Validity and Reliability of the Indian Version of the HLS-EU-Q16 Questionnaire.

Jyoshma Preema Dsouza,Stephan Van Den Broucke,Sanjay Pattanshetty

doi:10.3390/ijerph18020495

Abstract

Health literacy is a key topic in public health. Several measurement tools exist that operationalize health literacy, but only a few standard tools measure health literacy at a population level, and none of those are currently available for the Indian context. This study aimed to develop and validate an Indian version of the short form of the European Health literacy Questionnaire (HLS-EU Q16). Following the translation of the English version of the questionnaire in Hindi and Kannada by language experts and confirmation of the item content by health literacy experts, the questionnaire was administered to 158 Hindi speaking and 182 Kannada speaking individuals, selected via purposive sampling. Pearson’s correlation was used to confirm test–retest reliability, and confirmatory factor analysis was used to assess the construct validity of the scales in both languages. Cronbach’s alpha was calculated for the scales and their sub-domains, and item-total correlations were used to calculate item discriminant indices. Discriminant validity was examined by comparing scores of participant groups based on educational status and training in health care. Cronbach’s alpha for the Hindi version of the tool (HLS-IND-HIN-Q16) was 0.98, and for Kannada version (HLS-IND-KAN-Q16) 0.97. Confirmatory factor analysis produced fit indices within acceptable limits. The results allowed us to conclude that the two Indian language questionnaires allow valid and reliable measurements of health literacy among the Hindi and Kannada speaking population of India.

Highlights

Health literacy (HL) has become a key concept in public health
The HLS-EU-Q16 is a 16-item self-report questionnaire measuring difficulties experienced by the respondent in accessing, understanding, appraising, and applying information to tasks related to making decisions in health care, disease prevention, and health promotion
Confirmatory factor analysis was applied to consider the fit of the factor solution obtained in both Indian subsamples to the 3 factors of “Health care”, “Disease Prevention” and “Health Promotion” of the HLS-EU-Q16

Summary

Introduction

While originally the term only referred to a person’s ability to understand medical information in a health care context, over the past two decades it has found its way into public health and has expanded in both scope and meaning [1]. Different definitions are still being used, there is a growing consensus that HL refers to the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, appraise and use information to promote and maintain good health [2,3]. A large and consistently growing body of literature has demonstrated that low HL is associated with poor medication adherence, poor self-care management, less favorable treatment outcomes, lower participation in screening programs, suboptimal use of preventive services, lower engagement in health promoting behaviors, and a higher cost of care [1,5,6,7,8]. It is not surprising that a growing number of studies

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