Using the Health Literacy Questionnaire (HLQ) with Providers in the Early Intervention Setting: A Qualitative Validity Testing Study.

Catherine J Leslie,Diane L Smith,Melanie Hawkins

doi:10.3390/ijerph17072603

Abstract

More than one in four parents in the United States of America (USA) have low health literacy, which is associated with reduced health equity and negatively impacts child health outcomes. Early intervention (EI) programs are optimally placed to build the health literacy capacity of caregivers, which could improve health equity. The health literacy of interdisciplinary EI providers has not previously been measured. This study used the Health Literacy Questionnaire (HLQ) with EI providers (n = 10) to investigate evidence based on response (cognitive) processes. Narratives from cognitive interviews gave reasons for HLQ score choices, and concordance and discordance between HLQ item intent descriptions and narrative data were assessed using thematic analysis. Results found scales with highest concordance for Scales 3, 6, and 9 (each 96%, n = 24). Concordance was lowest on Scale 5 (88%, n = 22), although still strong with only 12% discordance. Three themes reflecting discordance were identified: (1) Differences between Australian and USA culture/health systems; (2) Healthcare provider perspective; and (3) Participants with no health problems to manage. Results show strong concordance between EI providers’ narrative responses and item intents. Study results contribute validity evidence for the use of HLQ data to inform interventions that build health literacy capacity of EI providers to then empower and build the health literacy of EI parents.

Highlights

This study addressed the following aim and research questions (RQ): Specific Aim: To qualitatively examine the use of the Health Literacy Questionnaire (HLQ) to measure the health literacy of Early Intervention (EI)
The study sought to generate evidence based on response processes to determine if EI providers in the United States of America (USA) engage with the HLQ items as intended by the HLQ developers
EI providers for each item supported the choice of HLQ item scores and, overall, these data were concordant with the HLQ item intent descriptions

Summary

Introduction

Low parent health literacy is a national problem in the USA [2,3], and is associated with both negative child health outcomes [4,5,6] and health equity [7]. Health literacy has been defined by the World Health Organization (WHO) 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” [8]. Americans’ low health literacy is significantly associated with race, socioeconomic status, and level of education [3,7]. By addressing low parent health literacy, EI providers can begin to address health inequities and disparities [7]. A healthcare provider’s understanding of health literacy can help mitigate the negative impact of low health literacy, and has resulted in improved pediatric and adult

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Discussion

Conclusion