Developing a Health Literacy Scale for adults in Hong Kong: A modified e‐Delphi study with healthcare consumers and providers

Mo²,

Dong³

et al. 2023

Front. Public Health

Self Cite

IntroductionHealth literacy (HL) refers to an individual's ability to process and use health information to make health-related decisions. However, previous HL scales did not fully cover all aspects of this concept. This study aimed to develop a comprehensive Hong Kong HL scale (HLS-HK) and evaluate its psychometric properties among Chinese adults.MethodsA scale of 31-item covering Nutbeam's framework, namely functional and interactive HL (FHL and IHL), and critical HL (CHL) within three subdomains: critical appraisal of information, understanding of social determinants of health, and actions to address social determinants of health, was developed based on previous literature review and Delphi survey. Cognitive interviews were performed to examine all items' face validity in terms of three aspects: comprehensiveness, clarity, and acceptability. A cross-sectional survey was conducted to investigate the scale's psychometric properties, including its internal consistency reliability, factorial structure validity, convergent validity, and predictive validity.ResultsNine interviewees participated in the cognitive interviews in October 2021. Based on the input from respondents, two items were deleted, two items were combined, and several items' wording was revised. The other items were clear and readable. Finally, 28 items remained. A total of 433 adults completed the questionnaire survey between December 2021 and February 2022. After excluding one item with low inter-item correlations, the scale's internal consistency reliability was acceptable, with a Cronbach's alpha of 0.89. Exploratory factor analysis produced a five-factor model, as shown in the original theoretical framework. These factors accounted for 53% of the total variance. Confirmatory factor analysis confirmed that the fit indices for this model were acceptable (comparative fit index = 0.91, root mean square error of approximation = 0.06, and root mean square residual = 0.06). The scale is also significantly correlated with theoretically selected variables, including education and self-rated health.ConclusionThe HLS-HK is a valid and reliable tool for evaluating HL. Compared with existing tools, this scale extended the operationalization of FHL, IHL, and CHL and fully operationalized the CHL via three subdomains. It can be used to understand the difficulties and barriers that people may encounter when they use health-related information and services.

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Development and validation of a comprehensive health literacy tool for adults in Hong Kong

Mo²,

Dong³

et al. 2023

Front. Public Health

Self Cite

“…Furthermore, its internal consistency, factorial structural validity, convergent validity, and predictive validity were assessed in one cross-sectional survey among 433 Hong Kong Chinese [ 35 ]. The results demonstrate overall good psychometric qualities of the scale in the context of Hong Kong [ 34 , 35 ]. The process of the scale development and validation has been documented elsewhere [ 34 , 35 ], and the present study was the first to explore the association between HL and other variables in Hong Kong using the scale after its development.…”

Section: Methodsmentioning

confidence: 93%

“…The results demonstrate overall good psychometric qualities of the scale in the context of Hong Kong [ 34 , 35 ]. The process of the scale development and validation has been documented elsewhere [ 34 , 35 ], and the present study was the first to explore the association between HL and other variables in Hong Kong using the scale after its development. In the present study, Cronbach’s alpha of the total scale was 0.90.…”

Section: Methodsmentioning

confidence: 93%

“…The scale comprehensively operationalized the five domains mentioned above: FHL, IHL, CHL-1, CHL-2, and CHL-3 (see Figure 1 ). Its content validity was examined by local healthcare providers and consumers in one Delphi study [ 34 ]. Furthermore, its internal consistency, factorial structural validity, convergent validity, and predictive validity were assessed in one cross-sectional survey among 433 Hong Kong Chinese [ 35 ].…”

Section: Methodsmentioning

confidence: 99%

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Associations between Health Literacy, Trust, and COVID-19 Vaccine Hesitancy: The Case of Hong Kong

Dong

et al. 2023

Vaccines

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This study investigates how health literacy (HL) and trust in health information affected COVID-19 vaccine hesitancy among Chinese Hong Kong adults. A cross-sectional study was conducted in August 2022. A total of 401 participants completed the study. Participants completed a newly developed Hong Kong HL scale and self-reported their trust levels in health information from different resources. The proportions of early uptake of the first dose and booster dose of COVID-19 vaccine were 69.1% and 71.8%, respectively. The risk of delaying the first dose was higher among participants with inadequate functional HL (OR = 0.58, p = 0.015), adequate levels of two subdomains of critical HL (OR = 1.82, p = 0.013; OR = 1.91, p < 0.01), and low-level trust in health information from the government (OR = 0.57, p = 0.019). Respondents with adequate interactive HL (OR = 0.52, p = 0.014) and inadequate level of one subdomain of critical HL (OR =1.71, p = 0.039) were more likely to delay the booster dose. This negative association between critical HL and vaccination was suppressed by trust in health information from the government. This study shows that HL and trust in health information from the government are associated with COVID-19 vaccine hesitancy. Efforts should be directed at providing tailored communication strategies with regard to people’s HL and increasing public confidence in health authorities to decrease vaccine hesitancy.

Developing a Health Literacy Scale for adults in Hong Kong: A modified e‐Delphi study with healthcare consumers and providers

Wong

Cheung

et al. 2022

Health Expectations

Self Cite

Introduction Health literacy (HL) refers to individuals' abilities to process and use health information to promote health. This study aimed to develop the first HL measurement tool for the Chinese Hong Kong population. Methods A two‐phase methodology was adopted. In Phase I , evidence synthesis with a deductive method was conducted to formulate the item list from the literature. In Phase II , a modified e‐Delphi survey was conducted among stakeholders (i.e., healthcare providers and healthcare consumers) to confirm the content validity of the item list. The stakeholders were invited to rate the relevance of each draft item on a 4‐point scale and provide suggestions for revisions, removal or adding new items. Results In Phase I , a total of 34 items covering functional, interactive and critical HL were generated. In Phase II , to obtain a balanced view from experts and laypeople, healthcare professionals ( n = 12) and consumers ( n = 12) were invited to participate in the Delphi panel. The response rates of the three rounds were 100%. After the third round, the consensus was reached for 31 items, and no further comments for adding or revising items were received. All items exhibited excellent content validity (item content validity index: 0.79–1.00; K* : 0.74–1.00). Conclusions A Health Literacy Scale for Hong Kong was developed. Compared with existing HL scales, the scale fully operationalized the skills involved in functional, interactive and critical HL. The Delphi study shows evidence supporting the high content validity of all items in the scale. In future studies, these items should undergo rigorous testing to examine their psychometric properties in our target population groups. By illuminating the details in the development process, this paper provides a deeper understanding of the scale's scope and limitations for others who are interested in using this tool. Patient or Public Contribution Public as healthcare consumers, in addition to healthcare providers, were involved in developing a new HL scale for this study. The input from the public contributed to examining the scale's content validity by judging whether all items reflected the skills that they need to find and use health‐related information in their daily life.