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

Abstract

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.

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

“…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.…”

“…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 ]. The results demonstrate overall good psychometric qualities of the scale in the context of Hong Kong [ 34 , 35 ].…”

“…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.…”

“…Additionally, given that participant HL was measured after the fifth wave and their HL might evolve within health education programs during this wave, we conducted propensity score matching (PSM) to examine whether subjects’ HL were relatively stable over time. Based on age, gender, income, education, and self-reported health status, participants in our previous survey (conducted before and in the fifth wave) [ 35 ] and the current survey (conducted after the fifth wave) were propensity score matched at a 1:1 ratio. The results show no difference in the HL levels between the two groups (see Tables S1 and S2 in the supplement ).…”

Psychometric properties of the Chinese version of the health behavior motivation scale: a translation and validation study

“…Chronic illness risk is increased by poor health practices such as smoking, drinking, physical inactivity, a lack of exercise, and a poor diet ( Ojo, 2019 ). According to research, we can successfully prevent and treat more than 80% of type 2 diabetes and cardiovascular disease by modifying individual behavior, and we can also lower the risk of cancer by at least 40% ( Tian et al, 2023 ). The stage model of behavior change states that there are five different stages of achieving positive behavior change: pre-contemplation, contemplation, preparation, action, and maintenance ( Coscioni et al, 2022 ; Mizuno et al, 2023 ).…”