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Saboga-Nunes L, Bittlingmayer UH, Harsch S, Vincenzi SL, da Silva SA, Konrath AC, Estabel LB, da Silva Moro EL, Santini LA, da Silveira FX, Cardoso D, Sebold R, Pereira Barbosa CA, Farinelli MR, de Andrade DF. Psychometric properties of the health literacy instrument in Brazil (HLS-EU-BR47). BMC Public Health 2024; 24:1655. [PMID: 38902651 PMCID: PMC11191178 DOI: 10.1186/s12889-024-19108-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Health literacy (HL) is a key component of health promotion and sustainability and contributes to well-being. Despite its global relevance, HL is an under-researched topic in South America but is now debuting its exploration in Brazil. To leverage its benefits for South America, the mere translation of validated tools into Portuguese is insufficient. Rather, it is necessary to examine their validity. This study aims to assess the psychometric properties of the European Health Literacy Questionnaire (HLS-EU-BR47) using the Item Response Theory (IRT) in a population-based sample of adults in Brazil. METHODS A cross-sectional online study was conducted across Brazil and included 1028 participants aged 18 years and above (80% women). Cronbach's alpha, McDonald's omega, factor analysis, graded responses model, Item Characteristic Curve, HL levels based on this, HL standard calculation, IRT, and regular score correlation were computed. RESULTS The instrument exhibit high reliability (Cronbach's alpha 0.95). Factor analysis yielded one factor. IRT was appropriate for data analysis because it allowed quality evaluation of items and constructed a scale to quantify HL. The 47 items and latent features of respondents in the same unit of measurement are positioned in the construction of the HLS-EU-BR47 instrument. The percentages of individuals at each HL level, calculated using IRT, were found to be comparable to those obtained through the standard computation, e.g., 3.2% of people reported very low HL versus 10.8% inadequate HL, 56.2% reported low HL versus 39.5% problematic HL, 31.1% had moderate HL versus 30.1% sufficient HL, and 9.5% had high HL versus 19.7% with excellent HL. The mean HL scores were comparable between women and men (33.9 vs. 33.7, P = 0.36). CONCLUSION This study provides new evidence of the validity of a widely used HL instrument for the population of South America (in this case, Brazil). This tool can be utilized by citizens, health professionals, and regional/national policymakers to inform the development of initiatives to assess and improve the HL of individuals, groups, and communities. Further studies are needed to confirm and extend the findings and to explore the influence of local cultures and practices in the vast Brazilian territory on HL.
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Affiliation(s)
- Luis Saboga-Nunes
- Institute of Sociology, University of Education Freiburg, Freiburg, Germany
- UNESCO Chair and WHO Collaborating Center in Global Health & Education, Paris, France
| | | | - Stefanie Harsch
- Institute of Sociology, University of Education Freiburg, Freiburg, Germany.
| | | | | | | | | | | | | | | | - Darclé Cardoso
- Programa de pós ?graduação em odontologia em saúde coletiva, Postgraduate Program in Dentistry, collective health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Roselita Sebold
- Federal University of Santa Catarina, Rio do Sul, Santa Catarina, Brazil
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Tavousi M, Mohammadi S, Sadighi J, Zarei F, Kermani RM, Rostami R, Montazeri A. Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PLoS One 2022; 17:e0271524. [PMID: 35839272 PMCID: PMC9286266 DOI: 10.1371/journal.pone.0271524] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Mahmoud Tavousi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Samira Mohammadi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Jila Sadighi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Fatemeh Zarei
- Faculty of Medical Sciences, Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Ramin Mozafari Kermani
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Rahele Rostami
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Ali Montazeri
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
- Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran
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Sabbagh RS, Shah NS, Newyear BM, Matar RN, Johnson BM, Grawe BM. What are the risk factors associated with limited musculoskeletal health literacy in shoulder arthroplasty patients? Musculoskeletal Care 2021; 20:307-315. [PMID: 34480828 DOI: 10.1002/msc.1588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Low health literacy is both pervasive in the United States and a substantial barrier to satisfactory patient care and the appropriate utilization of healthcare resources. This prospective study aims to evaluate the factors that contribute to limited musculoskeletal literacy in patients who undergo shoulder arthroplasty. METHODS Ninety patients undergoing shoulder replacement surgery completed demographics and Literacy in Musculoskeletal Problems (LiMP) surveys. Scores of less than six were considered indicative of limited musculoskeletal literacy. RESULTS The overall percentage of participants with limited musculoskeletal literacy was 38.8%. Multivariable logistic regression analysis with multiple imputation modeling demonstrated a significant positive relationship between patient income and adequate LiMP scores (p = 0.009) with an odds ratio of 1.15 (CI: 1.04; 1.28) while level of education (p = 0.173) and patient ethnicity (p = 0.830) among other patient characteristics did not have a significant relationship with LiMP scores. CONCLUSION In patients undergoing shoulder replacement surgery, low income was the only variable found to be predictive of limited musculoskeletal health literacy scores. Therefore, when discussing the risks and benefits of shoulder arthroplasty, orthopaedic surgeons should be cognizant of the possibility that any given patient may not meet the threshold of adequate musculoskeletal literacy.
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Affiliation(s)
- Ramsey S Sabbagh
- Department of Orthopaedics and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nihar S Shah
- Department of Orthopaedics and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brian M Newyear
- Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Robert N Matar
- Department of Orthopaedics and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brian M Johnson
- Department of Orthopaedics and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brian M Grawe
- Department of Orthopaedics and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Tian CY, Xu RH, Mo PKH, Dong D, Wong ELY. Generic Health Literacy Measurements for Adults: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7768. [PMID: 33114157 PMCID: PMC7660647 DOI: 10.3390/ijerph17217768] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Generic health literacy measurement (GHLM) is an important tool to identify individuals with limited health literacy and can assist the design of tailored interventions for improving public health literacy. However, there is no consensus on measuring generic health literacy. The present study aims to review current GHLM used for adults in the literature. METHODS A scoping review was undertaken to map the available measurements designed to assess generic health literacy. RESULTS The review identified 19 GHLM for adults. Most of them applied a multidimensional definition of health literacy with a focus on individuals' abilities to access, appraise, understand, and apply health information and services. Nutbeam's conceptual model and Sørensen's integrated model were widely used among the identified measures as the theoretical foundation. While the social determinants of health (SDH) were acknowledged in the two models, it remains unmentioned in many of the identified measures based on the Nutbeam's model and needs further development in the measure based on the Sørensen's model. A total of 39 different domains were assessed in the 19 measurements: prose was identified in 8 measurements and was the most prominent domain; followed by numeracy (n = 7) and interactive (n = 7). SDH related domains such as social support (n = 3), social capital (n = 1) were seldom included in the identified measurements. CONCLUSIONS Although current GHLM adopted a multidimensional construct, they mainly focused on individuals' abilities and SDH has not been well-developed in the assessment. Further research is required to advance the measuring of the interaction between SDH and health literacy.
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Affiliation(s)
- Cindy Yue Tian
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China; (C.Y.T.); (R.H.X.); (P.K.-H.M.); (D.D.)
| | - Richard Huan Xu
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China; (C.Y.T.); (R.H.X.); (P.K.-H.M.); (D.D.)
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Phoenix Kit-Han Mo
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China; (C.Y.T.); (R.H.X.); (P.K.-H.M.); (D.D.)
| | - Dong Dong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China; (C.Y.T.); (R.H.X.); (P.K.-H.M.); (D.D.)
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Eliza Lai-Yi Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China; (C.Y.T.); (R.H.X.); (P.K.-H.M.); (D.D.)
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China
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Ploomipuu I, Holbrook J, Rannikmäe M. Modelling health literacy on conceptualizations of scientific literacy. Health Promot Int 2020; 35:1210-1219. [PMID: 31773133 DOI: 10.1093/heapro/daz106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This paper recognizes the need to promote health literacy as the goal of health education for all, at all educational levels. It particularly explores the meaning of health literacy, based on the literature and seeks to put forward a new meaning, applicable for the general public with further considerations for healthcare professionals. The vision and scope of health literacy is promoted as the goal for health education, reflecting on a comparison with scientific literacy (SL) and science education. A model is proposed interrelating health education, health literacy, science education and science literacy and discusses areas where health literacy is seen as having attributes beyond SL. A revised definition of health literacy is proposed.
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Affiliation(s)
- Inga Ploomipuu
- Centre of Science Education, University of Tartu, Vanemuise 46, 51014 Tartu, Estonia
| | - Jack Holbrook
- Centre of Science Education, University of Tartu, Vanemuise 46, 51014 Tartu, Estonia
| | - Miia Rannikmäe
- Centre of Science Education, University of Tartu, Vanemuise 46, 51014 Tartu, Estonia
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Diviani N, Obrenovic J, Montoya CL, Karcz K. Disentangling health information appraisal competence: Results from an interdisciplinary scoping review and online consultation among Swiss stakeholders. PLoS One 2020; 15:e0235474. [PMID: 32614869 PMCID: PMC7332022 DOI: 10.1371/journal.pone.0235474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The ability to critically appraise health information-often referred to as critical health literacy-is recognized as a crucial component of health literacy. Yet to date, it is not clear what specific abilities are needed to adequately accomplish this task, thereby hindering both its assessment and the development and evaluation of related interventions. By systematically building on past research, this study aimed to operationally define the concept of health information appraisal competence. METHODS We systematically searched five scholarly databases to identify the conceptualizations and operational definitions of information appraisal in different disciplines. The resulting operationalization was subsequently validated through an online consultation exercise among 85 Swiss stakeholders. RESULTS Ninety-four publications were included in the review to the point of saturation. We extracted 646 skills, attitudes, and knowledge for health information appraisal. We then collated overlapping or duplicate statements, which produced a list of 43 unique statements belonging to six emergent themes or core competences: (1) basic competence, (2) predisposition, (3) identification competence, (4) critical evaluation competence, (5) selection competence, and (6) application competence. The consultation exercise enriched the operationalization of some of the core competences and confirmed the importance of all competences. Most skills, attitudes, and knowledge, however, were assigned low feasibility by the stakeholders. CONCLUSIONS This study was the first attempt to systematically operationalize health information appraisal competence. From a theoretical perspective, it sheds light on an understudied, health literacy domain, thus contributing to clarity around the concept. From a practical perspective, it provides a strong theoretical basis for the development of a tool to measure health information appraisal competence. This could be used routinely as a screening tool, as an outcome measure for public health interventions, or to identify citizens who are most at risk. Furthermore, it will provide support for the development of future interventions to build health information appraisal competence in the population.
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Affiliation(s)
- Nicola Diviani
- University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | | | | | - Katarzyna Karcz
- University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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Shayakhmetov SS, Toguzbayeva KK, Ismailova AA, Tabibi R, Derbishalieva ZK, Dzhusupov KO. Health Literacy of Rural Population of Kazakhstan. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1269-1277. [PMID: 33083293 PMCID: PMC7548489 DOI: 10.18502/ijph.v49i7.3580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND To date, there is no data available of health literacy of the population in Kazakhstan. This study was aimed to assess the health literacy of the rural population for the development of the targeted health education programs. METHODS The adapted HLS-EU-Q47 survey was carried out among 1650 respondents aged 18-76 from rural settlements in Almaty region of Kazakhstan in 2013. The health literacy competences to assess, understand, appraise and apply health information on healthcare, disease prevention and health promotion were measured. The associations between the health literacy competencies and demographic and socio-economic characteristics were shown through a multiple linear regression analysis. RESULTS The overall health literacy rate of the rural population of Almaty region was problematic and inadequate. With regards to their age, sex, social and economic characteristics, the health literacy competencies differ according to health literacy domain. Respondents with low education level or perceived social status had respectively low health literacy scores, especially in appraising and applying information of disease prevention. CONCLUSION Low educated people and with lower income have lower health literacy in comparison to respondents with higher education level and higher income. Respondents with higher health literacy have higher rate of self-assessed health.
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Affiliation(s)
- Syrym S Shayakhmetov
- Department of Public Health, Semey State Medical University, Semey, Republic of Kazakhstan
| | - Karlygash K Toguzbayeva
- Department of Nutrition and Preventive Medicine, JSC National Medical University, Almaty, Republic of Kazakhstan
| | - Aigul A Ismailova
- Department of Ecology, Seyfullin Agrotechnical University, Nur-Sultan, Republic of Kazakhstan
| | - Ramin Tabibi
- School of Medicine, Abadan University of Medical Sciences, Abadan, Iran
| | | | - Kenesh O Dzhusupov
- Department of Public Health, International School of Medicine, Bishkek, Kyrgyzstan
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Harrington RL, Hanna ML, Oehrlein EM, Camp R, Wheeler R, Cooblall C, Tesoro T, Scott AM, von Gizycki R, Nguyen F, Hareendran A, Patrick DL, Perfetto EM. Defining Patient Engagement in Research: Results of a Systematic Review and Analysis: Report of the ISPOR Patient-Centered Special Interest Group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:677-688. [PMID: 32540224 DOI: 10.1016/j.jval.2020.01.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Lack of clarity on the definition of "patient engagement" has been highlighted as a barrier to fully implementing patient engagement in research. This study identified themes within existing definitions related to patient engagement and proposes a consensus definition of "patient engagement in research." METHODS A systematic review was conducted to identify definitions of patient engagement and related terms in published literature (2006-2018). Definitions were extracted and qualitatively analyzed to identify themes and characteristics. A multistakeholder approach, including academia, industry, and patient representation, was taken at all stages. A proposed definition is offered based on a synthesis of the findings. RESULTS Of 1821 abstracts identified and screened for eligibility, 317 were selected for full-text review. Of these, 169 articles met inclusion criteria, from which 244 distinct definitions were extracted for analysis. The most frequently defined terms were: "patient-centered" (30.5%), "patient engagement" (15.5%), and "patient participation" (13.4%). The majority of definitions were specific to the healthcare delivery setting (70.5%); 11.9% were specific to research. Among the definitions of "patient engagement," the most common themes were "active process," "patient involvement," and "patient as participant." In the research setting, the top themes were "patient as partner," "patient involvement," and "active process"; these did not appear in the top 3 themes of nonresearch definitions. CONCLUSION Distinct themes are associated with the term "patient engagement" and with engagement in the "research" setting. Based on an analysis of existing literature and review by patient, industry, and academic stakeholders, we propose a scalable consensus definition of "patient engagement in research."
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Affiliation(s)
| | - Maya L Hanna
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT USA
| | | | - Rob Camp
- Community Advisory Board Programme, EURORDIS, Barcelona, Spain
| | | | - Clarissa Cooblall
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
| | - Theresa Tesoro
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
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Shannon HA, Parker AW. Evaluation of a Health Literacy Instrument Designed for the Mining Industry. Health Lit Res Pract 2020; 4:e84-e93. [PMID: 32293688 PMCID: PMC7156259 DOI: 10.3928/24748307-20200316-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 05/06/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Health literacy can manifest as an outcome of health education and communication, and it has potential as an antecedent for changes in health-related attitudes, values, and behaviors. Effective communication is vital for the health and safety of mining industry workers, and the ability to accurately measure impact is a necessary advancement in evaluation practices. Higher-risk, production-driven industries require specialized instruments and data collection methods that are sensitive to the workplace environment and capable of generating comprehensive and representative data, with minimal impact on productivity. Objective: This research investigated the validity, reliability, and utility of the Health Communication Questionnaire (HCQ), a new instrument for measuring interactive and critical health literacy within the mining industry. Methods: The applied research methodology included HCQ readability assessment, content validity indexing, substantive validity analysis, and reliability appraisal via a test-retest procedure with regression analysis and Bland-Altman plots to evaluate intra-subject agreement. Key Results: The results demonstrate content validity, exceeding minimum target values after evidence-based refinement of the instrument via substantive validity analysis. Readability targets were met, and reliability outcomes verify that the HCQ is consistent across two time points when tested under true work conditions. Conclusion: This study determined the validity, reliability, and utility of the HCQ as an interactive and critical health literacy data collection instrument and an evidence-based solution to concerns regarding absent or highly variable evaluation of Occupational Health and Safety communication practices within the mining industry. [HLRP: Health Literacy Research and Practice. 2020;4(2):e84–e93.] Plain Language Summary: This study sought to develop and evaluate a survey instrument capable of determining health literacy indicators within the complex environment of mining industry work sites. Outcomes of this research demonstrate the Health Communication Questionnaire accurately and consistently measures two forms of health literacy and is suitable for use within the mining industry.
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Affiliation(s)
- Hugh A. Shannon
- Address correspondence to Hugh A. Shannon, PhD, BScApp (HMS-Ed) (Hons), Queensland University of Technology, School of Exercise and Nutrition Sciences, Victoria Park Road, Kelvin Grove 4059, Australia;
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Bourne A, Peerbux S, Jessup R, Staples M, Beauchamp A, Buchbinder R. Health literacy profile of recently hospitalised patients in the private hospital setting: a cross sectional survey using the Health Literacy Questionnaire (HLQ). BMC Health Serv Res 2018; 18:877. [PMID: 30458773 PMCID: PMC6247774 DOI: 10.1186/s12913-018-3697-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/08/2018] [Indexed: 11/26/2022] Open
Abstract
Background Health service providers should understand and attend to the health literacy needs of their population in view of the known association between low health literacy and poorer health outcomes. This study aimed to determine the health literacy profile of patients treated at a large private hospital in Melbourne, Australia, and any associations between this profile and socio-economic position, health behaviours, health status and use of hospital services. Methods A mailed survey was sent to 9173 people aged ≥18 years with a hospital admission between February and October 2014. It included the Health Literacy Questionnaire (HLQ), a multidimensional tool comprising nine independent scales, and socio-demographic and clinical questions. For both respondents and non-respondents, we also extracted residential postcode and admission and follow up details from the Patient Administrative Services database. Differences in demographic, socio-economic and hospital use patterns between respondents and non-respondents were analysed using descriptive statistics. Regression-tests were used to identify differences in health literacy between socio-economic subgroups, with the magnitude of these differences determined using Cohen’s d effect sizes. Results There were 3121 respondents (response rate: 35% excluding 154 returned invitations), the majority born in Australia (74.6%) and living in areas of high socio-economic advantage. Respondents were slightly older than non-respondents (mean (SD) age 65.6 (17.0) versus 60.6 (20.8) years) and included proportionately less females (51.9 versus 59.1%) but were similar with regard to other socio-demographic factors and health service use. Participants who did not speak English at home, reported lower scores across several HLQ scales, including those that measure health provider support and engagement. Those who smoked and reported low physical activity had lower scores for actively managing their health. No relationship was seen between HLQ scale scores and use of hospital services. Conclusions Based upon the health literacy profile of a large cohort of patients attending a large private hospital, we found no relationship between HLQ scale scores and use of hospital services. However we did identify significant health literacy needs particularly among patients whose primary language at home was not English and patients needing assistance completing the survey. Identifying ways of addressing these needs may improve patient outcomes.
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Affiliation(s)
- Allison Bourne
- Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale Street, Malvern, VIC, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
| | - Shehzaad Peerbux
- Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale Street, Malvern, VIC, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
| | - Rebecca Jessup
- Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale Street, Malvern, VIC, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
| | - Margaret Staples
- Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale Street, Malvern, VIC, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
| | - Alison Beauchamp
- Department of Medicine, Western Health, The University of Melbourne, Sunshine Hospital, Level 3, 176 Furlong Road, WCHRE Building, St Albans, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Sunshine Hospital, Level 3, 176 Furlong Road, WCHRE Building, St Albans, VIC, Australia.,Health Systems Improvement Unit, Deakin University, 221 Burwood Highway, Burwood, VIC, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale Street, Malvern, VIC, Australia. .,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia.
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O'Hara J, Hawkins M, Batterham R, Dodson S, Osborne RH, Beauchamp A. Conceptualisation and development of the Conversational Health Literacy Assessment Tool (CHAT). BMC Health Serv Res 2018; 18:199. [PMID: 29566755 PMCID: PMC5863801 DOI: 10.1186/s12913-018-3037-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 03/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to develop a tool to support health workers’ ability to identify patients’ multidimensional health literacy strengths and challenges. The tool was intended to be suitable for administration in healthcare settings where health workers must identify health literacy priorities as the basis for person-centred care. Methods Development was based on a qualitative co-design process that used the Health Literacy Questionnaire (HLQ) as a framework to generate questions. Health workers were recruited to participate in an online consultation, a workshop, and two rounds of pilot testing. Results Participating health workers identified and refined ten questions that target five areas of assessment: supportive professional relationships, supportive personal relationships, health information access and comprehension, current health behaviours, and health promotion barriers and support. Conclusions Preliminary evidence suggests that application of the Conversational Health Literacy Assessment Tool (CHAT) can support health workers to better understand the health literacy challenges and supportive resources of their patients. As an integrated clinical process, the CHAT can supplement existing intake and assessment procedures across healthcare settings to give insight into patients’ circumstances so that decisions about care can be tailored to be more appropriate and effective.
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Affiliation(s)
- Jonathan O'Hara
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia
| | - Melanie Hawkins
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia
| | - Roy Batterham
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia.,Faculty of Economics, Dhurakij Pundit University, Bangkok, Thailand
| | - Sarity Dodson
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia.,The Fred Hollows Foundation, Melbourne, Australia
| | - Richard H Osborne
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia
| | - Alison Beauchamp
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia. .,Department of Rural Health, Monash University, Moe, Australia.
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Storms H, Claes N, Aertgeerts B, Van den Broucke S. Measuring health literacy among low literate people: an exploratory feasibility study with the HLS-EU questionnaire. BMC Public Health 2017; 17:475. [PMID: 28526009 PMCID: PMC5438531 DOI: 10.1186/s12889-017-4391-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Health literacy (HL) is defined as necessary competencies to make well-informed decisions. As patients’ decision making is a key element of patient-centered health care, insight in patients’ HL might help healthcare professionals to organize their care accordingly. This is particularly true for people in a vulnerable situation, potentially with limited HL, who are, for instance, at greater risk of having limited access to care [1, 2]. As HL correlates with education, instruments should allow inclusion of low literate people. To that end, the relatively new instrument, HLS-EU-Q47, was subjected to a comprehensibility test, its shorter version, HLS-EU-Q16, was not. Therefore, the goal of this study was to examine feasibility of HLS-EU-Q16 (in Dutch) for use in a population of people with low literacy. Methods Purposive sampling of adults with low (yearly) income (< €16,965.47) and limited education (maximum high school), with Dutch language proficiency. Exclusion criteria were: psychiatric, neurodegenerative diseases or impairments. To determine suitability (length, comprehension and layout) participants were randomly distributed either HLS-EU-Q16 or a modified version and were interviewed directly afterwards by one researcher. To determine feasibility a qualitative approach was chosen: cognitive interviews were carried out using the verbal probing technique. Results Thirteen participants completed HLS-EU-Q16 (n = 7) or the modified version (n = 6). Questions about ‘disease prevention’ or ‘appraisal’ of information are frequently reported to be incomprehensible. Difficulties are attributed to vocabulary, sentence structure and the decision process (abstraction, distinguishing ‘appraising’ from ‘applying’ information, indecisive on the appropriate response). Conclusions HLS-EU-Q16 is a suitable instrument to determine HL in people with limited literacy. However, to facilitate the use and interpretation, some questions would benefit from minor adjustments: by simplifying wording or providing explanatory, contextual information. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4391-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannelore Storms
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. .,Campus Diepenbeek, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Gebouw D, B-3590, Diepenbeek, Belgium.
| | - Neree Claes
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Campus Diepenbeek, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Gebouw D, B-3590, Diepenbeek, Belgium
| | - Bert Aertgeerts
- Academic Center for General Practice, KU Leuven - University of Leuven, Leuven, Belgium.,Academic Center for General Practice, Kapucijnenvoer 33 blok j, bus 7001, B-3000, Leuven, Belgium
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium.,IPSY - Place Cardinal Mercier 10 bte L3.05.01, B-1348, Louvain-la-Neuve, Belgium
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Nguyen TH, Park H, Han HR, Chan KS, Paasche-Orlow MK, Haun J, Kim MT. State of the science of health literacy measures: Validity implications for minority populations. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)30021-5. [PMID: 26275841 PMCID: PMC4732928 DOI: 10.1016/j.pec.2015.07.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 07/07/2015] [Accepted: 07/15/2015] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To review the evidence supporting the validity of health literacy (HL) measures for ethnic minority populations. METHODS PubMed, CINAHL, and PsycINFO databases were searched for HL measures between 1965 and 2013. RESULTS A total of 109HL measures were identified; 37 were non-English HL measures and 72 were English language measures. Of the 72 English language measures, 17 did not specify the racial/ethnic characteristic of their sample. Of the remaining 55 measures, 10 (18%) did not include blacks, 30 (55%) did not include Hispanics, and 35 (64%) did not include Asians in their validation sample. When Hispanic and Asian Americans were included, they accounted for small percentages in the overall sample. Between 2005-2013, a growing number of REALM and TOFHLA translations were identified, and new HL measures for specific cultural/linguistic groups within and outside the United States were developed. CONCLUSIONS While there are a growing number of new and translated HL measures for minority populations, many existing HL measures have not been properly validated for minority groups. PRACTICE IMPLICATIONS HL measures that have not been properly validated for a given population should be piloted before wider use. In addition, improving HL instrument development/validation methods are imperative to increase the validity of these measures for minority populations.
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Affiliation(s)
- Tam H Nguyen
- School of Nursing, Boston College, Chestnut Hill, USA.
| | | | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, USA
| | - Kitty S Chan
- School of Public Health, Johns Hopkins University, Baltimore, USA
| | | | - Jolie Haun
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, USA; Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, USA
| | - Miyong T Kim
- School of Nursing, University of Texas at Austin, Austin, USA
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15
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Wang C, Kane RL, Xu D, Meng Q. Health literacy as a moderator of health-related quality of life responses to chronic disease among Chinese rural women. BMC WOMENS HEALTH 2015; 15:34. [PMID: 25887361 PMCID: PMC4399716 DOI: 10.1186/s12905-015-0190-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/23/2015] [Indexed: 11/23/2022]
Abstract
Background Chronic disease is the leading global health threat and impairs patients’ health-related quality of life (HRQoL). Low health literacy is linked with chronic diseases prevalence and poor HRQoL. However, the interaction of health literacy with chronic disease on HRQoL remains unknown. Therefore, we examined how health literacy might modify the association between chronic disease and their HRQoL impacts. Methods We conducted a health survey of 913 poor rural women aged 23–57 years in Northwestern China. We assessed health literacy and HRQol using the revised Chinese Adult Health Literacy Questionnaire (R-CAHLQ) and Euroqol-5D (EQ-5D), respectively. Low health literacy was indicated by a cut-off of less than the mean of the factor score. Self-reported preexisting physician-diagnosed chronic disease and socio-demographic characteristics were also included. We fitted log-binomial regression models for each dimension of EQ-5D to examine its association with health literacy and chronic disease. We also ran linear regression models for EQ VAS scores and utility scores. Results The low health literacy group was 1.33 times more likely to have a chronic disease than the high health literacy group. Pain/discomfort was the most prevalent impairment, and was more common in the low health literacy group (PR [prevalence ratio] = 1.23; 95% CI = 1.01, 1.50). Chronic disease strongly predicted impairments in all the EQ-5D dimensions, with PRs ranging from 2.14 to 4.07. The association between chronic disease and pain/discomfort varied by health literacy level (health literacy × chronic disease: P = 0.033), and was less pronounced in the low health literacy group (PR = 2.15; 95% CI = 1.76, 2.64) than in the high health literacy group (PR = 3.19; 95% CI = 2.52, 4.05). The low health literacy group had lower VAS scores and utility scores, and slightly less decrement of VAS scores and utility scores associated with chronic disease. Conclusions Health literacy modified the impacts of chronic disease on HRQoL, and low health literacy group reported less HRQoL impacts related to chronic disease. Research should address health literacy issues as well as root causes of health disparities for vulnerable populations.
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Affiliation(s)
- Cuili Wang
- Shandong University School of Nursing, Jinan, 250012, China.
| | - Robert L Kane
- University of Minnesota School of Public Health, Minneapolis, 55455, US.
| | - Dongjuan Xu
- Shandong University School of Nursing, Jinan, 250012, China. .,University of Minnesota School of Public Health, Minneapolis, 55455, US.
| | - Qingyue Meng
- Peking University China Center for Health Development Studies, Beijing, 100191, China.
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Children with mental versus physical health problems: differences in perceived disease severity, health care service utilization and parental health literacy. Soc Psychiatry Psychiatr Epidemiol 2015; 50:407-18. [PMID: 25085110 DOI: 10.1007/s00127-014-0944-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/28/2014] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare children with mental and physical health problems regarding (1) perceived disease severity; (2) the impact of their condition on their families; (3) their utilization of health care services (including satisfaction with care); and (4) parents' health literacy about their child's condition and its treatment. Furthermore, we examined whether parents' health literacy differs between types of mental health condition. METHODS Parental reports about their 9- to 14-year-old children with mental (n = 785) or physical health problems (n = 475) were analyzed from the population-based National Survey of Children with Special Health Care Needs in Switzerland. RESULTS Mental health problems were perceived as being more severe (p < 0.001) and exerting a larger impact upon the family (e.g., financial impact) than physical health problems. Furthermore, fewer parents of children with a mental health problem mentioned having a particular person or place to contact if they needed information or advice regarding the child's condition (p = 0.004) and were satisfied with the health care services their child received (p < 0.001). The odds of low health literacy was higher among parents with children suffering from mental health problems vs. parents of children with physical health problems (OR in the adjusted model = 1.92; 95 % CI 1.47-2.50; p < 0.001); this finding held generally for mental health problem (although only a trend was observable for internalizing problems). CONCLUSIONS The large impact of children's mental health conditions on themselves and their families might be reduced by adapting the provision of health care and by increasing parents' health literacy.
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Altin SV, Finke I, Kautz-Freimuth S, Stock S. The evolution of health literacy assessment tools: a systematic review. BMC Public Health 2014; 14:1207. [PMID: 25418011 PMCID: PMC4289240 DOI: 10.1186/1471-2458-14-1207] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health literacy (HL) is seen as an increasingly relevant issue for global public health and requires a reliable and comprehensive operationalization. By now, there is limited evidence on how the development of tools measuring HL proceeded in recent years and if scholars considered existing methodological guidance when developing an instrument. METHODS We performed a systematic review of generic measurement tools developed to assess HL by searching PubMed, ERIC, CINAHL and Web of Knowledge (2009 forward). Two reviewers independently reviewed abstracts/ full text articles for inclusion according to predefined criteria. Additionally we conducted a reporting quality appraisal according to the survey reporting guideline SURGE. RESULTS We identified 17 articles reporting on the development and validation of 17 instruments measuring health literacy. More than two thirds of all instruments are based on a multidimensional construct of health literacy. Moreover, there is a trend towards a mixed measurement (self-report and direct test) of health literacy with 41% of instruments applying it, though results strongly indicate a weakness of coherence between the underlying constructs measured. Overall, almost every third instrument is based on assessment formats modeled on already existing functional literacy screeners such as the REALM or the TOFHLA and 30% of the included articles do not report on significant reporting features specified in the SURGE guideline. CONCLUSIONS Scholars recently developing instruments that measure health literacy mainly comply with recommendations of the academic circle by applying multidimensional constructs and mixing up measurement approaches to capture health literacy comprehensively. Nonetheless, there is still a dependence on assessment formats, rooted in functional literacy measurement contradicting the widespread call for new instruments. All things considered, there is no clear "consensus" on HL measurement but a convergence to more comprehensive tools. Giving attention to this finding can help to offer direction towards the development of comparable and reliable health literacy assessment tools that effectively respond to the informational needs of populations.
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Affiliation(s)
- Sibel Vildan Altin
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Gleuelerstr 176-178 50935, Cologne.
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Toçi E, Burazeri G, Sørensen K, Kamberi H, Brand H. Concurrent validation of two key health literacy instruments in a South Eastern European population. Eur J Public Health 2014; 25:482-6. [PMID: 25395401 DOI: 10.1093/eurpub/cku190] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Public health practice has come to increasing recognition of health promotion and the central role of knowledge, attitude, beliefs and practices in achieving health promotion. Health literacy (HL) is an under-explored topic in South Eastern European countries. There are no HL reports from Albania to date. The aim of this study was to assess the concurrent validity of the European Health Literacy Survey Questionnaire (HLS-EU-Q) and the Test of Functional Health Literacy in Adults (TOFHLA) in a population-based sample of adults in Albania. METHODS A cross-sectional study was conducted in 2013 in Tirana, Albania, including 239 individuals aged ≥ 18 years (61% women; 87% response). A structured interviewer-administered questionnaire was applied twice (test and retest procedure after 2 weeks) including HLS-EU-Q and TOFHLA instruments. RESULTS The internal consistency was high for both instruments (Cronbach's alpha for the test procedure was 0.92 for TOFHLA and 0.98 for HLS-EU-Q). Both tools exhibited a high stability over time (Spearman's rho: 0.88 for TOFHLA and 0.87 for HLS-EU). Mean values of both instruments were similar in men and women (mean score for TOFHLA: 76.0 vs. 76.5, P = 0.83; mean score for HLS-EU-Q: 32.2 vs. 32.6, P = 0.63). For both instruments, higher HL scores were significantly associated with younger age, higher educational and economic level and lower body mass index. CONCLUSIONS Our study provides valuable novel evidence on concurrent validation of two major HL instruments in a South Eastern European population-based sample. Future studies should be conducted in order to confirm and expand our findings.
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Affiliation(s)
- Ervin Toçi
- 1 Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands 2 Faculty of Public Health, University of Medicine, Tirana, Albania
| | - Genc Burazeri
- 1 Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands 2 Faculty of Public Health, University of Medicine, Tirana, Albania
| | - Kristine Sørensen
- 1 Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Helmut Brand
- 1 Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Haun JN, Valerio MA, McCormack LA, Sørensen K, Paasche-Orlow MK. Health literacy measurement: an inventory and descriptive summary of 51 instruments. JOURNAL OF HEALTH COMMUNICATION 2014; 19 Suppl 2:302-333. [PMID: 25315600 DOI: 10.1080/10810730.2014.936571] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article aimed to provide a descriptive review of the psychometric properties and conceptual dimensions of published health literacy measurement tools. PsycINFO and PubMed search from 1999 through 2013, review of the grey literature, and an environmental scan was conducted to identify health literacy measurement tools. For each tool, we evaluated the conceptual dimensions assessed, test parameters, and psychometric properties. Of the 51 tools identified, 26 measured general health literacy, and 15 were disease or content specific, and 10 aimed at specific populations. Most tools are performance based, require in-person administration, and are exclusively available in a pencil and paper testing mode. The tools assess 0 (proxy measure) to 9 of the 11 defined dimensions of health literacy. Reported administration times vary, from less than 1 to 60 minutes. Validation procedures for most of the tools are limited by inadequate power to ensure reliability across subgroups (i.e., race, age, ethnicity, and gender). The health literacy measurement tools currently available generally represent a narrow set of conceptual dimensions with limited modes of administration. Most of the tools lack information on key psychometric properties. Significant work is needed to establish important aspects of the construct, convergent, and predictive validity for many tools. As researchers develop new measures, inclusion of a full range of conceptual dimensions of health literacy, more representative sampling for testing, and additional modes of administration will allow a more refined and flexible approach to research in this field.
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Affiliation(s)
- Jolie N Haun
- a Veterans Health Administration, HSR&D Center of Innovation for Disability and Rehabilitation Research , James A. Haley VA Hospital
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20
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Sørensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, Kondilis B, Stoffels V, Osborne RH, Brand H. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health 2013; 13:948. [PMID: 24112855 PMCID: PMC4016258 DOI: 10.1186/1471-2458-13-948] [Citation(s) in RCA: 538] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several measurement tools have been developed to measure health literacy. The tools vary in their approach and design, but few have focused on comprehensive health literacy in populations. This paper describes the design and development of the European Health Literacy Survey Questionnaire (HLS-EU-Q), an innovative, comprehensive tool to measure health literacy in populations. METHODS Based on a conceptual model and definition, the process involved item development, pre-testing, field-testing, external consultation, plain language check, and translation from English to Bulgarian, Dutch, German, Greek, Polish, and Spanish. RESULTS The development process resulted in the HLS-EU-Q, which entailed two sections, a core health literacy section and a section on determinants and outcomes associated to health literacy. The health literacy section included 47 items addressing self-reported difficulties in accessing, understanding, appraising and applying information in tasks concerning decisions making in healthcare, disease prevention, and health promotion. The second section included items related to, health behaviour, health status, health service use, community participation, socio-demographic and socio-economic factors. CONCLUSIONS By illuminating the detailed steps in the design and development process of the HLS-EU-Q, it is the aim to provide a deeper understanding of its purpose, its capability and its limitations for others using the tool. By stimulating a wide application it is the vision that HLS-EU-Q will be validated in more countries to enhance the understanding of health literacy in different populations.
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Affiliation(s)
- Kristine Sørensen
- Department of International Health, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, P,O, Box 616, 6200, Maastricht, MD, the Netherlands.
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Dermota P, Wang J, Dey M, Gmel G, Studer J, Mohler-Kuo M. Health literacy and substance use in young Swiss men. Int J Public Health 2013; 58:939-48. [PMID: 23842581 DOI: 10.1007/s00038-013-0487-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 05/28/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The purpose of the present study was to describe health literacy and its association with substance use among young men. METHODS The present study was part of the Cohort Study on Substance Use Risk Factors that included 11,930 Swiss males participating in initial screening from August 2010 to July 2011. Self-completed questionnaires covered use of three substances and three components of health literacy. RESULTS Roughly 22 % reported having searched the Internet for health information and 16 % for information on substances over the past 12 months. At-risk and not at-risk users of alcohol (adjusted odds ratio (AOR) = 2.50 and 1.46), tobacco (AOR = 2.51 and 1.79) and cannabis (AOR = 4.86 and 3.53) searched for information about substances significantly more often via the Internet than abstainers. Furthermore, at-risk users reported better knowledge of risks associated with substance use and a marginally better ability to understand health information than abstainers. CONCLUSIONS Substance users appear to be more informed and knowledgeable about the risks of substance use than non-users. Consequently, interventions that focus only on information provision may be of limited benefit for preventing substance use.
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Affiliation(s)
- Petra Dermota
- Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland,
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van der Heide I, Rademakers J, Schipper M, Droomers M, Sørensen K, Uiters E. Health literacy of Dutch adults: a cross sectional survey. BMC Public Health 2013; 13:179. [PMID: 23445541 PMCID: PMC3599856 DOI: 10.1186/1471-2458-13-179] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 02/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relatively little knowledge is available to date about health literacy among the general population in Europe. It is important to gain insights into health literacy competences among the general population, as this might contribute to more effective health promotion and help clarify socio-economic disparities in health. This paper is part of the European Health Literacy Survey (HLS-EU). It aims to add to the body of theoretical knowledge about health literacy by measuring perceived difficulties with health information in various domains of health, looking at a number of competences. The definition and measure of health literacy is still topic of debate and hardly any instruments are available that are applicable for the general population. The objectives were to obtain an initial measure of health literacy in a sample of the general population in the Netherlands and to relate this measure to education, income, perceived social status, age, and sex. METHODS The HLS-EU questionnaire was administered face-to-face in a sample of 925 Dutch adults, during July 2011. Perceived difficulties with the health literacy competences for accessing, understanding, appraising and applying information were measured within the domains of healthcare, disease prevention and health promotion. Multiple linear regression analyses were applied to explore the associations between health literacy competences and education, income, perceived social status, age, and sex. RESULTS Perceived difficulties with health information and their association with demographic and socio-economic variables vary according to the competence and health domain addressed. Having a low level of education or a low perceived social status or being male were consistently found to be significantly related to relatively low health literacy scores, mainly for accessing and understanding health information. CONCLUSIONS Perceived difficulties with health information vary between competences and domains of health. Health literacy competences are associated with indicators of socio-economic position and with the domain in which health information is provided.
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Affiliation(s)
- Iris van der Heide
- Centre for Nutrition, Prevention and health Services, National Institute for Public Health and Environment, Bilthoven, Netherlands.
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van der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E. The relationship between health, education, and health literacy: results from the Dutch Adult Literacy and Life Skills Survey. JOURNAL OF HEALTH COMMUNICATION 2013; 18 Suppl 1:172-84. [PMID: 24093354 PMCID: PMC3814618 DOI: 10.1080/10810730.2013.825668] [Citation(s) in RCA: 414] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Health literacy has been put forward as a potential mechanism explaining the well-documented relationship between education and health. However, little empirical research has been undertaken to explore this hypothesis. The present study aims to study whether health literacy could be a pathway by which level of education affects health status. Health literacy was measured by the Health Activities and Literacy Scale, using data from a subsample of 5,136 adults between the ages of 25 and 65 years, gathered within the context of the 2007 Dutch Adult Literacy and Life Skills Survey. Linear regression analyses were used in separate models to estimate the extent to which health literacy mediates educational disparities in self-reported general health, physical health status, and mental health status as measured by the Short Form-12. Health literacy was found to partially mediate the association between low education and low self-reported health status. As such, improving health literacy may be a useful strategy for reducing disparities in health related to education, as health literacy appears to play a role in explaining the underlying mechanism driving the relationship between low level of education and poor health.
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Affiliation(s)
- Iris van der Heide
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, and The Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Address correspondence to Iris van der Heide, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Post Box 1, 3720 BA Bilthoven, The Netherlands. E-mail:
| | - Jen Wang
- Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Mariël Droomers
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Jany Rademakers
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Ellen Uiters
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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