Qom University of Medical Sciences Journal

Introduction
According to the centers for disease control (CDC), racial and ethnic minorities, low socioeconomic status, and poor access to medical services are more prone to a variety of health problems. Currently, there is neither reliable information about the level of health literacy regarding the coronavirus nor a reliable tool for measuring the level of health literacy of coronavirus in Persian language in the population of Iran. Considering the importance of knowing the society's health literacy level, we conducted appropriate interventions to design a psychometric of the health literacy measurement in Iran.
Methods
The present study is of a descriptive-correlation type. The research population includes all adults living in Sistan and Baluchestan Province, Iran, in 2021. The inclusion criteria included being between 18 and 65 years old, wanting to participate in the research, being able to complete the electronic questionnaire, and being literate. The exclusion criterion included not completing the questionnaire. Sampling was done by sequential non-probability method. In this study, the ratio of variables to the subject was considered equal to one to thirteen, and according to the number of items in the initial questionnaire (30 items), the sample size was 390, and finally, 400 people were selected. The Kaiser-Meyer-Oikin (KMO) test was also performed to ensure the study sample size's adequacy.
This study used methodological research to design and validate the questionnaire. This method considered steps such as tool formulation, validity determination, and tool evaluation. The design of the tool was done using the method of Waltz 2010, using the following four steps: 1) Choosing a conceptual model to determine the dimensions of the subject under study, 2) Determining the goals of the tool, 3) Developing a blueprint plan, and 4) Engineering the measurement tool (construction of the measure) which includes the use of procedures, item sets, and scoring rules.
In the first stage, health literacy and its dimensions were identified through a targeted study and review of articles related to coronavirus and health literacy.
In the second stage, the items related to the questionnaire were designed using the existing documents, articles, and questionnaires. The initial version of the questionnaire included 30 items.
In the third step, after preparing the questionnaire items, three methods of face validity, content validity, and construct validity were used to check and determine their validity. At first, 15 people (5 people from the north of the province, 5 people from the center, and 5 people from the south of the province) from adults of Sistan and Baluchestan Province were asked to determine the qualitative face validity to examine the items of the questionnaire in terms of simplicity, grammar, and clarity, and express their opinion.
In the fourth step, the reliability of the questions was determined, and the questions were verified. The Cronbach α value was calculated to determine the internal correlation of the questionnaire. Also, to determine the external reliability of the questionnaire, the test-retest method was used, and the questionnaire was completed by 30 people who qualified for the research in two stages, one week apart.
Results
According to the findings, the initial version of the coronavirus health literacy questionnaire with 30 items was obtained. In the formal validity process, the results obtained by calculating the item impact index showed that except for 5 questions that did not get the minimum score, the rest were more than one and a half. Hence, the number of 25 items was suitable for checking the content validity.
The results of content validity were calculated by calculating the content validity index (CVI) and content validity ratio (CVR), respectively, as 0.95 and 0.85. At this stage, except for 3 items, the other items had the minimum score required for construct validity, so the remaining 22 items were used for construct validity through exploratory factor analysis.
Based on the results of factor analysis with varimax rotation, 22 questions of the questionnaire have the required factor load. Finally, the final questionnaire with 22 questions was extracted in the form of 4 factors: The first factor with 6 items under the title of access dimension, the second factor with 6 items under the title of understanding dimension, the third factor with 5 items under the title of evaluating dimension, and the fourth factor with 5 items under the title of using information and health services dimension were named.
After performing factor analysis, the internal consistency of the entire 22-item questionnaire was examined. All items remained during the reliability process of the questionnaire. The final version of the questionnaire with 22 items and a Cronbach α coefficient of 0.81 was prepared in a sample of 400 adults of Sistan and Baluchestan Province for the entire questionnaire and separately for each factor of the questionnaire with a minimum of 0.79 and a maximum of 0.84.
Also, the external reliability of the questionnaire using the test-retest method on 30 eligible adults who completed the research in two stages with an interval of one week showed that it has a favorable correlation coefficient (R=0.92).
Conclusion
The results of this study showed that the designed tool has good validity in terms of content and structure and also has acceptable reliability in terms of internal correlation. The current research is due to the design of a special questionnaire to measure the health literacy of the coronavirus in the four areas of access, understanding, evaluation, use of information, and health services, scored on a 4-point Likert scale from 1 to 4 and a small number of items (22 items) is considered an innovation in Iranian adult population.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Zahedan University of Medical Sciences (Code: IR.ZAUMS.REC.1400.007).
Funding
This research was financially supported by Zahedan University of Medical Sciences.
Authors contributions
Conceptualization and supervision: Hossein Izadirad; Editing the original  article : Mohammad Saeed Jadgal; Editing the original draft: Jamshid Hosseinzehi Zamani.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
Authors would like to express their gratitude to Zahedan University of Medical Sciences, Zabol University of Medical Sciences and Iranshahr University of Medical Sciences and to all those who helped us conduct this study.