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

Abstract

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.

Are personal health literacy and school health literacy environment important to schoolteachers’ health outcomes?

“…The European Health Literacy Population Survey 2019-2021 (HLS 19 -Q12) was used to measure teachers’ personal health literacy (14). The HLS 19 -Q12 is a 12-item instrument to assess personal health literacy and was developed by the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) working group.…”

“…The total score of the HLS 19 -Q12 was calculated as the percentage (ranging from 0 to 100) of items with valid responses that were answered with “very easy” or “easy” provided that at least 80% of the items contain valid responses (14). If less than 80% of the items contain valid responses, the score was coded as “missing.” Higher scores of the HLS 19 -Q12 indicate higher levels of health literacy.…”

“…If less than 80% of the items contain valid responses, the score was coded as “missing.” Higher scores of the HLS 19 -Q12 indicate higher levels of health literacy. A categorical variable of the HLS 19 -Q12 was also calculated based on the recommended cut-off points by WHO M-POHL working group (14) to show the population distribution of health literacy.…”

“…Currently, there have been a number of studies that examine the measures, levels, influencing factors, and impact of health literacy across populations (10)(11)(12)(13). Findings from a recent European health literacy survey show that low health literacy is prevalent across countries, ranging from 25% in Slovakia to 72% in Germany (14). In China, the 2021 national health literacy survey showed 74.6% of Chinese residents aged 15 to 69 years had low health literacy.…”

The association between health literacy, COVID-19 knowledge and adherence to preventive measures in Turkey

“…Surveys carried out in numerous nations indicated that people's levels of HL were inadequate. According to studies conducted in the United States and 17 European countries, 88% and 46% of people were found to have inadequate HL, respectively (13,14). Furthermore, 80% of Turks were found to have inadequate HL (15).…”