Development and initial validation of the mental health literacy questionnaire for chinese adults

Low mental health literacy is a public health concern in China and contributes to the low underutilization of mental health resources. We extended the current conceptualization of mental health literacy and developed a comprehensive self-report measure of mental health literacy in the Chinese context, the Mental Health Literacy Questionnaire (MHLQ). We generated items based on existing literature, extensive qualitative interviews with mental health professionals and community members. We revised these items based on expert review to examine content validity, after which we conducted a pilot test with a representative sample of 734 urban and rural community members to illicit feedback on wording clarity and select items within appropriate difficulty levels (i.e., correct rate). We then examined dimensionality and item performance using multidimensional item response theory analyses in a combined sample of mental health professionals (n = 122), community members (n = 121), and college students (n = 144). We concluded a six-factor structure for the MHLQ encompassing mental health knowledge, mental illness knowledge, attitudes towards mental health, attitudes towards mental illness, behaviors regarding mental health promotion, and behaviors regarding mental illness coping. The scale yielded adequate internal reliability estimates and test-retest agreement, and convergent evidence and known-group comparisons results in support of construct validity. The six-factor MHLQ largely supported our extended theoretical conceptualization of the mental health literacy in the Chinese context. Future studies are needed to further validate the factor structure and examine measurement invariance.