Development of a Computerized Adaptive Testing of the Health Literacy in Stroke Rehabilitation

Background: Health literacy is defined as the people's abilities to access, understand, appraise, and apply the health-related information in order to make proper health decisions and health actions. Many western counties has been proposed promoting people’s health literacy is the primary goal of the healthcare policy in the future, because it can facilitate people’s self-management and health behavior, promote the effective utilization of medical service, decrease the medical costs, and improve the quality and effects of the medical care. Previous research has reported that the general health literacy is averaged low among the people in Taiwan, which severely influences the effects of medical services seeking, patient-doctor relationship, rehabilitation, and prevent recurrences. The main principle of the stroke rehabilitation is promoting healthy and independent lives. Therefore, how to evaluate the rehabilitation-related health literacy precisely and comprehensively will be the most important issue for clinicians’ confirming and promoting the stroke rehabilitation health literacy in stroke patients and their families. However, nowadays, there are lacking of the evaluation tools tailored-made for the stroke patients to assess the “stroke rehabilitation health literacy”, in order to access, understand, appraise, and apply the health-related information about the stroke rehabilitation. In addition, the clinical health professionals are quite busy during the daily practices, our research will combine the testing theory and techniques of the Rasch analysis of item response theory and the computerized adaptive testing (CAT) to develop “A computerized Adaptive Testing of the LEALth Literacy in strokE Rehabilitation (CAT-HEALER)" system, in order to evaluate the stroke rehabilitation health literacy among the stroke patients and their families precisely, comprehensively, and efficiently. Methods: This 3-year project will be divided into 6 phases which including: (1): to construct the item bank of the CAT-HEALER in the basis of the Consortium Health Literacy Project European (HLS-EU); (2): the item testing; (3): the item analysis; (4): the simulation; (5): to develop a personal version of the CAT-HEALER; (6): the filed testing and examine the psychometric properties of the CAT-HEALER. Psychometric properties of Rasch hypothesis testing, unidimentionality, concurrent validity, predictive validity, responsiveness, and minimal important difference will be validated. We will also compare the CAT-HEALER and traditional measurement tools of health literacy, and to identify the psychometric properties and testing efficiency of the CAT-HEALER if better than the traditional evaluation tools. Anticipated Results: The proposal will develop the first international CAT system of stroke rehabilitation health literacy which in charge of the three merits as follows: (1): evaluation contents including comprehensive variety dimensions of the stroke rehabilitation health literacy for the stroke patients and their families; (2): the precise, fast, and practical measurement tool; (3): sound psychometric properties with easily compared with the interval scale, providing clinical and research people the better rehabilitation decision-making and therapeutic effects. Therefore, we anticipate that to develop and apply the CAT-HEALER will help us to further understand the different levels of stroke rehabilitation health literacy and establish the patient-centered rehabilitation programs for promoting the effects of stroke rehabilitation among patients with stroke.