Health Literacy throughout adolescence: Invariance and validity study of three measurement scales in the general population

Rouquette, Alexandra; Rigal, Laurent; Mancini, Julien; Guillemin, Françis; Broucke, Stephan Van den; Allaire, Cécile; Azogui-Lévy, Sylvie; Ringa, Virginie; Hassler, Christine

doi:10.1016/j.pec.2021.07.044

Cited by 12 publications

(8 citation statements)

References 35 publications

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“…Therefore, the HLS-EU-Q16 was developed based on the data of the 8 original HLS-EU countries [ 10 , 11 , 15 , 16 , 17 ] and further validated for two additional studies in CZ and HU [ 10 ], an Austrian study of adolescents [ 10 , 18 ] and an Austrian study on two groups of migrants [ 10 , 19 , 20 ]. Later studies validating or applying the instruments in further languages were published: in Swedish and Arabic [ 21 ], in Somali [ 22 ], in Arabi, Dari, and Somali [ 23 ], in Italian [ 24 , 25 ], in Indonesian [ 26 ], in Austrian German [ 27 ], in French [ 28 , 29 ], in Turkish [ 30 ], in Japanese [ 31 ], in Islandic [ 32 ], in Romanian [ 33 ], and in an adapted Q18 version in Malaysian [ 34 ].…”

Section: Methodsmentioning

confidence: 99%

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

Link¹,

Straßmayr

Waldherr³

et al. 2022

IJERPH

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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.

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Section: Methodsmentioning

confidence: 99%

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

Link¹,

Straßmayr

Waldherr³

et al. 2022

IJERPH

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“…In contrast, the NVS was a performance-based and functional measure for reading comprehension and numeracy [ 52 ]. These three assessment tools have shown satisfactory or acceptable internal consistency (Cronbach’s alpha = 0.79, 0.54 and 0.82 for HLAT, NVS and HLS, respectively, in our sample) and structural validity among children [ 54 , 55 , 56 ]. The total score range for each assessment tool was 0–37, 0–6, and 0–16, respectively, with higher scores indicating higher levels of health literacy.…”

Section: Methodsmentioning

confidence: 74%

Comparison of Health Literacy Assessment Tools among Beijing School-Aged Children

Guo

Davis

et al. 2022

Children

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Health literacy is a broad and multidimensional construct, making its measurement and conclusions inconsistent. This study aims to compare the patterning of health literacy using different assessment tools and examine their impact on children’s developmental outcomes. A cross-sectional study was conducted with 650 students in Years 7–9 from four secondary schools in Beijing. Health literacy was measured by the eight-item health literacy assessment tool (HLAT, score range 0–37), the six-item Newest Vital Sign (NVS, score range 0–6), and the 16-item Health Literacy Survey (HLS, score range 0–16). Based on Manganello’s health literacy framework, information on upstream factors (e.g., gender, ethnicity, socioeconomic status) and developmental outcomes (e.g., health-promoting behaviours, health service use, global health status) was collected. Overall, the average scores for health literacy were 26.34 ± 5.89, 3.64 ± 1.64, and 13.72 ± 2.94, respectively, for HLAT, NVS, and HLS. The distribution of health literacy varied by socio-demographics and individual characteristics except for gender, no matter which health literacy assessment tool was used. The magnitude of associations between health literacy, its upstream factors and developmental outcomes was greater when using three-domain instruments (HLAT and HLS) than using single-domain instruments (NVS). The approach to health literacy measurement will influence the conclusion. Using multidimensional assessment tools may better capture a child’s health literacy and contribute to the maximum efficiency and effectiveness of school-based health literacy interventions.

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“…Originally, ten items were developed and tested among Finnish 13-and 15-year-olds. The scale has been reported to be suitable for use in monitoring children's and young people's HL 11,12,[18][19][20][21][22][23] . The ten items cover five core components of HL: theoretical knowledge, practical knowledge, critical thinking, self-awareness, and citizenship 11 .…”

Section: Measures Hlsacmentioning

confidence: 99%

“…No validated instrument for measuring HL among Norwegian children and adolescents has been identified. A recent validation study comparing three measurement scales for HL among adolescents, namely, the HLSAC, the Health Literacy Assessment Scale for Adolescents (HAS-A) and the 16-item European Health Literacy Survey questionnaire (HLS-EU-Q16), supported the use of the HLSAC to assess HL during adolescence 23 . The HLSAC has been used in previous studies in Norway 24 , 25 ; however, no studies have investigated the psychometric properties of the Norwegian version of the measure.…”

Section: Introductionmentioning

confidence: 99%

Validation of the brief instrument “Health Literacy for School-Aged Children” (HLSAC) among Norwegian adolescents

Bjørnsen

Moksnes

Eilertsen

et al. 2022

Sci Rep

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Health literacy (HL) has been identified as an important and modifiable determinant of health. To succeed in promoting HL, it is crucial to evaluate interventions addressing HL using validated instruments. However, HL measurement is an under-researched area among adolescents. The Health Literacy for School-Aged Children (HLSAC) scale is developed in Finland to measure the subjective HL levels of school-aged children. The HLSAC has been used and validated across Europe. No validated instrument for measuring HL among Norwegian adolescents has been identified. Therefore, the aim of this study was to assess the psychometric properties of the HLSAC among Norwegian adolescents in upper secondary schools. Cross-sectional data were collected in 2017 from 1 054 adolescents with a response rate of 93.5%. The participants were students aged 16–21 (mean = 17.3) years from four upper secondary schools in an urban area in Mid-Norway. Confirmatory factor analysis (CFA) was utilized to investigate the underlying dimensionality of the data together with composite reliability based on Raykov’s reliability coefficient and certain aspects of construct validity. The original ten-item one-dimensional version of the HLSAC revealed a poor fit. A one-dimensional version including six of the original ten items presented the best fit to our data, demonstrating good reliability and construct validity. This validation study suggests a one-dimensional solution of the HLSAC scale including six of the original ten items, i.e., the HLSAC-6 as a statistical valid and reliable measure for HL among adolescents in upper secondary schools. However, the modifications of the instrument indicate the need for further investigation of the HLSAC in this age group, i.e. by conducting cognitive interviews and focus-group discussions on the concept of HL among adolescents. Testing the wording of the HLSAC prior to additional psychometric evaluations of both the original HLSAC and the suggested HLSAC-6 is recommended. Finally, developing more age-appropriate items for the measurement of HL in this age-group is suggested.

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Health Literacy throughout adolescence: Invariance and validity study of three measurement scales in the general population

Cited by 12 publications

References 35 publications

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

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

Comparison of Health Literacy Assessment Tools among Beijing School-Aged Children

Validation of the brief instrument “Health Literacy for School-Aged Children” (HLSAC) among Norwegian adolescents

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