教育部2021年最新发布的《生命安全与健康教育进中小学课程教材指南》(以下简称《指南》)进行更新[12]。因此,本研究依据《指南》研制高中生专用的健康素养评价工具,为高中学段生命安全与健康教育工作的开展提供抓手,同时为健康学校建设目标任务的实施效果提供评价工具。
定性资料来源于中国知网、万方数据、PubMed等数据库及教育部、国家卫生健康委员会等官方网站。定量资料来源于德尔菲专家咨询,遵循广泛性、代表性、权威性的原则[22],邀请学校卫生、健康教育与健康促进、儿少卫生与妇幼保健学等领域的专家;具有初级及以上职称;具有本科及以上学历。预调查采用方便抽样方法,于2024年11月在北京市和天津市各选取1所普通高中,3个年级以班级为单位整群抽样,每个年级抽取2~4个班级。进行验证性因子分析要求样本量为条目数量的5~10倍以上[22-23],量表有39个题目,以10倍为标准,考虑问卷有效性90%,至少需要434例样本。调查对象纳入标准:高一、高二、高三年级在读学生(实足年龄15~18岁);排除标准:由于智力障碍或身体、精神疾病等原因无法独立完成问卷填写。共收集到895份答卷,根据无效问卷判定标准,2道注意力检查题均未通过的有91人,出生年份在2006年之前或2009年之后的有1人,作答时长不足2 min的有3人,共剔除95份无效答卷,保留800份有效答卷,问卷有效率为89.39%。调查实施前获取高中生本人及其监护人的知情同意;对学校教师进行培训后,请其组织高中生统一到学校机房填写电子问卷。本研究已经获得北京大学生物医学伦理委员会批准(批件号:IRB00001052-24137)。
在中国知网、万方、PubMed等数据库系统检索2014—2024年国内外儿童青少年健康素养相关论著,了解评价工具指标体系结构、内容。在教育部、国家卫生健康委员会等官方网站查阅学校卫生、健康教育与健康促进相关政策文件,梳理出应在高中学段开展的生命安全与健康教育内容,构建中国高中生健康素养评价指标体系,形成《中国高中生健康素养评价条目池1.0》(以下简称《条目池1.0》)。《条目池1.0》框架包括横向维度和纵向维度2个方面,以《指南》中的五大领域为5个横向维度[12];以知信行模型为理论基础,参考《中国公民健康素养——基本知识与技能(2024年版)》[24]的框架设置4个纵向维度。《条目池1.0》内容来源于《指南》,共有99个条目。其中横向维度包括健康行为与生活方式(28个条目)、生长发育与青春期保健(16个条目)、心理健康(15个条目)、传染病预防与突发公共卫生事件应对(18个条目)和安全应急与避险(22个条目),纵向维度包括知识(44个条目)、态度(15个条目)、技能(19个条目)和行为(21个条目)。
邀请专家对《条目池1.0》中每个条目的重要性(1~5级评分)、适用性(适合、不适合或修改后适合)、熟悉程度(1~5级评分)和判断依据(直觉、国内外参考文献、实践经验、理论分析)等[22]作出评价。以“背靠背”函询的方式开展2轮德尔菲专家咨询,相关材料通过电子邮件或微信进行发放与回收。用每一轮专家咨询表的回收率来评价专家积极性,回收率=(回收的咨询表数量/发放的咨询表数量)×100%[22];根据专家对条目的熟悉程度和判断依据计算专家权威系数,来衡量专家权威程度,一般要求专家权威系数70%[22];根据专家对每个条目的重要性评分计算条目重要性得分均值、满分比、变异系数,一般以重要性得分均值>3.50、满分比>20.00%、变异系数<0.25作为条目的保留标准[22],如其中有任何一项不符合保留标准,或至少2位专家认为不适合高中学段,则删除相应条目。经2轮德尔菲专家咨询后,得到《条目池2.0》;在2名具有30年以上中学健康教育经验的一线教师指导下,将《条目池2.0》中的每个条目设计成题目,根据题目内容的相关性重新排列题目,形成《中国高中生健康素养评价量表1.0》(以下简称《量表1.0》)。
邀请4名健康教育专家和4名北京市高中班主任/任课教师参与第1轮专题小组访谈,在北京市邀请20名高中生(男女各半)参与第2轮专题小组访谈,请参与者围绕访谈提纲提出对《量表1.0》的修改建议。访谈提纲:(1)有哪些问题让你感到不舒服或不愿意回答?(2)你觉得哪些问题表达得不够清楚、让你感到困惑、难以理解或难以回答?你认为应该如何修改?(3)你觉得哪些问题难度过大?(4)你觉得量表中还需要补充哪些健康相关内容?(5)你对量表的题型、题量及其他任何方面有其他建议吗?
使用SPSS 27.0计算专家积极性、专家权威系数、条目重要性得分均值、满分比、变异系数、量表内部一致性系数等,一般要求内部一致性系数不低于0.70[22]。使用Rstudio 2024.12.0计算预调查数据KMO值并进行Bartlett球形度检验。使用Rstudio 2024.12.0进行验证性因子分析,通过模型χ2值与自由度比值(χ2/df)、渐近残差均方和平方根(root mean-square error of approximation,RMSEA)、调整适配度指数(adjusted goodness-of-fit index, AGFI)3个指标评价预调查数据与预设模型的拟合效果,3个指标的参考范围分别为χ2/df≤3.00,RMSEA≤0.05,AGFI>0.90,因子负荷位于0.40~0.95为宜[22-23]。检验水准α=0.05。
参与第1轮专家咨询的24位专家中,18位(75.00%)最高学历为硕士或博士,22位(91.67%)为中级及以上职称,22位(91.67%)在相应领域的工作年数达到10年及以上。参与第2轮专家咨询的23位专家中,17位(73.91%)最高学历为硕士或博士,21位(91.30%)为中级及以上职称,21位(91.30%)在相应领域的工作年数达到10年及以上。
第1和2轮咨询专家积极性分别为95.83%,100.00%,均大于80%;权威程度系数分别为0.86和0.88,均大于0.70;2轮咨询中所有条目的重要性得分均值均大于3.50、满分比均大于20.00%,均符合保留标准。除第1轮咨询中,条目2.07,4.09,4.15的变异系数大于0.25需要删除外,第1轮咨询其余条目和第2轮咨询所有条目变异系数均小于0.25,均符合保留标准。第1和2轮咨询专家意见协调系数分别为0.21,0.19(P值均<0.01)。根据专家意见和建议增加、删除、合并部分条目及修改部分条目表述后,得到《条目池2.0》。总计39个条目,其中横向维度包括健康行为与生活方式(12个条目)、生长发育与青春期保健(5个条目)、心理健康(8个条目)、传染病预防与突发公共卫生事件应对(6个条目)和安全应急与避险(8个条目);纵向维度包括知识(13个条目)、态度(8个条目)、技能(9个条目)和行为(9个条目)。
大部分受访者能够在20 min以内填写完《量表1.0》。受访者主要意见及修改说明如下:(1)部分题目内容对高中生来说比较陌生,深度超出高中生应了解的水平,有些专业名词给高中生理解和作答造成阻碍。对此,重新设计这部分题目,修改为与高中生日常学习和生活较为贴近或熟悉的内容;同时适当降低内容深度,使之与高中生的认知水平更加匹配,再对专业名词进行解释或替换为易于理解的表述。(2)部分题目内容过于详细,会增加作答时长,造成受试者在填写过程中出现疲惫和倦怠,从而降低填写质量或导致受试者中途退出作答。对此,精简题目和选项表述,在不影响表意的情况下,尽量简化表述、缩短作答时长,保证填写质量和问卷的回收率。(3)个别选项表述有歧义或争议,会给高中生作答带来干扰。对此,核实与修改相应选项,使选项表意准确、无歧义、无争议,保证高中生能准确理解选项含义并作答。
参考2轮专题小组访谈受访者意见修订后,得到《量表2.0》。共有39个题目,题目类型包括单选题、多选题、Likert 5级评分题。至此,完成《中国高中生健康素养评价量表》的初步编制。
预调查量表整体内部一致性系数为0.911,其中横向维度中健康行为与生活方式、生长发育与青春期保健、心理健康、传染病预防与突发公共卫生事件应对和安全应急与避险的内部一致性系数分别为0.637,0.433,0.874,0.646,0.729;纵向维度中知识、态度、技能和行为的内部一致性系数分别为0.567,0.912,0.785,0.830。
预调查数据的KMO=0.933,Bartlett球形度检验P<0.01,说明预调查数据满足因子分析的条件,可以进行验证性因子分析。以5个横向维度为5个因子构建预设模型,验证性因子分析结果:χ2/df=3.321,RMSEA=0.054,AGFI=0.991。
由表1可见,健康行为与生活方式、生长发育与青春期保健、心理健康、传染病预防与突发公共卫生事件应对和安全应急与避险各题目的因子负荷范围分别为0.02~0.62,0.10~0.78, 0.57~0.71,-0.03~0.74,0.10~0.76。
与国内现有高中生健康素养评价工具相比,本研究所制的工具有3点优势:(1)依据教育部最新健康教育文件《指南》构建指标体系,评价结果更能反映当下高中生健康素养真实水平与学校生命安全与健康教育效果;而国内现有高中生健康素养评价工具,其指标体系未根据《指南》进行更新[15-21]。(2)以高中学段健康教育内容为依据研制高中生专用的健康素养评价工具,评价结果更接近真实水平、能反映高中学校健康教育效果;而国内现有高中生健康素养评价工具少有专为高中生研制的[15-20]。(3)研究从健康知识、态度、技能、行为4个角度评价健康素养,对健康素养内涵的理解与我国从公共卫生视角对健康素养的阐述更为一致[11]。
本研究从理论、专家、受试者3个角度,通过理论研究、德尔菲专家咨询、专题小组访谈3个环节保证量表的适用性与科学性。在理论研究阶段,以《指南》为主要依据初步构建指标体系,保证其科学性与适用性。在德尔菲专家咨询阶段,专家来自多个相关学科领域,其权威系数和参与积极性较高,严格按照指标计算结果和专家意见筛选与修订条目,保证条目池修订过程科学严谨。在专题小组访谈环节,邀请健康教育专家、高中教师、高中生对量表提出意见,受访者意见集中在题目难度、题目与选项设计等方面,考虑每位受访者的建议修改量表,保证量表适用于高中生。
量表的内部一致性良好,结构效度尚可。验证性因子分析结果显示:χ2/df、RMSEA略超出参考范围,AGFI在参考范围内。χ2/df、RMSEA与χ2值和自由度有关,在自由度不变的情况下,χ2/df、RMSEA随着χ2值的增大而增大[22]。而χ2值容易受样本量影响,当样本量较小时,χ2值容易偏大[22]。在预调查环节,指标数量恒定,即自由度是固定的。尽管预调查样本量超出预期计算结果,但由于本研究中指标数量较多,仍有可能出现由于样本量相对偏小导致χ2值增大,进一步导致χ2/df、RMSEA略超出参考范围的情况。部分题目的因子负荷小于0.40,可能是因为这部分题目类型为单选题、多选题,计分方式为1或0计分,相比于Likert 5级评分题来说,1或0计分题目无法区分被试在态度或能力上的细微差异,导致数据变异度显著降低、方差变小,从而削弱了题目与因子之间的相关性[22-23]。另外,因子负荷为区分度与因子标准差的乘积[22-23],个别1或0计分题目区分度较低,导致因子负荷偏小。
本研究也存在一定的局限性:首先,研究的专题小组访谈仅选取了北京市1所普通高中高二、高三年级的20名高中生,预调查仅在北京市、天津市开展,存在选择偏倚,对量表的意见和建议缺乏全国代表性;研究同时邀请了2名具有30年以上中学健康教育经验的一线教师指导量表的编制,一定程度上弥补了研究对象代表性的不足。其次,量表中部分题目的因子负荷有待提升,未来需要适当增加条目数量、优化题目设计、调整题目区分度与难度,以提高题目因子负荷与量表结构效度。
  • 中国教育学会教育科研重点规划课题项目(202416305735A)
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2025年第46卷第5期
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doi: 10.16835/j.cnki.1000-9817.2025145
  • 接收时间:2024-12-02
  • 首发时间:2026-11-06
  • 出版时间:2025-05-25
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  • 收稿日期:2024-12-02
  • 修回日期:2025-04-08
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中国教育学会教育科研重点规划课题项目(202416305735A)
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    1北京大学公共卫生学院儿童青少年卫生研究所,北京 100191
    2人民教育出版社体育与健康编辑室

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