Abstract
BackgroundMany health literacy instruments focus on reading skills, numeracy and/or information processing aspects only. In the Netherlands, as in other countries, the need for a comprehensive, person-centred measure of health literacy was observed and consequently the decision was made to translate the Health Literacy Questionnaire (HLQ) into Dutch. The HLQ has nine health literacy domains covering people’s experiences and skills. This research sought to translate, culturally adapt and psychometrically test the HLQ.MethodsThe translation and adaptation was done using a systematic approach with forward translation guided by item intents, blind back translation, and a consensus meeting with the developer. The Dutch version of the HLQ was applied in a sample of non-hospitalized, chronically ill patients. Descriptive statistics were generated to describe mean, standard deviation and floor and ceiling effects for all items. A Confirmatory Factor Analysis (CFA) model was fitted to the data. Scores on the nine domains of the HLQ were compared across demographic and illness characteristics as a form of known-groups validity. Psychometric analyses included Cronbach’s alpha, item-rest and item-remainder correlations.ResultsUsing CFA, the Dutch HLQ psychometric structure was found to strongly align with the hypothesised (original) nine independent domains of the English version. The nine scales were found to be highly reliable (all scales had alpha between 0.83 and 0.94). Six of the nine HLQ-scales had items that show ceiling-effects. There were no ceiling effects present at the scale level. Scores on the scales of the HLQ differed according to demographic and illness characteristics: people who were older, lower educated and living alone and patients with multiple chronic diseases generally scored lower.ConclusionsThe Dutch version of the HLQ is a robust and reliable instrument that measures nine different domains of health literacy. The questionnaire was tested in a sample of chronically ill patients, and should be further tested in the general population as well as in different disease groups. The HLQ is a major addition to currently available instruments in the Netherlands, since it measures health literacy from a multi-dimensional perspective and builds on patients’ experiences and skills.
Highlights
Many health literacy instruments focus on reading skills, numeracy and/or information processing aspects only
Such validity issues can arise when a). the questionnaire is translated from English to Dutch and some words might have a different meaning or connotation than intended in the original instrument and b). the Health Literacy Questionnaire (HLQ) is developed in another country (Australia) and aspects of the health care system might differ from the situation in the Netherlands
We examined the model fit with the Non-Normed Fit Index (NNFI), the comparative fit index (CFI), the standardize root mean square residual (SRMR), and the root mean square measure of approximation (RMSEA)
Summary
Many health literacy instruments focus on reading skills, numeracy and/or information processing aspects only. Health literacy is defined by the World Health Organisation 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]. Health literacy skills are an important asset for people to find and understand health information, and to take control and responsibility over their health. Health literacy began as a notion that concentrated primarily on people’s ability to read and understand health-related information. Governments, health and community services, consumer groups and researchers increasingly recognize their responsibilities to respond appropriately and effectively to the health literacy needs of the consumers they serve and represent and that system changes are needed to align health care demands better with people’s skills and abilities
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