The Death Literacy Index: translation, cultural adaptation, and validation of the Chinese version

Sok Leng Che; Xiang Li; Mingxia Zhu; Wai I Ng

doi:10.3389/fpubh.2023.1140475

The Death Literacy Index: translation, cultural adaptation, and validation of the Chinese version

Front Public Health. 2023 May 11:11:1140475. doi: 10.3389/fpubh.2023.1140475. eCollection 2023.

Authors

Sok Leng Che¹, Xiang Li², Mingxia Zhu², Wai I Ng²

Affiliations

¹ Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China.
² Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China.

Abstract

Objective: Applying public health approaches to address palliative care allows for a broader perspective. The Death Literacy Index (DLI) is a novel instrument designed to assess the knowledge and skills required to access, comprehend, and make informed decisions regarding end-of-life care. Translation of the DLI could strengthen the capacity to build desirable services and policies regarding dying and death. It could also help to identify the barriers to services and future advocacy efforts.

Methods: The DLI was forward translated into Chinese and backward translated through two panels. Two rounds of cognitive interviews and a pilot test were conducted before the survey. A sample of 3,221 participants was recruited via an online survey in five cities in southern China (Guangzhou, Zhuhai, Jiangmen, Hong Kong and Macao) to evaluate the factor structure, validity and reliability of the translated DLI. Additionally, multi-group confirmatory factor analyses (MGCFA) were performed to examine measurement invariance across genders and the experiences of parental death.

Results: Exploratory factor analysis showed a six-factor structure for the translated DLI, and confirmatory factor analysis confirmed the structure. The overall scale and subscales had high internal consistency and satisfactory validity. The results from MGCFA showed that death literacy was adequately invariant for different genders and experiences of parental death.

Conclusion: The Chinese DLI is a reliable and valid instrument for measuring death literacy among people in southern China, and therefore can be used for both research and community practice.

Keywords: Death Literacy Index; death literacy; factor analysis; reliability; validity.

Publication types

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

MeSH terms

China
Female
Hong Kong
Humans
Literacy*
Male
Psychometrics
Reproducibility of Results

Grants and funding

This study was funded by the Financial Support Plan for Academic Projects 2022 of the Macao Foundation (ID: G-BXX-00047-2112367-02). The funding body had no role in the design of this study nor its execution, analyses, interpretation of the data, or decision to submit results.