Cultural Adaptation and Validity Testing of the Portuguese Version of the Health Literacy Questionnaire (HLQ)

Dulce Nascimento Do Ó; Ana Rita Goes; Gerald Elsworth; João F Raposo; Isabel Loureiro; Richard H Osborne

doi:10.3390/ijerph19116465

Cultural Adaptation and Validity Testing of the Portuguese Version of the Health Literacy Questionnaire (HLQ)

Int J Environ Res Public Health. 2022 May 26;19(11):6465. doi: 10.3390/ijerph19116465.

Authors

Dulce Nascimento Do Ó^{1

2

3}, Ana Rita Goes^{1

2}, Gerald Elsworth⁴, João F Raposo^{3

5}, Isabel Loureiro^{1

2}, Richard H Osborne⁴

Affiliations

¹ NOVA National School of Public Health, NOVA University Lisbon, 1169-056 Lisboa, Portugal.
² NOVA National School of Public Health, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, 1600-560 Lisboa, Portugal.
³ APDP-Diabetes Portugal, Rua Rodrigo da Fonseca 1, 1250-189 Lisbon, Portugal.
⁴ Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, 453/469-477 Burwood Road, Hawthorn, VIC 3122, Australia.
⁵ CEDOC-Center for the Study of Chronic Disease, NOVA Medical School, R. Câmara Pestana 6, 1150-199 Lisbon, Portugal.

Abstract

Background: Health literacy is considered a determinant of self-management behaviors and health outcomes among people with diabetes. The assessment of health literacy is central to understanding the health needs of a population. This study aimed to adapt the Health Literacy Questionnaire (HLQ) to the Portuguese context and to examine the psychometric properties of a population of people with diabetes.

Methods: Data were collected using a self-administrated questionnaire from 453 people with diabetes in a specialized diabetes care unit. Analysis included item difficulty level, composite scale reliability, and confirmatory factor analysis (CFA).

Results: The HLQ showed that the items were easily understood by participants. Composite reliability ranged from 0.74 to 0.83. A nine-factor CFA model was fitted to the 44 items. Given the very restricted model, the fit was quite satisfactory [χ²_wlsmv = 2147.3 (df = 866), p = 0.001; CFI = 0.931, TLI = 0.925, RMSEA = 0.057 (90% C.I. 0.054-0.060), and WRMR = 1.528].

Conclusion: The Portuguese version of the HLQ has shown satisfactory psychometric properties across its nine separate scales in people with diabetes. Given the strong observed properties of the HLQ across cultures, languages, and diseases, the HLQ is likely to be a useful tool in a range of Portuguese settings.

Keywords: HLQ; diabetes; health literacy; psychometric testing; questionnaire.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Health Literacy*
Humans
Language
Portugal
Psychometrics
Reproducibility of Results
Surveys and Questionnaires

Grants and funding

The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020). RHO was funded in part through a National Health and Medical Research Council (NHMRC) of Australia Principal Research Fellowship (APP1155125).