Measuring Comprehensive, General Health Literacy in the General Adult Population: The Development and Validation of the HLS 19 -Q12 Instrument in Seventeen Countries

Jürgen M. Pelikan, Thomas Link, Christa Straßmayr (), Karin Waldherr, Tobias Alfers, Henrik Bøggild, Robert Griebler, Maria Lopatina, Dominika Mikšová, Marie Germund Nielsen, Sandra Peer and Mitja Vrdelja
Additional contact information
Jürgen M. Pelikan: Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria
Thomas Link: Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, and HLS 19 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
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
Robert Griebler: Competence Centre for Health Promotion and Health System, 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 HLS 19 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
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

IJERPH, 2022, vol. 19, issue 21, 1-31

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 HLS 19 -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 HLS 19 -Q12 score with social determinants and selected consequences of HL. The HLS 19 -Q12 score correlates sufficiently highly (r ≥ 0.897) with the equivalent score for the HLS 19 -Q47 long form. Conclusions: The HLS 19 -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.

Keywords: health literacy measurement; instrument development; validation; HLS 19; HLS 19 -Q12; national adult population (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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