Abstract
Health literacy is an important construct in population health and healthcare requiring rigorous measurement. The Health Literacy Questionnaire (HLQ), with nine scales, measures a broad perception of health literacy. This study aimed to adapt the HLQ to the Danish setting, and to examine the factor structure, homogeneity, reliability and discriminant validity. The HLQ was adapted using forward–backward translation, consensus conference and cognitive interviews (n = 15). Psychometric properties were examined based on data collected by face-to-face interview (n = 481). Tests included difficulty level, composite scale reliability and confirmatory factor analysis (CFA). Cognitive testing revealed that only minor re-wording was required. The easiest scale to respond to positively was ‘Social support for health’, and the hardest were ‘Navigating the healthcare system’ and ‘Appraisal of health information’. CFA of the individual scales showed acceptably high loadings (range 0.49–0.93). CFA fit statistics after including correlated residuals were good for seven scales, acceptable for one. Composite reliability and Cronbach’s α were >0.8 for all but one scale. A nine-factor CFA model was fitted to items with no cross-loadings or correlated residuals allowed. Given this restricted model, the fit was satisfactory. The HLQ appears robust for its intended application of assessing health literacy in a range of settings. Further work is required to demonstrate sensitivity to measure changes.
Highlights
The complexity of modern healthcare and the many health messages being promoted have led to health literacy being a key consideration for health promotion and improving the quality of health services (Nutbeam 2000; Protheroe et al 2009; Sørensen et al 2012; Kickbusch et al 2013; Norgaard et al 2014)
Just over a quarter of respondents lived in the capital area of Denmark and 63 % lived in other Danish cities across different geographical regions
The use of modern psychometric procedures permitted the application of highly demanding tests, and the analysis has clearly shown that the Health Literacy Questionnaire (HLQ) multi-dimensional construct of health literacy comprises nine separate and cogent scales
Summary
The complexity of modern healthcare and the many health messages being promoted have led to health literacy being a key consideration for health promotion and improving the quality of health services (Nutbeam 2000; Protheroe et al 2009; Sørensen et al 2012; Kickbusch et al 2013; Norgaard et al 2014). The need for people to manage their health themselves, including using various health technologies, requires individuals to have a wide range of health literacy competencies. From the consumer’s perspective the required competencies include being able to read and understand health information, and being able to navigate the health system, communicate and engage with healthcare providers, engage in critical appraisal of health information, and advocate for one’s right to health services (HLS-EU Consortium 2012; Kickbusch et al 2013; Osborne et al 2013). There is, great potential to improve public health and clinical medicine by addressing health literacy in organisations on many. In Denmark, and many other countries, there is a need for data about population health literacy in order to cultivate an inclusive health system that meets the needs of individuals and diverse population groups (Sorensen et al 2014)
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