Improving measurement in nutrition literacy research using Rasch modelling: examining construct validity of stage-specific ‘critical nutrition literacy’ scales

Objective Critical nutrition literacy (CNL), as an increasingly important area in public health nutrition, can be defined as the ability to critically analyse nutrition information, increase awareness and participate in action to address barriers to healthy eating behaviours. Far too little attention has been paid to establishing valid instruments for measuring CNL. The aim of the present study was to assess the appropriateness of utilizing the latent scales of a newly developed instrument assessing nursing students’ ‘engagement in dietary habits’ (the ‘engagement’ scale) and their level of ‘taking a critical stance towards nutrition claims and their sources’ (the ‘claims’ scale). Design Data were gathered by distributing a nineteen-item paper-and-pencil self-report questionnaire to university colleges offering nursing education. The study had a cross-sectional design using Rasch analysis. Data management and analysis were performed using the software packages RUMM2030 and SPSS version 20. Setting School personnel handed out the questionnaires. Subjects Four hundred and seventy-three students at ten university colleges across Norway responded (52 % response rate). Results Disordered thresholds were rescored, an under-discriminating item was discarded and one item showing uniform differential item functioning was split. The assumption of item locations being differentiated by stages was strengthened. The analyses demonstrated possible dimension violations of local independence in the ‘claims’ scale data and the ‘engagement’ scale could have been better targeted. Conclusions The study demonstrates the usefulness of Rasch analysis in assessing the psychometric properties of scales developed to measure CNL. Qualitative research designs could further improve our understanding of CNL scales

Developing the HLS19-YP12 for measuring health literacy in young people: a latent trait analysis using Rasch modelling and confirmatory factor analysis

Background Accurate and precise measures of health literacy (HL) is supportive for health policy making, tailoring health service design, and ensuring equitable access to health services. According to research, valid and reliable unidimensional HL measurement instruments explicitly targeted at young people (YP) are scarce. Thus, this study aims at assessing the psychometric properties of existing unidimensional instruments and developing an HL instrument suitable for YP aged 16–25 years. Methods Applying the HLS19-Q47 in computer-assisted telephone interviews, we collected data in a representative sample comprising 890 YP aged 16–25 years in Norway. Applying the partial credit parameterization of the unidimensional Rasch model for polytomous data (PCM) and confirmatory factor analysis (CFA) with categorical variables, we evaluated the psychometric properties of the short versions of the HLS19-Q47; HLS19-Q12, HLS19-SF12, and HLS19-Q12-NO. A new 12-item short version for measuring HL in YP, HLS19-YP12, is suggested. Results The HLS19-Q12 did not display sufficient fit to the PCM, and the HLS19-SF12 was not sufficiently unidimensional. Relative to the PCM, some items in the HLS19-Q12, the HLS19-SF12, and the HLS19-Q12-NO discriminated poorly between participants at high and at low locations on the underlying latent trait. We observed disordered response categories for some items in the HLS19-Q12 and the HLS19-SF12. A few items in the HLS19-Q12, the HLS19-SF12, and the HLS19-Q12-NO displayed either uniform or non-uniform differential item functioning. Applying one-factorial CFA, none of the aforementioned short versions achieved exact fit in terms of non-significant model chi-square statistic, or approximate fit in terms of SRMR ≤ .080 and all entries ≤ .10 that were observed in the respective residual matrix. The newly suggested parsimonious 12-item scale, HLS19-YP12, displayed sufficiently fit to the PCM and achieved approximate fit using one-factorial CFA. Conclusions Compared to other parsimonious 12-item short versions of HLS19-Q47, the HLS19-YP12 has superior psychometric properties and unconditionally proved its unidimensionality. The HLS19-YP12 offers an efficient and much-needed screening tool for use among YP, which is likely a useful application in processes towards the development and evaluation of health policy and public health work, as well as for use in clinical settings.publishedVersio

Health Literacy in Five Immigrant Populations in Norway: Pakistan, Poland, Somalia, Turkey, and Vietnam. English summary. In Helsekompetansen i fem innvandrerpopulasjoner i Norge: Pakistan, Polen, Somalia, Tyrkia og Vietnam. Befolkningens helsekompetanse, del II

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Nursing students’ experiences with concept cartoons as an active learning strategy for developing conceptual understanding in anatomy and physiology: A mixed-method study

Aim: The aim of this study was to explore bachelor-level nursing students’ experiences with concept cartoons as an active learning strategy and formative assessment to develop conceptual understanding in anatomy and physiology (A&P). Background: Many first-year nursing students struggle to understand central concepts in A&P. Concept cartoons–cartoon characters proposing scientifically acceptable statements and misconceptions combined with an illustration–might facilitate active learning in lectures, overcome misconceptions and promote deep learning. Voting on the most precise statement using a student response system gives formative information about the students’ conceptual understanding. Design: Parallel mixed methods design with an emphasis on a qualitative approach. Methods: Nine concept cartoons were developed based on former students’ written answers to exam items and applied in lectures at three universities/university colleges. Qualitative data of students’ experiences were collected in three focus group interviews during November 2019, one focus group at each of the three universities/university colleges (n = 5, 8 and 8). A short questionnaire was also applied (n = 343) to all students at the three universities/university colleges. Qualitative data were analysed using qualitative content analyses, whereas frequency analysis and Chi-square statistics were applied for the quantitative data. The study was approved by the Norwegian Centre for Research Data, ref. 779586. Results: Qualitative data analysis indicated that the use of concept cartoons addresses different learning styles and could promote deep learning and enhance the environment for learning. The concept cartoons were also seen as valuable for examination preparation. Regarding potential improvements, more information about concept cartoons, how they were developed and how they were supposed to be used would be beneficial, and the cartoons could be used in a more time-efficient manner during lectures. Quantitative data indicated that most of the students thought that concept cartoons were useful and inspiring in learning A&P, and they would recommend further use to increase their understanding of central concepts. There were no significant differences across sex, age, or entrance qualifications when it comes to the benefits of using concept cartoons in learning A&P.publishedVersio

Health Literacy in the Norwegian Population. English Summary. In Befolkningens helsekompetanse, del I. The International Health Literacy Population Survey 2019 – 2021 (HLS19) – et samarbeidsprosjekt med nettverket M-POHL tilknyttet WHO-EHII

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HLS19-NAV-Validation of a New Instrument Measuring Navigational Health Literacy in Eight European Countries

To manoeuvre a complex and fragmented health care system, people need sufficient navigational health literacy (NAV-HL). The objective of this study was to validate the HLS19-NAV measurement scale applied in the European Health Literacy Population Survey 2019-2021 (HLS19). From December 2019 to January 2021, data on NAV-HL was collected in eight European countries. The HLS19-NAV was translated into seven languages and successfully applied in and validated for eight countries, where language and survey method differed. The psychometric properties of the scale were assessed using confirmatory factor analysis (CFA) and Rasch modelling. The tested CFA models sufficiently well described the observed correlation structures. In most countries, the NAV-HL data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). For some countries, some items showed poor data-model fit when tested against the PCM, and some items displayed differential item functioning for selected person factors. The HLS19-NAV demonstrated high internal consistency. To ensure content validity, the HLS19-NAV was developed based on a conceptual framework. As an estimate of discriminant validity, the Pearson correlations between the NAV-HL and general health literacy (GEN-HL) scales were computed. Concurrent predictive validity was estimated by testing whether the HLS19-NAV, like general HL measures, follows a social gradient and whether it forms a predictor of general health status as a health-related outcome of general HL. In some countries, adjustments at the item level may be beneficial. Keywords: HLS19 survey; Rasch modelling; confirmatory factor analysis; health care system; health information; health literacy; instrument; navigation; questionnaire; validation.publishedVersio

Using ‘concept cartoons’ in combination with a digital student-response system to support learning in Anatomy, Physiology, and Biochemistry in nursing education: A teaching strategy to promote student-active learning

Bakgrunn: Gode kunnskaper i anatomi, fysiologi og biokjemi (AFB) er nødvendig for at sykepleierstudenter skal kunne utvikle et klinisk blikk. Resultater fra nasjonal eksamen i AFB viser at mange sykepleierstudenter strever med dette emnet. Studentaktive læringsformer i undervisningen kan bidra til økt kognitivt engasjement hos studentene. Bruk av concept cartoons (CC) sammen med digitalt student-respons-system (SRS) kan anvendes som undervisningsstrategi for å fremme studentaktivitet i store studentgrupper. CC består av illustrasjoner som presenterer både vitenskapelig aksepterte påstander og feilforestillinger om sentrale begreper og prosesser i AFB. Hensikt: Hensikten med denne studien var å beskrive hvordan CC i kombinasjon med digital SRS kan benyttes som en studentaktiv læringsform i ulike undervisningsformer for å støtte sykepleierstudenters læring i AFB. Metode: Studien har et kvasieksperimentelt deskriptivt kvantitativt design. CC ble anvendt sammen med SRS i digital undervisning ved sykepleierutdanningen ved tre universiteter/høgskoler høsten 2020 (n = 92–671). Anvendelsen av CC fulgte tenk–par–del-modellen, og studentene stemte på samme CC tre ganger i samme undervisningsøkt. Data ble analysert ved bruk av frekvensanalyser, Cochrans Q og Chi-square test. Resultat: Det var en økning i prosentandelen studenter som valgte det beste svaralternativet mellom de tre avstemningene. For de fleste CC var det en særlig økning i prosentandelen beste svar ved andre avstemning, etter at svaralternativene hadde blitt diskutert med medstudenter. Konklusjon: CC kan støtte læringen av sentrale begreper og fysiologiske prosesser. Undervisningsstrategien med CC i kombinasjon med digital SRS kan egne seg til å fremme studentaktiv læring, særlig i forelesning.Background:Sufficient knowledge in anatomy, physiology, and biochemistry (AFB) is necessary for nursing stu-dents to develop a clinical gaze. Results from the national examination show that many students struggle with thissubject. Student-active learning can contribute to increased cognitive engagement among students. In this context,the use of concept cartoons (CC) together with a digital student-response system (SRS) can be appropriate. CC con-sists of illustrations presenting both scientifically accepted claims and misconceptions about concepts and pro-cesses in AFB.Aim:The study aimed to describe how CC, in combination with digital SRS, can be used as a student-active learn-ing strategy in various forms of teaching, to support nursing students’learning in AFB.Methods:The study has a quasi-experimental descriptive quantitative design. CC was used together with SRS indigital lectures in nursing education at three universities/colleges in autumn 2020, n=92–671. The application follo-wed the Think-Pair-Share model, and the students voted on the same CC three times during the lesson. Frequencyanalyses, Cochran’s Q and Chi-square test were applied for data analyses.Results:There was an increase in the proportion of students who chose the best response option between the threepolls. For most CCs, there was a particular increase in the proportion of best responses at the second poll, after theresponse options had been discussed with fellow students.Conclusion:CC might support the learning of concepts and physiological processes. The teaching strategy withCC in combination with digital SRS can be suitable for promoting student-active learning, especially in lecturespublishedVersio

Study design

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