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Validation of the Simplified Chinese Clear Communication Index Using Diabetes Education Materials: Instrument
1Department of Nursing, School of Public Health and Nursing, Hangzhou Normal University, No. 2318, Yuhangtang Road, Hangzhou, 311121, China, 8615785423928.
Journal of Medical Internet Research
|February 20, 2026
Summary
A new Clear Communication Index (C-CCI) in simplified Chinese shows good validity and reliability for assessing health materials. Findings highlight the need to improve health communication clarity and actionability in China.
Area of Science:
- Public Health Communication
- Health Literacy
- Psychometrics
Background:
- The postpandemic era has increased demand for clear digital health information, especially in China, facing health literacy disparities.
- The US Centers for Disease Control and Prevention's Clear Communication Index (CCI) is a tool for assessing health material clarity, but a simplified Chinese version was unavailable.
Purpose of the Study:
- To translate and culturally adapt the CCI into simplified Chinese (C-CCI).
- To validate the psychometric properties of the C-CCI using diabetes health communication materials from China's provincial CDCs.
Main Methods:
- A cross-cultural adaptation process (forward-back translation, expert review) created the C-CCI, a 12-item scale across 4 dimensions.
- Thirty provincial CDC websites provided diabetes health education materials for evaluation by 12 trained raters.
- Psychometric properties including structural validity (EFA, CFA), content validity (CVI), reliability (Cronbach's α, Fleiss' κ), and convergent/discriminant validity were assessed.
Main Results:
- The C-CCI confirmed a 4-factor structure with high content validity (S-CVI/Ave = 0.976 for clarity, 1 for relevance) and acceptable overall reliability (Cronbach's α = 0.837).
- Inter-rater agreement was substantial (κ = 0.624), with satisfactory convergent and discriminant validity.
- Materials evaluated had a mean C-CCI score of 53.84, significantly below the recommended 90, indicating a need for improvement.
Conclusions:
- The C-CCI is a valid, reliable, and feasible tool for evaluating simplified Chinese health communication materials.
- Findings emphasize the need to enhance health communication practices and align material development with national health literacy goals in China.
- Integrating the C-CCI into routine review processes can improve the quality and actionability of public health communication nationwide.
