Measuring Comprehensive, General Health Literacy in the General Adult Population: The Development and Validation of the HLS19-Q12 Instrument in Seventeen Countries

Jürgen M Pelikan; Thomas Link; Christa Straßmayr; Karin Waldherr; Tobias Alfers; Henrik Bøggild; Robert Griebler; Maria Lopatina; Dominika Mikšová; Marie Germund Nielsen; Sandra Peer; Mitja Vrdelja; HLS19 Consortium of the WHO Action Network M-POHL

doi:10.3390/ijerph192114129

Measuring Comprehensive, General Health Literacy in the General Adult Population: The Development and Validation of the HLS₁₉-Q12 Instrument in Seventeen Countries

Int J Environ Res Public Health. 2022 Oct 29;19(21):14129. doi: 10.3390/ijerph192114129.

Authors

Jürgen M Pelikan^{1

2}, Thomas Link³, Christa Straßmayr^{1

2}, Karin Waldherr⁴, Tobias Alfers⁵, Henrik Bøggild^{6

7}, Robert Griebler^{1

2}, Maria Lopatina⁸, Dominika Mikšová³, Marie Germund Nielsen^{6

9}, Sandra Peer¹⁰, Mitja Vrdelja¹¹; HLS19 Consortium of the WHO Action Network M-POHL

Affiliations

¹ Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria.
² HLS19 International Coordination Center at the Austrian National Public Health Institute, A-1010 Vienna, Austria.
³ Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, and HLS19 International Coordination Center at the Austrian National Public Health Institute, A-1010 Vienna, Austria.
⁴ Ferdinand Porsche FernFH, A-2700 Wiener Neustadt, Austria.
⁵ Department of Education and Psychology, Freie Universität Berlin, 14195 Berlin, Germany.
⁶ Public Health and Epidemiology, Health Science and Technology, Aalborg University, DK-9220 Aalborg, Denmark.
⁷ Unit of Clinical Biostatistics, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
⁸ National Medical Research Center for Therapy and Preventive Medicine, Ministry of Health of the Russian Federation, 101000 Moscow, Russia.
⁹ Clinical Nursing Research Unit, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
¹⁰ Institute for Water Quality and Resource Management, TU Wien, A-1040 Vienna, Austria.
¹¹ National Institute of Public Health, 1000 Ljubljana, Slovenia.

Abstract

Background: For improving health literacy (HL) by national and international public health policy, measuring population HL by a comprehensive instrument is needed. A short instrument, the HLS₁₉-Q12 based on the HLS-EU-Q47, was developed, translated, applied, and validated in 17 countries in the WHO European Region.

Methods: For factorial validity/dimensionality, Cronbach alphas, confirmatory factor analysis (CFA), Rasch model (RM), and Partial Credit Model (PCM) were used. For discriminant validity, correlation analysis, and for concurrent predictive validity, linear regression analysis were carried out.

Results: The Cronbach alpha coefficients are above 0.7. The fit indices for the single-factor CFAs indicate a good model fit. Some items show differential item functioning in certain country data sets. The regression analyses demonstrate an association of the HLS₁₉-Q12 score with social determinants and selected consequences of HL. The HLS₁₉-Q12 score correlates sufficiently highly (r ≥ 0.897) with the equivalent score for the HLS₁₉-Q47 long form.

Conclusions: The HLS₁₉-Q12, based on a comprehensive understanding of HL, shows acceptable psychometric and validity characteristics for different languages, country contexts, and methods of data collection, and is suitable for measuring HL in general, national, adult populations. There are also indications for further improvement of the instrument.

Keywords: HLS19; HLS19-Q12; health literacy measurement; instrument development; national adult population; validation.

Publication types

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

MeSH terms

Factor Analysis, Statistical
Health Literacy*
Language
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 were no support for data collection in Belgium from any organization. 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. CH The Swiss Federal Office of Public Health FOPH with a financial contribution from the foundation Health Promotion Switzerland. 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/956-740 4/2020/EKF). IE: Department of Health, Dublin. IL: The Israel study was funded by the Israel Ministry of Health and Clalit Health Services, Israel. IT: The Italian participation to the Action Network on Measuring Population and Organizational Health Literacy (M-POHL Network) was funded by the Istituto Superiore di Sanità, Rome, Italy; the implementation of the Health Literacy Survey-HLS₁₉ in Italy was funded by the National Centre for Disease Prevention and Control (CCM) of the Italian Ministry of Health and coordinated by the Department of cardiovascular, endocrine–metabolic diseases and aging of the Istituto Superiore di Sanità, Rome, Italy. NO: The Norwegian HLS₁₉ was commissioned and financed by the Norwegian Ministry of Health and Care Services. The Norwegian Directorate of Health funded the data collection and the administrative costs for the whole project, while Oslo Metropolitan University and Inland Norway University of Applied Sciences contributed with the scientific workforce. PT: Direção-Geral da Saúde, Lisbon. RU: The Russian study was supported by the Ministry of Health of the Russian Federation and WHO Europe. 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 to the amount of 20% of the value and the European Union from the European Social Fund to the amount of 80% of the value. SK: Public Health Authority of the Slovak Republic, Bratislava.