Assessing knowledge and attitudes about mental illness in Ningxia, China

To assess the effectiveness of China's recent moves to increase community mental health literacy and decrease stigma, we developed the Mental Health Knowledge Questionnaire (MHKQ) and the Mental Health Attitude Questionnaire (MHAQ). Preliminary versions were assessed in pilot studies and revised versions were included in an interviewer-administered community survey of a representative sample of 2425 adult residents of Ningxia Province and a re-test survey in 188 individuals. Internal consistency, factor structure and test-retest reliability were assessed for three measures: (a) the 25-item MHKQ (alpha = .71, 6 factors accounting for 51% of variance identified in exploratory factor analysis of one-half of the sample, and intraclass correlation coefficient [ICC] for total score of .40); (b) the 14-item attitudinal subscale of MHAQ (alpha = .69, 3 factors accounting for 42% of variance, ICC = .47); and (c) the 7-item causal attribution subscale of MHAQ (alpha = .60, 3 factors accounting for 60% of variance, ICC = .26). Confirmatory factor analysis assessed fitness of modified models of the measures using chi-squared, comparative fit index (CFI), Tucker-Lewis index (TLI), and root mean square error of approximation (RMSEA): (a) for the MHKQ, RMSEA = .037 (90% CFI = .033, .040), CFI = .86, TLI = .84, χ² = 682.86 (df = 260); (b) for the attitudinal subscale of MHAQ, RMSEA = .045 (CI = .039, .052), CFI = .94, TLI = .92, χ² = 226.67 ( df = 66); and (c) for the causal attribution subscale of MHAQ, RMSEA = .054 (.039, .069), CFI = .97, TLI = .94, χ² = 49.13 ( df = 11). We conclude that the internal consistency and factor structure of the new measures are satisfactory, but further work is needed to improve the scales' stability and to assess the construct validity and responsiveness of the scales.