Top

Published in:

01-06-2017 | Original Article

Structural properties and psychometric improvements of the Health Literacy Questionnaire in a Slovak population

Authors: Peter Kolarcik, Eva Cepova, Andrea Madarasova Geckova, Gerald R. Elsworth, Roy W. Batterham, Richard H. Osborne

Published in: International Journal of Public Health | Issue 5/2017

Abstract

Objectives

Health literacy is an important determinant of health and health equity and therefore requires robust measurement. The aim was to examine the psychometric properties of the Slovak version of the Health Literacy Questionnaire (HLQ) including revised wording of response categories.

Methods

A cross-sectional survey of the general Slovak adult population (N = 360, mean age 39) was conducted with the HLQ following its translation and cultural adaptation. Psychometric tests (confirmatory factor analysis, Cronbach’s alpha, composite reliability) and association (linear regression, ANOVA) with sociodemographic variables were undertaken. The performance of alternative version of response options were explored with the Mann–Whittney U test and item response theory.

Results

A highly restrictive nine-factor confirmatory factor analysis showed acceptable fit [χ ²WLSMV = 1684 (df = 866), p < 0.0001; CFI = 0.943, TLI = 0.938, RMSEA = 0.051, WRMR = 1.297] and reliability was acceptable (range 0.73–0.84). The revised response categories had a better distribution with lower average scores in three domains, compared with the original, and improved item information curves.

Conclusions

The nine HLQ scales are robust, providing a fine-grained assessment of health literacy. The revised response options improve psychometric properties and are recommended for future studies.

Altin SV, Finke I, Kautz-Freimuth S, Stock S (2014) The evolution of health literacy assessment tools: a systematic review. BMC Public Health 14:1–24CrossRef

Andrich D (2013) An expanded derivation of the threshold structure of the polytomous Rasch model that dispels any “threshold disorder controversy. Educ Psychol Meas 73:78–124CrossRef

Australian Bureau of Statistics (2009) Health literacy. Australian Bureau of Statistics, Sydney

Barber MN, Staples M, Osborne RH, Clerehan R, Elder C, Buchbinder R (2009) Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey. Health Promot Int 24:252–261CrossRefPubMed

Batterham RW, Buchbinder R, Beauchamp A, Dodson S, Elsworth GR, Osborne RH (2014) The OPtimising HEalth LIterAcy (Ophelia) process: study protocol for using health literacy profiling and community engagement to create and implement health reform. BMC Public Health 14:694–694CrossRefPubMedPubMedCentral

Batterham RW, Hawkins M, Collins PA, Buchbinder R, Osborne RH (2016) Health literacy: applying current concepts to improve health services and reduce health inequalities. Public Health 132:3–12CrossRefPubMed

Beauchamp A, Buchbinder R, Dodson S, Batterham RW, Elsworth GR, McPhee C, Sparkes L, Hawkins M, Osborne RH (2015) Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ). BMC Public Health 15:1–13CrossRef

Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K (2011) Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 155:97–107CrossRefPubMed

Bo A, Friis K, Osborne RH, Maindal HT (2014) National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers—a population-based survey among Danish adults. BMC Public Health 14:1095CrossRefPubMedPubMedCentral

Davis TC, Williams MV, Marin E, Parker RM, Glass J (2002) Health Literacy and cancer communication. CA Cancer J Clin 52:134–149CrossRefPubMed

Dodson S, Good S, Osborne R (2015) Health Literacy Toolkit: for low- and middle-income countries. A series of information sheets to empower communities and strengthen health systems. World Health Organization, Regional Office for South-East Asia, New Delhi

Edwards M, Wood F, Davies M, Edwards A (2012) The development of health literacy in patients with a long-term health condition: the health literacy pathway model. BMC Public Health 12:130–144CrossRefPubMedPubMedCentral

European Commission (2015) Study on sound evidence for a better understanding of health literacy in the European Union. National Institute for Public Health and the Environment, Luxembourg

Friis K, Lasgaard M, Osborne RH, Maindal HT (2016) Gaps in understanding health and engagement with healthcare providers across common long-term conditions: a population survey of health literacy in 29,473 Danish citizens. BMJ Open 6:10CrossRef

Haun JN, Valerio MA, McCormack LA, Sørensen K, Paasche-Orlow M (2014) Health literacy measurement: an inventory and descriptive summary of 51 instruments. J Health Commun 19:302–333CrossRefPubMed

Heijmans M, Waverijn G, Rademakers J, van der Vaart, Rijken M (2015) Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management. Patient Educ Counsel 98:41–48CrossRef

HLS-EU Consortium (2012) Comparative report of health literacy in eight EU member states: the European Health Literacy Survey HLS-EU. Maastricht University, Mastricht

Howard DH, Sentell TL, Gazmararian JA (2006) Impact of health literacy on socioeconomic and racial differences in health in an elderly population. J Gen Intern Med 21:857–861CrossRefPubMedPubMedCentral

Hudon C, Fortin M, Poitras ME, Almirall J (2012) The relationship between literacy and multimorbidity in a primary care setting. BMC Fam Pract 13:33CrossRefPubMedPubMedCentral

Institute of Medicine (2004) Health literacy a prescription to end confusion. The National Academies, Washington DC

Jordan JE, Osborne RH, Buchbinder R (2011) Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses. J Clin Epidemiol 64:366–379CrossRefPubMed

Kanj M, Mitic W (2009) Health literacy and health promotion: definitions, concepts and examples in the eastern mediterranean region. Individual empowerment—conference working document. World Health Organization, Geneva

Maindal, HT, Kayser L, Norgaard O, Bo A, Elsworth GR, Osborne RH (2016) Cultural adaptation and validation of the Health Literacy Questionnaire (HLQ): robust nine-dimension Danish language confirmatory factor model. SpringerPlus 5:1232CrossRefPubMedPubMedCentral

Miller D, Brownlee C, McCoy T, Pignone M (2007) The effect of health literacy on knowledge and receipt of colorectal cancer screening: a survey study. BMC Fam Pract 8:1–7CrossRef

National Health Information Center (2014) Zubnolekárska starostlivosť v SR 2013. [Dental healthcare in Slovak Republic in 2013]. National Health Information Center, Bratislava

Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R (2013) The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health 13:1–17CrossRef

Pignone M, DeWalt DA, Sheridan S, Berkman N, Lohr KN (2005) Interventions to improve health outcomes for patients with low literacy. J Gen Intern Med 20:185–192CrossRefPubMedPubMedCentral

Pleasant A, McKinney J (2011) Coming to consensus on health literacy measurement: an online discussion and consensus-gauging process. Nurs Outlook 59:95–106CrossRefPubMed

Sentell T, Braun KL (2012) Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. J Health Commun 17:82–99CrossRefPubMedPubMedCentral

Sørensen K, Van dB, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H, (HLS-EU) Consortium Health Literacy, Project European (2012) Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 12:80CrossRefPubMedPubMedCentral

Sørensen K, Van dB, Pelikan JM, Fullam J, Doyle G, Slonska Z, Kondilis B, Stoffels V, Osborne RH, Brand H (2013) Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health 13:1–22CrossRef

Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, Fullam J, Kondilis B, Agrafiotis D, Uiters E, Falcon M, Mensing M, Tchamov K, Broucke S, Brand H, HLS-EU Consortium (2015) Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU) 25:3–6. doi:10.1093/eurpub/ckv043

Statistical Office of the Slovak Republic (2015) The 2011 population and Housing Census 2011: facts about changes in the life of the Slovak population. Statistical Office of the Slovak Republic, Bratislava

Toci E, Burazeri G, Jerliu N, Sorensen K, Ramadani N, Hysa B, Brand H (2015) Health literacy, self-perceived health and self-reported chronic morbidity among older people in Kosovo. Health Promot Int 30:667–674CrossRefPubMed

US Department of Health and Human Services (2008) America’s health literacy: why we need accessible health information. US Department of Health and Human Services, Washington, DC

van der Heide I, Rademakers J, Schipper M, Droomers M, Sørensen K, Uiters E (2013a) Health literacy of Dutch adults: a cross sectional survey. BMC Public Health 13:1–11CrossRef

van der Heide, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E (2013b) The relationship between health, education, and health literacy: results from the Dutch adult literacy and life lkills survey. J Health Commun 18:172–184CrossRefPubMedPubMedCentral

World Health Organization (1998) Health promotion glossary. World Health Organization, Geneva

Zumbo BD (1999) Handbook on the theory and methods of differential item functioning (DIF): logistic regression modelling as unitary framework for binary and likert-type (ordinal) item scores. Directorate of Human Resources Research and Evaluation, Department of National Defense, Ottawa

Title: Structural properties and psychometric improvements of the Health Literacy Questionnaire in a Slovak population
Authors: Peter Kolarcik
Eva Cepova
Andrea Madarasova Geckova
Gerald R. Elsworth
Roy W. Batterham
Richard H. Osborne
Publication date: 01-06-2017
Publisher: Springer International Publishing
Published in: International Journal of Public Health / Issue 5/2017
Print ISSN: 1661-8556
Electronic ISSN: 1661-8564
DOI: https://doi.org/10.1007/s00038-017-0945-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Structural properties and psychometric improvements of the Health Literacy Questionnaire in a Slovak population

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2017

Harmful drinking after job loss: a stronger association during the post-2008 economic crisis?

Acculturation and health-related quality of life: results from the German National Cohort migrant feasibility study

Influence of kindergarten on numbers of multiple developmental delays in preschoolers: an analysis over 14 years

Differences in healthy life expectancy between older migrants and non-migrants in three European countries over time

Gender Differences in the relationship between carbonated sugar-sweetened beverage intake and the likelihood of hypertension according to obesity

Measuring antenatal care use in Europe: is the content and timing of care in pregnancy tool applicable?