Abstract:

Objective To evaluate the methodological quality and measurement characteristics of health literacy assessment tools for diabetic patients and to provide references for medical staff to select the best assessment tools. Methods The PubMed，Embase，CINAHL，Web of Science，CNKI，VIP database，Wanfang Data，and Chinese Biomedical Database were searched from inception to December 31，2022. Data were screened and extracted independently by 2 researchers. The consensus-based standards for the selection of health measurement instruments （COSMIN） system evaluation guidelines were spontaneously used to evaluate the included assessment tools. Finally，recommendations were made. Results A total of 15 studies were included，involving 12 health literacy assessment tools for diabetic patients. Among them，KHLS-DM and DNT-15 have satisfactory content validity and internal consistency and are recommended as Grade A. HLSQ-3 has high-quality evidence to suggest that its internal consistency is "inadequate" and recommended as Grade C，while the other 9 scales are recommended as Grade B for content validity or internal consistency of uncertain/inadequate evidence at or above the intermediate level. Conclusion KHLS-DM can evaluate written literacy，numeracy，and critical literacy of patients，and each measurement characteristic has been comprehensively evaluated with high reliability and validity，so it is recommended to be applied first. DNT-15 focuses on evaluating the numeracy of patients，which can be used in combination with other scales to evaluate health literacy of patients more comprehensively.

Key words: Diabetes Mellitus, Health Literacy, Assessment Instruments, Measurement Characteristic, COSMIN Guideline, Systematic Review

摘要： 目的 系统评价糖尿病患者健康素养评估工具的方法学质量和测量属性质量，为医护人员选择最佳评估工具提供依据。方法 系统检索PubMed、Embase、CINAHL、Web of Science、中国知网、维普数据库、万方数据库及中国生物医学文献数据库中有关糖尿病患者健康素养评估工具的研究，检索时限为建库至2022年12月31日。由2名研究者独立进行文献筛选和资料提取，采用基于共识的健康测量工具遴选标准（consensus-based standards for the selection of health measurement instruments，COSMIN）系统评价指南对纳入的评估工具进行评价，形成最终推荐意见。结果 共纳入15项研究，包含12种糖尿病患者健康素养评估工具。其中，韩国糖尿病健康素养量表（Korean Health Literacy Scale for Diabetes Mellitus，KHLS-DM）和15条目糖尿病计算测试量表（Diabetes Numeracy Test-15，DNT-15）具有满意的内容效度和内部一致性，为A级推荐；3条目健康素养筛查问卷（Health Literacy Screening Questions-3，HLSQ-3）具有高质量证据证明其内部一致性“不充分”，为C级推荐；其余9种量表因有中级及以上的证据证明其内容效度或内部一致性为不确定或不充分，推荐等级均为B级。结论 KHLS-DM可综合评估患者书面素养、计算能力和评判性素养，各测量学特性得到较为全面的评价，且信效度较好，优先推荐应用；DNT-15仅侧重评估患者的计算能力，可与其他量表互补结合使用。

关键词: 糖尿病, 健康素养, 评估工具, 测量属性, COSMIN指南, 系统评价