REVISION OF THE QUESTIONNAIRE ON TRADITIONAL CHINESE MEDICINE HEALTH CULTURAL LITERACY FOR CHINESE CITIZENS BASED ON THE KNOWLEDGE-ATTITUDE-PRACTICE THEORY

Zhiheng Zhou*, Xianhui Chen, Shengqing Zhou, Weiliang Zhu, Zeling Zhu, Siqin Li

ABSTRACT

Background and Objective: Since 2016, the National Administration of Traditional Chinese Medicine of China has conducted annual surveillance using the Questionnaire on Traditional Chinese Medicine Health Cultural Literacy for Chinese Citizens. However, the original questionnaire has limitations, including excessively high item difficulty and excessive cognitive load, necessitating revision. This study aimed to revise the Chinese Citizens’ Traditional Chinese Medicine Health Cultural Literacy Survey Questionnaire through a series of methodological approaches. Methods: This study employed the Knowledge-Attitude-Practice (KAP) theory as the core framework and utilized literature analysis, two rounds of Delphi expert consultation, the Analytic Hierarchy Process (AHP), and field cognitive interviews to revise the original questionnaire. A pilot survey was conducted among 200 community residents aged 18 years and older, and the reliability, validity, and difficulty characteristics of the questionnaire were evaluated. Results: The revised questionnaire comprised 35 items covering six dimensions: dissemination status (8 items), conceptual cognition (4 items), lifestyle (4 items), appropriate techniques (4 items), cultural knowledge (4 items), and information comprehension (4 items), with a total score of 35 points. The criterion for possessing basic TCM health cultural literacy was set at a 60% correct response rate. The positive coefficients for the two rounds of Delphi expert consultation were 95.2% and 100.0%, respectively; the authority coefficient was 0.93，and the Kendall’s coordination coefficients were 0.168 and 0.248 (P < 0.05), respectively. Pilot survey results showed that the overall Cronbach’s alpha coefficient of the questionnaire was 0.912, and the Cronbach’s alpha coefficients for each dimension ranged from 0.784 to 0.901. Item Response Theory (IRT) analysis revealed that the discrimination parameters of all items ranged from 1.58 to 3.30, and the difficulty parameters demonstrated a reasonable gradient distribution. Compared with the original questionnaire, the average completion time of the revised version was reduced from 18.6 minutes to 8.4 minutes. Conclusion: The TCM health cultural literacy survey questionnaire revised based on the KAP theory demonstrates good reliability, validity, and feasibility, with moderate item difficulty and effective discrimination among populations with different literacy levels. It can serve as a standardized assessment tool for large-scale population surveillance and targeted health education interventions.

Keywords: Traditional Chinese medicine health cultural literacy, Knowledge-Attitude-Practice theory, Questionnaire, Delphi method.