The HLS19-COM-P, a New Instrument for Measuring Communicative Health Literacy in Interaction with Physicians: Development and Validation in Nine European Countries

Hanne Søberg Finbråten; Peter Nowak; Robert Griebler; Éva Bíró; Mitja Vrdelja; Rana Charafeddine; Lennert Griese; Henrik Bøggild; Doris Schaeffer; Thomas Link; Zdenek Kucera; Julien Mancini; Jürgen M Pelikan

doi:10.3390/ijerph191811592

The HLS₁₉-COM-P, a New Instrument for Measuring Communicative Health Literacy in Interaction with Physicians: Development and Validation in Nine European Countries

Int J Environ Res Public Health. 2022 Sep 14;19(18):11592. doi: 10.3390/ijerph191811592.

Authors

Affiliations

¹ Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, 2418 Elverum, Norway.
² Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria.
³ Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4028 Debrecen, Hungary.
⁴ Communication Unit, National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia.
⁵ Department of Public Health and Epidemiology, Sciensano, 1050 Brussels, Belgium.
⁶ Interdisciplinary Centre for Health Literacy Research [ICHL], School of Public Health, Bielefeld University, 33615 Bielefeld, Germany.
⁷ Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark.
⁸ Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, A-1010 Vienna, Austria.
⁹ Czech Health Literacy Institute, Sokolská 490/31, 120 00 Prague, Czech Republic.
¹⁰ Aix Marseille University, APHM INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, F-13009 Marseille, France.
¹¹ WHO-CC Health Promotion in Hospitals and Health Care, Austrian National Public Health Institute, A-1010 Vienna, Austria.

Abstract

Background: Sufficient communicative health literacy (COM-HL) is important for patients actively participating in dialogue with physicians, expressing their needs and desires for treatment, and asking clarifying questions. There is a lack of instruments combining communication and HL proficiency. Hence, the aim was to establish an instrument with sufficient psychometric properties for measuring COM-HL.

Methods: The HLS₁₉-COM-P instrument was developed based on a conceptual framework integrating HL with central communicative tasks. Data were collected using different data collection modes in nine countries from December 2019 to January 2021 (n = 18,674). Psychometric properties were assessed using Rasch analysis and confirmatory factor analysis. Cronbach's alpha and Person separation index were considered for reliability.

Results: The 11-item version (HLS₁₉-COM-P-Q11) and its short version of six items (HLS₁₉-COM-P-Q6) fit sufficiently the unidimensional partial credit Rasch model, obtained acceptable goodness-of-fit indices and high reliability. Two items tend to under-discriminate. Few items displayed differential item functioning (DIF) across person factors, and there was no consistent pattern in DIF across countries. All items had ordered response categories.

Conclusions: The HLS₁₉-COM-P instrument was well accepted in nine countries, in different data collection modes, and could be used to measure COM-HL.

Keywords: Calgary-Cambridge Guide framework (C-CG); HLS19; Rasch analysis; communicative health literacy; confirmatory factor analysis; data collection modes; measurement; physician–patient communication.

Publication types

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

MeSH terms

Communication
Health Literacy*
Humans
Physicians*
Psychometrics
Reproducibility of Results
Surveys and Questionnaires

Grants and funding

This research received no external funding, but the data collection was supported either by ministries of health, university, public health institutes or insurance funds in the different countries. AT: The Austrian Health Literacy Survey was commissioned and financed by the Austrian Federal Health Agency and the Federation of Austrian Social Insurance Institutions. BE: There was no support for data collection in Belgium from any organisation. BG: Medical University—Sofia, Faculty of Public Health and AGREEMENT No. D-125/24.06.2020, PROJECT No. 8418/21.11.2019, “GRANT-2020”, MU-Sofia. CZ: Data collection was funded by (all seven) Czech health insurance funds. DE: The German study was funded by the German Federal Ministry of Health, grant number: Kapitel 1504 Titel 54401, ZMV I 1-2518 004 (HLS-GER 2). DK: The distribution of the questionnaire was funded by Aalborg University. FR: The research was supported by the National Public Health agency (Santé Publique France, 21DPPA040-0) and by Ligue Contre le Cancer (LIGUE2019). HU: The research was supported by the Ministry of Human Capacities, Hungary (IV/956-4/2020/EKF). SI: The national survey of Health literacy in Slovenia took place within the framework of the project Increasing health literacy in Slovenia—ZaPiS, which is co-financed by the Republic of Slovenia in the amount of 20% of the value and the European Union from the European Social Fund in the amount of 80% of the value.