Development and validation of a schizophrenia literacy scale for individuals diagnosed with schizophrenia

Schizophrenia literacy is key to early identification of schizophrenia and diminishment of stigma. This facilitates help-seeking and adherence to mental health treatment for individuals suffering from schizophrenia. However, validated measures assessing schizophrenia literacy among individuals diagnosed with schizophrenia remain limited. This study aimed to develop and examine the psychometric properties of a schizophrenia literacy scale for individuals diagnosed with schizophrenia. The scale development involved three stages: (a) generating an initial 43 items from a review of literature and existing measures assessing literacy about schizophrenia and knowledge of schizophrenia as well as cognitive interviews; (b) assessing content and face validities; and (c) psychometric testing using a cross-sectional design (268 individuals diagnosed with schizophrenia) to examine construct validity and reliability. Twenty-nine items were retained after evaluating content validity, face validity, and item analysis. Exploratory factor analysis yielded 22 items including five factors (awareness of mental health promotion; stigma against schizophrenia; causal beliefs; recognition of psychiatric symptoms; and traditional and religion-based healthcare) explaining 58.85 % of the total variance. Confirmatory factor analysis showed an acceptable fit of the factor structure. Cronbach's α was 0.95 for the total scale with test-retest reliability of 0.91. The newly developed 22-item schizophrenia literacy scale is a valid and reliable five-dimensional measure and could be used to assess schizophrenia literacy for individuals diagnosed with schizophrenia. The scale may help mental healthcare providers design interventions directed at improving literacy about schizophrenia and promoting mental health for individuals diagnosed with schizophrenia in Chinese-speaking regions and adapted for use in Asian countries.