Health Literacy and Control of Glycaemia in Diabetes and Blood Pressure in Hypertension; A Study Based on Validated Sinhala Version of HLS-EU-Q16

Abstract

Aims: To validate Sinhala version of HLS-EU-Q16 and asses the relationship between level of health literacy and control of blood sugar among diabetics and blood pressure among hypertensives. 
 Study Design: This study evaluated the psychometric properties of Sinhala translation of HLS-EU-Q16 (HLS-EU-Q16-Sinhala) adhering to the standard methods. Following forward and backward translations, the Sinhala version of the questionnaire was applied to a group of 252 patients with chronic non-communicable diseases. Test-retest agreement was examined using a random subgroup of 120 patients. We assessed the association between the level of health literacy and the degree of glycaemic control among diabetics (n=1205, males 453) and blood pressure control among hypertensives (n=755, males 402) selected from outpatient department.
 Results: The HLS-EU-Q16-Sinhala total score ranged from 22 to 72 with mean(SD) of 52.1(7.7). The overall Cronbach alpha was 0.84 and the Corrected item-total correlation ranged from 0.32 to 0.60. The Interclass correlation coefficient (ICC) for the test-retest reliability was 0.65(95%CI; 0.55-0.71). Diabetics with “poor” glycaemic control had low HL (40.0) compared to those with “intermediate” (52.6) or “good” (52.1) control (P=.03), after adjusting for age, gender and education level. Similarly, hypertensives with “poor” blood pressure control had low HL (45.0) compared to “intermediate” (52.3) or “good” (53.5) control (P=.03), after adjusting for the same covariates.
 Conclusions: This study indicates that the psychometric indices of the Sinhala version of the HLS-EU-Q16 are adequate for it to be used to assess HL among Sinhala speaking subjects. Further, it shows that patients with poor HL fail to achieve their primary treatment goals in diabetes and hypertension.