Development and validation of a patient evaluation index system for health literate healthcare organisations in China: a modified Delphi study

Objective This study aimed to construct a patient evaluation index system for health literate healthcare organisations (HLHOs) within the Chinese context. Based on this, a patient self-assessment instrument—the Patient Evaluation of Health Literate Healthcare organisations (PEHLHO) scale—was developed to systematically assess and improve patients’ health literacy. Design This study employed a modified Delphi method to construct a patient evaluation index system for HLHOs and used the precedence chart method to determine the weights of the indicators. Based on this system, the PEHLHO scale was developed. Its validity and reliability were tested using exploratory factor analysis and confirmatory factor analysis. Setting Delphi experts were selected from secondary and tertiary hospitals and public health administrative institutions in Jiangsu Province, China. The empirical survey was administered in representative cities across China, including Shanghai, Chengdu, Guangzhou, Beijing and Wuhan. Participants A total of 53 experts were invited to participate in the Delphi process, with 35, 23 and 30 valid responses obtained in rounds 1, 2 and 3, respectively. In the empirical study, a total of 6411 questionnaires were collected, of which 5206 were valid, yielding a valid response rate of 81.20%. Results An evaluation index system for HLHOs was successfully established, which included 7 primary indicators and 19 secondary indicators. The weight analysis results revealed that organisational management (26.53%), doctor–patient communication (20.41%) and care delivery processes (20.41%) were the most influential domains. The PEHLHO scale showed good psychometric performance, with a Kaiser-Meyer-Olkin of 0.918. The average variance extracted for the three dimensions was 0.651, 0.703 and 0.744, and the composite reliability was 0.903, 0.876 and 0.897, respectively. The Cronbach’s α was 0.928, indicating excellent internal consistency and reliability. Conclusions This study has constructed an evaluation index system for HLHOs within the Chinese context, including indicators such as organisational management, doctor–patient communication and care delivery processes. The index system and the PEHLHO scale fill a significant research gap in China, providing measurement tools and guidance for HLHOs to improve patient health literacy and service quality.