HLS19-NAV—Validation of a New Instrument Measuring Navigational Health Literacy in Eight European Countries

Abstract

To manoeuvre a complex and fragmented health care system, people need sufficient navigational health literacy (NAV-HL). The objective of this study was to validate the HLS19-NAV measurement scale applied in the European Health Literacy Population Survey 2019–2021 (HLS19). From December 2019 to January 2021, data on NAV-HL was collected in eight European countries. The HLS19-NAV was translated into seven languages and successfully applied in and validated for eight countries, where language and survey method differed. The psychometric properties of the scale were assessed using confirmatory factor analysis (CFA) and Rasch modelling. The tested CFA models sufficiently well described the observed correlation structures. In most countries, the NAV-HL data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). For some countries, some items showed poor data–model fit when tested against the PCM, and some items displayed differential item functioning for selected person factors. The HLS19-NAV demonstrated high internal consistency. To ensure content validity, the HLS19-NAV was developed based on a conceptual framework. As an estimate of discriminant validity, the Pearson correlations between the NAV-HL and general health literacy (GEN-HL) scales were computed. Concurrent predictive validity was estimated by testing whether the HLS19-NAV, like general HL measures, follows a social gradient and whether it forms a predictor of general health status as a health-related outcome of general HL. In some countries, adjustments at the item level may be beneficial.

Psychometric validation of the French version of two scales measuring general (HLS19-Q12) and navigational (HLS19-NAV) health literacy using the Rasch model

“…In addition, internal consistency and reliability were high for both scales (i.e., high α/ѡ values), which was con rmed by the Rasch analyses, since the PSI was also well above 0.8. The latter result is comparable to reliability values in other countries participating in the HLS 19 study (17,37).…”

“…The same applied to the HLS 19 -NAV items, with the exception of item 9 which showed a mis t. This result has also been observed in other countries participating in HLS 19 (37). It is likely that this item not only measures the ability to understand how to make medical appointments, but also inadvertently measures the di culty encountered in obtaining a medical appointment.…”

Navigationale Gesundheitskompetenz der Bevölkerung in Deutschland

“…Das Instrument wurde bereits in 8 Ländern eingesetzt und validiert – darunter auch in Deutschland im HLS-GER 2, dessen Daten für die vorliegende Analyse genutzt wurden. Die Skala zeigt eine zufriedenstellende psychometrische Qualität 20 . Der HLS 19 -NAV misst die selbsteingeschätzten Schwierigkeiten beim Finden, Verstehen, Beurteilen und Anwenden von navigationsrelevanten Informationen.…”

“…Mit der vorgenommenen Analyse wurde die NGK der Bevölkerung in Deutschland erstmals tiefergehend untersucht. Wie angesichts der seit langem beklagten Fragmentierung und Intransparenz des deutschen Gesundheitssystems 2 3 4 6 zu erwarten war, fällt die NGK gering aus – deutlich niedriger als die allgemeine GK 13 und auch als in anderen Ländern 12 20 . Dennoch ist desillusionierend, dass die NGK derart gering ist.…”