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Naigaga DA, Kavanagh J, Spillane A, Hickey L, Scott K, Morrissey J, Elmer S, Goss H, Murrin C. Using co-design to develop the Adolescent Health Literacy Questionnaire for adolescents in Ireland. Health Promot Int 2024; 39:daae009. [PMID: 38365191 PMCID: PMC10873780 DOI: 10.1093/heapro/daae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Health literacy measurement studies are important for the success of health promotion efforts targeting adolescents. However, the majority of health literacy measurement tools were originally developed for adult populations and may not be reflective of health literacy in the context of adolescence. The present study sought to co-design a health literacy questionnaire and vignettes for adolescents in Ireland aged 12-18 years. This article describes the qualitative phase of the study. In 2019-2021, eight adolescents from the Irish Heart Foundation's Youth Advisory Panel participated in two concept mapping workshops during which they defined healthy living. Results of the thematic analysis indicated that adolescents defined 'healthy living' as a life that was balanced, prioritizing mental health and sleep. According to their definition, healthy living was comprised of six main constructs, namely, knowledge; sources of quality health information; facilitators and barriers; influence of others; self-efficacy, self-management and resilience; and citizenship and communication. These constructs were used to develop vignettes and items for the Adolescent Health Literacy Questionnaire (AHLQ). These were tested on a sample of 80 adolescents to check whether the respondents understood the items and vignettes as intended. Results of the nine cognitive interviews indicated that the adolescents understood the content of the 10 vignettes and 41 items. While the vignettes and AHLQ were developed with Irish adolescents, the approaches taken can be generalized to adolescents living in other countries. This will allow for the development of tailored and relevant solutions for health literacy development and health promotion for this sub-population.
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Affiliation(s)
- Desire Alice Naigaga
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, 4 Stillorgan Road, Dublin 4, Ireland
| | | | | | - Laura Hickey
- Irish Heart Foundation, Rathmines Rd Lower, Dublin 6, Ireland
| | - Katherine Scott
- Irish Heart Foundation, Rathmines Rd Lower, Dublin 6, Ireland
| | - Janis Morrissey
- Irish Heart Foundation, Rathmines Rd Lower, Dublin 6, Ireland
| | - Shandell Elmer
- School of Nursing, College of Health and Medicine, University of Tasmania, 71 Brooker Avenue, Glebe, TAS 7000, Australia
| | - Hannah Goss
- School of Health and Human Performance, Dublin City University, Whitehall, Dublin 9, Ireland
| | - Celine Murrin
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, 4 Stillorgan Road, Dublin 4, Ireland
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Pelikan JM, Link T, Straßmayr C, Waldherr K, Alfers T, Bøggild H, Griebler R, Lopatina M, Mikšová D, Nielsen MG, Peer S, Vrdelja M. Measuring Comprehensive, General Health Literacy in the General Adult Population: The Development and Validation of the HLS 19-Q12 Instrument in Seventeen Countries. Int J Environ Res Public Health 2022; 19:14129. [PMID: 36361025 PMCID: PMC9659295 DOI: 10.3390/ijerph192114129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND For improving health literacy (HL) by national and international public health policy, measuring population HL by a comprehensive instrument is needed. A short instrument, the HLS19-Q12 based on the HLS-EU-Q47, was developed, translated, applied, and validated in 17 countries in the WHO European Region. METHODS For factorial validity/dimensionality, Cronbach alphas, confirmatory factor analysis (CFA), Rasch model (RM), and Partial Credit Model (PCM) were used. For discriminant validity, correlation analysis, and for concurrent predictive validity, linear regression analysis were carried out. RESULTS The Cronbach alpha coefficients are above 0.7. The fit indices for the single-factor CFAs indicate a good model fit. Some items show differential item functioning in certain country data sets. The regression analyses demonstrate an association of the HLS19-Q12 score with social determinants and selected consequences of HL. The HLS19-Q12 score correlates sufficiently highly (r ≥ 0.897) with the equivalent score for the HLS19-Q47 long form. CONCLUSIONS The HLS19-Q12, based on a comprehensive understanding of HL, shows acceptable psychometric and validity characteristics for different languages, country contexts, and methods of data collection, and is suitable for measuring HL in general, national, adult populations. There are also indications for further improvement of the instrument.
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Affiliation(s)
- Jürgen M. Pelikan
- Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria
- HLS19 International Coordination Center at the Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Thomas Link
- Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, and HLS19 International Coordination Center at the Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Christa Straßmayr
- Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria
- HLS19 International Coordination Center at the Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Karin Waldherr
- Ferdinand Porsche FernFH, A-2700 Wiener Neustadt, Austria
| | - Tobias Alfers
- Department of Education and Psychology, Freie Universität Berlin, 14195 Berlin, Germany
| | - Henrik Bøggild
- Public Health and Epidemiology, Health Science and Technology, Aalborg University, DK-9220 Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Robert Griebler
- Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria
- HLS19 International Coordination Center at the Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Maria Lopatina
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Health of the Russian Federation, 101000 Moscow, Russia
| | - Dominika Mikšová
- Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, and HLS19 International Coordination Center at the Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Marie Germund Nielsen
- Public Health and Epidemiology, Health Science and Technology, Aalborg University, DK-9220 Aalborg, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Sandra Peer
- Institute for Water Quality and Resource Management, TU Wien, A-1040 Vienna, Austria
| | - Mitja Vrdelja
- National Institute of Public Health, 1000 Ljubljana, Slovenia
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Budhathoki SS, Hawkins M, Elsworth G, Fahey MT, Thapa J, Karki S, Basnet LB, Pokharel PK, Osborne RH. Use of the English Health Literacy Questionnaire (HLQ) with Health Science University Students in Nepal: A Validity Testing Study. Int J Environ Res Public Health 2022; 19:3241. [PMID: 35328928 DOI: 10.3390/ijerph19063241] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022]
Abstract
Research evidence shows that health literacy development is a key factor influencing non-communicable diseases care and patient outcomes. Healthcare professionals with strong health literacy skills are essential for providing quality care. We aimed to report the validation testing of the Health Literacy Questionnaire (HLQ) among health professional students in Nepal. A cross-sectional study was conducted with 419 health sciences students using the HLQ in Nepal. Validation testing and reporting were conducted using five sources outlined by ‘the 2014 Standards for Educational and Psychological Testing’. The average difficulty was lowest (17.4%) for Scale 4. Social support for health, and highest (51.9%) for Scale 6. Ability to actively engage with healthcare providers. One factor Confirmatory Factor Analysis (CFA) model showed a good fit for Scale 2, Scale 7 and Scale 9 and a reasonable fit for Scale 3 and Scale 4. The restricted nine-factor CFA model showed a satisfactory level of fit. The use of HLQ is seen to be meaningful in Nepal and warrants translation into native Nepali and other dominant local languages with careful consideration of cultural appropriateness using cognitive interviews.
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Choudhry FR, Ming LC, Munawar K, Zaidi STR, Patel RP, Khan TM, Elmer S. Health Literacy Studies Conducted in Australia: A Scoping Review. Int J Environ Res Public Health 2019; 16:E1112. [PMID: 30925706 PMCID: PMC6479782 DOI: 10.3390/ijerph16071112] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 02/07/2023]
Abstract
Health literacy (HL) is an essential component of various literacies mentioned in the field of health and education, including cultural, technological, media and scientific literacies. It is important for motivating higher consumer engagement. We aimed to review previous studies of HL in Australia to inform future studies, extend current knowledge and further enhance HL. Using search strings, a systematic search of four databases (i.e., MEDLINE; Embase; CINAHL and Eric) was carried out. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) based search strategy led to identification of a total of N = 9696 records, that were further screened for inclusion in the review. The review findings were categorized into three major themes: (1) HL and health numeracy; (2) contrast of: knowledge deficiency, knowledge gained, problems of current health care system and (3) HL measurement methods and its domains. The findings from this scoping review show a dearth of measurement tools with sound psychometric properties for assessing HL. The findings also reveal low levels of HL in consumers which is in turn affecting health-related behaviors, utilization of health services and navigation of the health system. More recent developments have tried to integrate vital aspects, including introduction of applications to increase HL and exploring HL in Aboriginal communities.
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Affiliation(s)
- Fahad Riaz Choudhry
- National Institute of Psychology, Quaid-i-Azam University, Islamabad 44000, Pakistan.
- Department of Psychology, Kulliyyah of Islamic Revealed Knowledge and Human Sciences, International Islamic University Malaysia, Kuala Lumpur 53100, Malaysia.
| | - Long Chiau Ming
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia.
- Faculty of Pharmacy, Quest International University Perak, Ipoh 30250, Perak, Malaysia.
| | - Khadeeja Munawar
- Department of Psychology, Jeffrey Cheah School of Medicine & Health Sciences, Monash University, Sunway City 47500, Selangor, Malaysia.
- Department of Psychology, University of Wah, Punjab 47000, Pakistan.
| | | | - Rahul P Patel
- Faculty of Pharmacy, Quest International University Perak, Ipoh 30250, Perak, Malaysia.
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Science, University of Veterinary & Animal Sciences, Lahore 54700, Pakistan.
- School of Pharmacy, Monash University Malaysia, Sunway City 45700, Selangor, Malaysia.
| | - Shandell Elmer
- School of Medicine, College of Health and Medicine, University of Tasmania, Launceston 7250, Australia.
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Ramirez-Zohfeld V, Rademaker AW, Dolan NC, Ferreira MR, Eder M“M, Liu D, Wolf MS, Cameron KA. Comparing the Performance of the S-TOFHLA and NVS Among and Between English and Spanish Speakers. J Health Commun 2015; 20:1458-1464. [PMID: 26147770 PMCID: PMC4729300 DOI: 10.1080/10810730.2015.1018629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Given the growing body of evidence demonstrating the significant implications of health literacy on a myriad of outcomes, researchers continue to incorporate health literacy metrics in studies. With this proliferation in measurement of health literacy in research, it has become increasingly important to understand how various health literacy tools perform in specific populations. Our objective was to compare the performance of two widely used tests, the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Newest Vital Sign (NVS) among and between a sample of English and Spanish-speaking patients. Adults (N = 402) ages 50-75 years participating in a trial to promote colorectal cancer screening completed in-person interviews which included both measures of health literacy. In the full sample, the tests were moderately correlated (r = 0.69, p < .0001); however, there was a stronger correlation among those completing the test in Spanish (r = 0.83) as compared with English (r = 0.58, p < .0001). English speakers more often were categorized as having adequate literacy by the S-TOFHLA as compared with the NVS, whereas Spanish speakers scored consistently low on both instruments. These findings indicate that the categorization of participants into levels of literacy is likely to vary, depending on whether the NVS or S-TOFHLA is used for assessment, a factor which researchers should be aware of when selecting literacy assessments.
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Affiliation(s)
- Vanessa Ramirez-Zohfeld
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alfred W. Rademaker
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nancy C. Dolan
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern Medical Faculty Foundation, Chicago, IL
| | - M. Rosario Ferreira
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern Medical Faculty Foundation, Chicago, IL
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL
| | | | - Dachao Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael S. Wolf
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kenzie A. Cameron
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Advancing Equity in Clinical Preventive Services, Northwestern University, Chicago, IL
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