Validation of the Dutch functional, communicative and critical health literacy scales

Abstract

ObjectiveWhile most existing health literacy (HL) measures focus primarily on reading comprehension, the functional, communicative and critical HL scales from Ishikawa et al. [19] aim to measure a broader HL spectrum. The objective of this study was to evaluate the validity of the Dutch translation of this instrument. MethodsTwo survey studies (n=79 and n=209) and one cognitive interview study (n=18) were performed among samples of breast cancer patients and patients with rheumatic diseases. ResultsAnalyses showed the scales measured three distinct factors and convergent validity was satisfactory for communicative and critical HL. Nevertheless, the comprehension of the items and the suitability of the response options raised some problems. ConclusionThe HL scales seem promising to measure a broad definition of HL. By revising some of the items and response options as proposed in this article, the scale will become more understandable for people with low HL skills, which might increase the content validity and the distributional properties of the scale. Practice implicationsThe scale should be revised and revalidated. An improved version should be used in practice to gain insight into HL levels of patients. This will help to develop suitable education programs for people with low HL skills.