Abstract
BackgroundHealth literacy has become an increasingly important concept in public health. We sought to develop a comprehensive measure of health literacy capable of diagnosing health literacy needs across individuals and organisations by utilizing perspectives from the general population, patients, practitioners and policymakers.MethodsUsing a validity-driven approach we undertook grounded consultations (workshops and interviews) to identify broad conceptually distinct domains. Questionnaire items were developed directly from the consultation data following a strict process aiming to capture the full range of experiences of people currently engaged in healthcare through to people in the general population. Psychometric analyses included confirmatory factor analysis (CFA) and item response theory. Cognitive interviews were used to ensure questions were understood as intended. Items were initially tested in a calibration sample from community health, home care and hospital settings (N=634) and then in a replication sample (N=405) comprising recent emergency department attendees.ResultsInitially 91 items were generated across 6 scales with agree/disagree response options and 5 scales with difficulty in undertaking tasks response options. Cognitive testing revealed that most items were well understood and only some minor re-wording was required. Psychometric testing of the calibration sample identified 34 poorly performing or conceptually redundant items and they were removed resulting in 10 scales. These were then tested in a replication sample and refined to yield 9 final scales comprising 44 items. A 9-factor CFA model was fitted to these items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ2WLSMV(866 d.f.) = 2927, p<0.000, CFI = 0.936, TLI = 0.930, RMSEA = 0.076, and WRMR = 1.698. Final scales included: Feeling understood and supported by healthcare providers; Having sufficient information to manage my health; Actively managing my health; Social support for health; Appraisal of health information; Ability to actively engage with healthcare providers; Navigating the healthcare system; Ability to find good health information; and Understand health information well enough to know what to do.ConclusionsThe HLQ covers 9 conceptually distinct areas of health literacy to assess the needs and challenges of a wide range of people and organisations. Given the validity-driven approach, the HLQ is likely to be useful in surveys, intervention evaluation, and studies of the needs and capabilities of individuals.
Highlights
Introduction to the issuePrev Hum Serv 1984, 3:1–7.49
Low health literacy has been reported to be associated with increased mortality [5,6], hospitalisation [7,8], lower use of preventive healthcare services [9], poor adherence to prescribed medications [10], difficulty communicating with health professionals [11], and poorer knowledge about disease processes and self-management skills among people with chronic conditions such as diabetes, heart disease and arthritis [12,13,14]
We developed a comprehensive model of health literacy based upon concept mapping workshops and patient interviews [26] to derive the Health Literacy Management Scale (HeLMS) [26]
Summary
Introduction to the issuePrev Hum Serv 1984, 3:1–7.49. Ad Hoc Committee on health literacy from the Council of Scientific Affairs of the American Medical Association: Health literacy: report of the Council on Scientific Affairs. The World Health Organisation (WHO) describes health literacy as “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health”[1]. In both developing and developed countries, health and social policies are being developed that highlight health literacy as a key determinant of a person’s ability to optimally manage their health and of a health system’s ability to ensure equitable access to, and use of, services [2,3,4]. Studies suggest that differences in health literacy abilities may explain observed health inequalities among people of different race, and with different educational attainments [16,17,18]
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