Development and validation of the Chinese Rural Middle-aged and Elderly Health Literacy Scale.

Introduction: A notable deficiency lies in the absence of tailored instruments for comprehensively evaluating the health literacy of middle-aged and elderly residents in rural areas of China. Given the context of China's ageing demographic and the increasing urban-rural disparities, it becomes imperative to formulate a dedicated assessment tool for appraising the health literacy of rural middle-aged and elderly populations. Methods: A systematic and rigorously structured development approach was used. First, the concept of health literacy was used to create a pool of items. Second, the Delphi method was used to revise and finalise the initial version of the Chinese Rural Middle-aged and Elderly Health Literacy Scale (CREHLS). Third, pretesting was used to assess the rationality of the item settings within the CREHLS. Finally, a large-sample survey was used to assess the reliability and validity of the finalisation CREHLS. Results: The CREHLS, which comprises 26 items distributed across four dimensions, is designed to evaluate the capacity to access, comprehend, assess and apply pertinent health information related to disease treatment, disease prevention, health promotion and environmental health. Multiple test results affirm the robust reliability and validity of the CREHLS, adhering to the established development standards. Conclusions: This study expects that the CREHLS will be validated in different rural regions of China and will be a reference for assessing the health literacy of rural middle-aged and elderly people in other countries, thereby increasing our attention to the health literacy of rural people.