Development and validation of Parents' Health Literacy Scale on Preventing Road Traffic Injuries for children aged 0-6 years in China.

Background: Road traffic injuries are the leading cause of death in children. Parents' health literacy (HL) is closely related to child safety, especially for the young children. This study aimed to develop an intervention-oriented parent HL scale: Parents' Health Literacy Scale on Preventing Road Traffic Injuries (PHLS-PRTIs).

Methods: We developed the scale including four parts: (1) definition and conceptualisation of PHLS-PRTIs; (2) domain and item development; (3) instrument construction; and (4) psychometric property validation. 685 parents participated in process of development (n=333) and validation (n=352). Cronbach's α and test-retest correlation were used to assess reliability. Content validity and construct validity were used to assess validity.

Results: The scale consisted of five domains (access, understand, belief, communication and use) and 16 subdomains. The Cronbach's α for each domain and the whole scale was 0.85, 0.70, 0.87, 0.80, 0.79 and 0.85, respectively. The test-retest reliability was acceptable (intraclass correlations >0.70). Content validity was good (item-level content validity index >0.79, average of the scale-level content validity index >0.80, kappa >0.74). For construct validity for domain understand, χ²/df=1.723, p=0.009, standardised root mean square residual (SRMR)=0.0404, root mean square error of approximation (RMSEA)=0.045, Comparative Fit Index (CFI)=0.942, Tucker-Lewis Index (TLI)=0.910; and for the other four domains, χ²/df=1.840, p<0.001, SRMR=0.043, RMSEA=0.049, CFI=0.958, TLI=0.952.

Conclusions: PHLS-PRTIs was developed and validated by a rigorous process, providing a tool for community doctors to measure parents' HL on child road traffic safety and develop targeted health education interventions.