Abstract
BackgroundThe Health Literacy Questionnaire (HLQ) has nine scales that each measure an aspect of the multidimensional construct of health literacy. All scales have good psychometric properties. However, it is the interpretations of data within contexts that must be proven valid, not just the psychometric properties of a measurement instrument. The purpose of this study was to establish the extent of concordance and discordance between individual patient and clinician interpretations of HLQ data in the context of complex case management.MethodsSixteen patients with complex needs completed the HLQ and were interviewed to discuss the reasons for their answers. Also, the clinicians of each of these patients completed the HLQ about their patient, and were interviewed to discuss the reasons for their answers. Thematic analysis of HLQ scores and interview data determined the extent of concordance between patient and clinician HLQ responses, and the reasons for discordance.ResultsHighest concordance (80%) between patient and clinician item-response pairs was seen in Scale 1 and highest discordance (56%) was seen in Scale 6. Four themes were identified to explain discordance: 1) Technical or literal meaning of specific words; 2) Patients’ changing or evolving circumstances; 3) Different expectations and criteria for assigning HLQ scores; and 4) Different perspectives about a patient’s reliance on healthcare providers.ConclusionThis study shows that the HLQ can act as an adjunct to clinical practice to help clinicians understand a patient’s health literacy challenges and strengths early in a clinical encounter. Importantly, clinicians can use the HLQ to detect differences between their own perspectives about a patient’s health literacy and the patient’s perspective, and to initiate discussion to explore this. Provision of training to better detect these differences may assist clinicians to provide improved care.The outcomes of this study contribute to the growing body of international validation evidence about the use of the HLQ in different contexts. More specifically, this study has shown that the HLQ has measurement veracity at the patient and clinician level and may support clinicians to understand patients’ health literacy and enable a deeper engagement with healthcare services.
Highlights
The Health Literacy Questionnaire (HLQ) has nine scales that each measure an aspect of the multidimensional construct of health literacy
Data derived from patient-reported outcomes measures (PROMs) affect care decisions for individual patients through to decisions about nationwide health plans
The majority of the 38 unclear patient-clinician item-response pairs were because clinicians changed their scores during the interview (13 changes across 6 clinicians) with this followed closely by patient narratives that did not support the HLQ scores (12 nonmatches across 6 patients)
Summary
The Health Literacy Questionnaire (HLQ) has nine scales that each measure an aspect of the multidimensional construct of health literacy. Data are used to justify, endorse or exclude treatments, interventions and policies Such responsibility requires the measurement tool and its data to be valid for the purpose [1, 2]. Meaning ascribed to data must be representative of the constructs the tool purports to measure, and the consequences of that interpretation must be valid for the intended purpose [2,3,4,5,6,7]. This means that validation of the data generated by a measurement tool is required for each new context in which it is used [2, 8]. Construct validity relies on a questionnaire measuring what it purports to measure in all relevant contexts and, that the measurement of a particular construct can occur systematically among groups and settings [9,10,11]
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