Measuring General Health Literacy in Chinese adults: validation of the HLS19-Q12 instrument

BACKGROUND

Health literacy measurement lays a solid foundation to identify associations with health outcomes and monitor population health literacy levels over time. In mainland China, most existing health literacy instruments are either knowledge-based or practice-based, making health literacy results incomparable between China and other countries. This study aimed to examine the reliability and validity of the 12-item Health Literacy Population Survey (HLS19-Q12) in a general population of Chinese adults.

METHODS

A cross-sectional study was conducted to recruit primary carers of students from 11 schools in Zhengzhou, Henan Province, using convenience cluster sampling. Participants completed an online self-administered survey that collected information on key sociodemographics, health literacy (HLS19-Q12 and a comparison tool: Health Literacy Questionnaire (HLQ)), and health-related outcomes. Using the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist as a guideline, we tested internal consistency, test-retest reliability, content validity, structural validity, concurrent predictive validity, and convergent validity of the HLS19-Q12.

RESULTS

Overall, 14,184 participants completed the full survey. The HLS19-Q12 showed excellent internal consistency (Cronbach's α = 0.93), moderate test-retest reliability (intra-class correlation coefficient = 0.54), satisfactory content validity (based on the 12-matrix health literacy model), and strong structural validity (comparative fit index = 0.94, Tucker and Lewis's index of fit = 0.93, root mean square error of approximation = 0.095). Concurrent predictive validity results showed health literacy was associated with both health determinants and health-related outcomes. The HLS19-Q12 had weak to strong correlations (coefficients = 0.24 to 0.42) with the nine scales of the HLQ. Respondents had an average score of 81.6 (± 23.0) when using the HLS19-Q12, with 35.0% and 7.5% having problematic and inadequate levels of health literacy, respectively.

CONCLUSIONS

The HLS19-Q12 is a reliable and valid instrument to measure health literacy in our sample. Further validation is needed with a more nationally representative sample of Chinese adults. The HLS19-Q12 could be used as a comprehensive, skills-based, and easy-to-administer health literacy assessment tool integrated into population surveys and intervention evaluations.

Developing the HLS(19)-YP12 for measuring health literacy in young people: a latent trait analysis using Rasch modelling and confirmatory factor analysis

BACKGROUND

Accurate and precise measures of health literacy (HL) is supportive for health policy making, tailoring health service design, and ensuring equitable access to health services. According to research, valid and reliable unidimensional HL measurement instruments explicitly targeted at young people (YP) are scarce. Thus, this study aims at assessing the psychometric properties of existing unidimensional instruments and developing an HL instrument suitable for YP aged 16-25 years.

METHODS

Applying the HLS₁₉-Q47 in computer-assisted telephone interviews, we collected data in a representative sample comprising 890 YP aged 16-25 years in Norway. Applying the partial credit parameterization of the unidimensional Rasch model for polytomous data (PCM) and confirmatory factor analysis (CFA) with categorical variables, we evaluated the psychometric properties of the short versions of the HLS₁₉-Q47; HLS₁₉-Q12, HLS₁₉-SF12, and HLS₁₉-Q12-NO. A new 12-item short version for measuring HL in YP, HLS₁₉-YP12, is suggested.

RESULTS

The HLS₁₉-Q12 did not display sufficient fit to the PCM, and the HLS₁₉-SF12 was not sufficiently unidimensional. Relative to the PCM, some items in the HLS₁₉-Q12, the HLS₁₉-SF12, and the HLS₁₉-Q12-NO discriminated poorly between participants at high and at low locations on the underlying latent trait. We observed disordered response categories for some items in the HLS₁₉-Q12 and the HLS₁₉-SF12. A few items in the HLS₁₉-Q12, the HLS₁₉-SF12, and the HLS₁₉-Q12-NO displayed either uniform or non-uniform differential item functioning. Applying one-factorial CFA, none of the aforementioned short versions achieved exact fit in terms of non-significant model chi-square statistic, or approximate fit in terms of SRMR ≤ .080 and all entries ≤ .10 that were observed in the respective residual matrix. The newly suggested parsimonious 12-item scale, HLS₁₉-YP12, displayed sufficiently fit to the PCM and achieved approximate fit using one-factorial CFA.

CONCLUSIONS

Compared to other parsimonious 12-item short versions of HLS₁₉-Q47, the HLS₁₉-YP12 has superior psychometric properties and unconditionally proved its unidimensionality. The HLS₁₉-YP12 offers an efficient and much-needed screening tool for use among YP, which is likely a useful application in processes towards the development and evaluation of health policy and public health work, as well as for use in clinical settings.

"Was Test Designed for Africans?" Health Literacy and African Immigrants

BACKGROUND

Immigrants experience barriers to accessing and utilizing health care. Language and cultural differences regarding health and healing impact use of health care. Limited health literacy is associated with decreased preventive health services and is reported among immigrant groups in the USA, but the health literacy of African immigrants is not known.

OBJECTIVE

Assess health literacy, its association with engagement in primary care and select sociodemographic variables, and the use of two health literacy measures with African immigrants.

METHODS

We conducted a community-based participatory research cross-sectional survey among African immigrants in Massachusetts. Participants completed the Newest Vital Sign, the Health Literacy Skills Instrument, acceptability questionnaires, and a Health Survey. We observed and recorded comments and questions as participants completed the surveys.

KEY RESULTS

Out of 75 participants, 60% have limited health literacy. Over 80% are connected to a health care system and comfortable speaking with their doctor/nurse. Education, English proficiency, country of origin, and access to health care are associated with health literacy. Participants found the measures easy to understand but difficult to answer. Observation data revealed unfamiliarity with nutrition labels, cooking measurements, and navigation of internet links, and the need for clarification of select items.

CONCLUSIONS

Most African immigrants in this study have limited health literacy despite English proficiency, college education, employment, and connection to a health system. Further research is needed to determine the value of aligning the measurement of health literacy with the cultural-linguistic identities of the population being assessed versus the need to understand their health literacy within the dominant culture.

Concurrent validity and acceptability of health literacy measures of adults hospitalized with heart failure

OBJECTIVES

To test concurrent validity and acceptability of the Single Item Literacy Screener (SILS), Test of Functional Health Literacy (S-TOFHLA) and the Newest Vital Sign (NVS) in hospitalized adults with heart failure (HF).

BACKGROUND

Health literacy is not routinely evaluated in adults hospitalized with HF. Low health literacy is linked to poor HF self-care and hospital readmissions.

METHODS

SILS, NVS and S-TOFHLA were completed by 85 patients with HF. Measures were examined for internal consistency reliability and acceptability. The NVS and S-TOFHLA were correlated with the SILS to establish concurrent validity.

RESULTS

The NVS (α = 0.70) and S-TOFHLA (α = 0.88) were reliable. The SILS significantly correlated with the S-TOFHLA (r = -0.308). The S-TOFHLA (M = 6.16) and NVS (M = 6.10) were acceptable measures.

CONCLUSION

The S-TOFHLA and NVS were reliable and acceptable measures of health literacy in hospitalized HF population. The SILS correlated with the S-TOFHLA and may predict low health literacy when hospitalized. NVS total scores in this population aligned with the recent NAAL survey. Hospitalized adults with HF agreed to share the health literacy scores with their providers.

Adaptation and validation of a measure of health literacy in Taiwan: The Newest Vital Sign

Background

Health literacy (HL) refers to the ability to obtain, read, understand, and use basic health care information required to make appropriate health decisions and follow instructions for treatment. The Newest Vital Sign (NVS) is an instrument developed for assessing aspects of HL relevant to reading and numeracy skills. This study aimed to develop a traditional Chinese version of the NVS (NVS-TC) and assess its feasibility, reliability, and validity in Taiwanese patients with type 2 diabetes.

Methods

The original NVS was translated into traditional Chinese in accordance with established guidelines. A cognitive testing procedure was subsequently performed to evaluate the ease of understanding and acceptability of the test in 30 patients with diabetes. Thereafter, a quantitative survey (N = 232) was administered for validating the NVS-TC against the accepted standard tests of HL and participant education level.

Results

The internal consistency (Cronbach's α) was 0.76. In accordance with a priori hypotheses, we found strong associations between the NVS-TC and objective HL and weaker associations between the NVS-TC and subjective HL. The known group validity of the NVS-TC was demonstrated through multivariate regression analyses, which showed that educational differences in the NVS-TC scores remained significant after adjustment for age, gender, and working in healthcare.

Conclusions

The results suggest that the NVS-TC is a reliable and valid tool that facilitates international comparable HL research in Taiwan. The NVS-TC can be used to investigate the role of HL in health care and can be easily incorporated into daily clinical practice for diabetes management.