Short Assessment of Health Literacy (SAHL) in Portugal: development and validation of a self-administered tool

Measuring Sexual Motivation as a Trait Dimension: A multisample study of the Portuguese (European) Version of the Trait Sexual Motivation Questionnaire

The current study aimed at translating and validating the TSMQ into Portuguese-European (TSMQ-PT) and to investigate its psychometric properties. Three online studies were conducted with independent samples collected between September 2020 and March 2022. Study 1 tested the exploratory factorial structure (N = 325; 206 women); Study 2 explored the confirmatory factorial structure and construct validity (N = 450; 230 women); and Study 3 examined the temporal stability of the TSMQ-PT (N = 30; 15 women). Participants completed the TSMQ-PT for all three studies. In study 2, further completed the Sexual Compulsivity Scale, the Sexual Sensation Seeking Scale, and the Sexual Desire Inventory. Data revealed that the TSMQ-PT yielded a four-structure model, (i.e., Sexually Oriented, Comparison with Others, Seeking for Sexual Encounters, and Importance of Sex) comprising 13 items, with seven additional items for assessing existence and number of sexual partners, and frequency of sexual behaviors. The TSMQ-PT achieved good internal consistency levels (McDonald's omega ranged from .71 to .89) and construct validity, and temporal stability over 10-11 months (values ranged from .80 to .87) supporting the trait-dimension of sexual motivation. Current findings support a brief, valid, and reliable self-report instrument for assessing sexual motivation in the Portuguese context.

A Systematic Review of Health Literacy Measurement Instruments in Portugal

Introduction

Health literacy evaluation is considered a priority issue in the health literacy research field. The complexity of the multiple definitions of health literacy and the diversity of instruments to evaluate health literacy has become a challenge to the establishment of comparisons across different studies. This work aimed to provide a systematic literature review of the existing measurement instruments adapted or developed for different groups of the Portuguese population.

Methods

A comprehensive search of digital databases was conducted to systematize and understand the available knowledge about health literacy measurement in Portugal and to identify assessment tools and studies developed. The selection process was based on PRISMA guidelines.

Results

A total of 17 publications were analysed regarding different aspects, which resulted in the identification of 11 different instruments, that were adapted or developed to measure health literacy in different groups of the Portuguese population, mainly adults, adolescents, and young adults. Seven instruments focusing on general health literacy (including e-health), 2 on mental health literacy, and the other 2 on oral health literacy were identified.

Discussion/Conclusion

This study presents the first general overview of health literacy measurement in Portugal and clearly shows that to deepen our knowledge of health literacy in the Portuguese population it is essential to broaden the scope and the target of health literacy assessment to have a comprehensive understanding that will allow transforming our reality regarding health and disease.

The Nutrition Literacy Assessment Instrument for Brazilians, NLit-Br: An Exploratory Cross-Cultural Validity Study

This study aimed to test the validity of the cross-cultural adapted Nutrition Literacy Assessment Instrument for Brazilians (NLit-Br). An observational cross-sectional study was performed in chronic disease clinics from the Brazilian Public Health System in two phases: (1) linguistic and cultural adaptation and (2) validity testing. Six registered dietitians and thirty adult patients diagnosed with at least one chronic disease participated in the study using the nutrition literacy assessment instrument (NLit-Br) and the short assessment of health literacy for Portuguese-speaking adults (SAHLPA-18). Sample descriptive variables: age, sex, race, income, education, and occupation. To adapt the instrument to the Brazilian Portuguese and Brazilian culture, we tested cognitive interviewing and the Scale Content Validity Index (S-CVI) with a group of dietitians and patients. To test the tool’s validity, health literacy (SAHLPA-18) was used as a construct that presents similarities and differences with nutrition literacy (NLit-Br). The correlation of NLit-Br and the SAHLPA-18 was tested (Spearman’s Rho). Internal consistency was measured by Kuder−Richardson Formula 20 (KR-20). The NLit-Br content validity (S-CVI = 0.85) and internal consistency (KR-20 = 0.868) were confirmed. Additionally, NLit-Br presented a significant and robust correlation with SAHLPA-18 (r = 0.665, p < 0.001). Therefore, the NLit-Br was considered a linguistic, cultural, and valid instrument to measure Brazilian’s nutrition literacy.

Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021

BACKGROUND

It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages.

METHODS

The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021.

RESULTS

The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties.

CONCLUSION

This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.

LitKDM2 study: the impact of health Literacy and knowledge about the disease on the metabolic control of type 2 diabetes mellitus

AIMS

Diabetes mellitus (DM) is a common chronic disease with serious individual and socioeconomic consequences. Low health literacy (HL) has been associated with higher morbimortality. Health knowledge about DM (HK-DM) may also influence individual health. We aimed to assess HL and HK-DM in patients with type 2 DM and their associations with metabolic control.

METHODS

Our sample comprised 194 diabetic patients from a primary care health centre. We collected clinical and demographic data and applied two validated questionnaires, the Newest Vital Sign (NST) and Diabetes Knowledge Test (DKT), to assess HL and HK-DM, respectively. Metabolic control was defined as HbA1c < 7.0%. Participants were classified according to the NST as having "high likelihood of limited HL" (HLL-HL), "possibility of limited HL" (PL-HL), or "adequate HL" (A-HL) and by the DKT as having "low", "average" and "good" HK. Statistical analysis included logistic regression models, using p < 0.05 as a cut-off for statistical significance.

RESULTS

Overall, 72.7 and 34.7% of participants had HLL-HL and low HK-DM, respectively. A-HL (OR = 6.02; 95% CI: 1.691-21.450) and PL-HL (OR = 4.78; 95% CI: 1.350-16.899) were significantly associated with better metabolic control than HLL-HL. We did not find a significant association between HK-DM and metabolic control.

CONCLUSIONS

HL seems to be associated with better metabolic control. We also found a high prevalence of illiteracy and scarce knowledge about DM. Primary care physicians should promote HL to help patients achieve better metabolic control.

Validation of a Scale of Religious and Spiritual Coping (RCOPE) for the Portuguese Population

The scale of religious and spiritual coping (RCOPE) is one of the most used measures in the evaluation of coping strategies based on faith. Despite being validated for the Portuguese language in the Brazilian context, there was still no validation for European Portuguese, which seems important considering the cultural differences. We aimed at examining the validity and reliability of the RCOPE with a Portuguese sample. The present study used cross-sectional data from 1103 volunteers that completed the online survey. After randomly splitting the sample (1:1) for cross-validation purposes, an ordinal exploratory factor analysis and confirmatory factor analysis were performed. McDonald's omega, Cronbach's alpha and mean inter-item correlations were used to determine the internal consistency and homogeneity of the RCOPE. The convergent and discriminant validity of the scale was assessed using standardized factor loadings, the average variance extracted and the squared correlation between latent factors, respectively. In the current study, the final structure of the scale included 17 items aggregated into two correlated latent factors. The Portuguese version of the RCOPE showed acceptable psychometric proprieties, which will be an advantageous instrument for the practice and research of psychology in religion and spirituality.

What is the Prevalence of Low Health Literacy in European Union Member States? A Systematic Review and Meta-analysis

BACKGROUND

Many studies have shown that low health literacy (HL) is associated with several adverse outcomes. In this study, we systematically reviewed the prevalence of low HL in Europe.

METHODS

PubMed, Embase, and Scopus were searched. Cross-sectional studies conducted in the European Union (EU), published from 2000, investigating the prevalence of low HL in adults using a reliable tool, were included. Quality was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled prevalence estimates. A meta-regression analysis was performed to assess the association between low HL and the characteristics of the studies.

RESULTS

The pooled prevalence of low HL ranged from of 27% (95% CI: 18-38%) to 48% (95% CI: 41-55%), depending on the literacy assessment method applied. Southern, Western, and Eastern EU countries had lower HL compared to northern Europe (β: 0.87, 95% CI: 0.40-1.35; β: 0.59, 95% CI: 0.25-0.93; and β: 0.72, 95% CI: 0.06-1.37, respectively). The assessment method significantly influenced the pooled estimate: compared to word recognition items, using self-reported comprehensions items (β: 0.61, 95% CI: 0.15-1.08), reading or numeracy comprehensions items (β: 0.77, 95% CI: 0.24-1.31), or a mixed method (β: 0.66, 95% CI: 0.01-1.33) found higher rates of low HL. Refugees had the lowest HL (β: 1.59, 95% CI: 0.26-2.92). Finally, lower quality studies reported higher rates of low HL (β: 0.56, 95% CI: 0.06-1.07).

DISCUSSION

We found that low HL is a public health challenge throughout Europe, where one in every three to almost one in every two Europeans may not be able to understand essential health-related material. Additional research is needed to investigate the underlying causes and to develop remedies.

PROSPERO REGISTRATION

CRD42019133377.

Validation of a new tool for evaluating subjects' satisfaction with medicine package leaflets: a cross-sectional descriptive study

BACKGROUND

Package leaflets of medicines need to be intelligible, but tools for their evaluation are scarce.

OBJECTIVE

To validate a new tool for assessing subjects' satisfaction with medicine package leaflets (LiS-RPL).

DESIGN AND SETTING

Cross-sectional descriptive study conducted in two regions of Portugal (Lisbon and Centre).

METHODS

503 participants (53.1% male) were selected according to convenience and homogenously distributed into three groups: 1 to 6; 7 to 12; and > 12 years of schooling. LiS-RPL was developed based on international regulation guidelines and was initially composed of 14 items. Twelve package leaflets were tested. Dimensionality calculations included: exploratory factor analysis and minimum rank factor analysis; Kaiser-Meyer-Olkin index and Bartlett's sphericity test to assess matrix adequacy for exploratory factor analysis; exploratory bifactor analysis with Schmid-Leiman solution to detect possible existence of a broad second-order factor; and Bentler's Simplicity Index and Loading Simplicity Index to assess factor simplicity. Diverse coefficients were calculated to assess reliability.

RESULTS

Minimum rank factor analysis detected a two-factor or single-factor structure. Exploratory factor analysis with 12 items showed a two-factor structure, explaining 69.11% of the variance. These items were strongly correlated with each other (r = 0.80). Schmid-Leiman: all items seemed to represent the general factor (loadings above 0.50), which was 76.4% of the extracted variance. Simplicity indices were good (percentile 99): Bentler's Simplicity Index of 0.99 and Loading Simplicity Index of 0.48. Internal consistency indexes indicated good reliability. LiS-RPL was shown to be homogenous.

CONCLUSION

LiS-RPL is a validated tool for evaluating subjects' satisfaction with medicine package leaflets.