Psychometric properties of an Arabic-language health literacy assessment scale for adolescents (HAS-A-AR) in Palestine

Abstract

ObjectivesHealth literacy research in Palestine is limited, and a locally validated tool for use among adolescents has been unavailable until now. Therefore, this study aimed to adapt health literacy assessment scale for adolescents (HAS-A) into Arabic language (HAS-A-AR) and Palestinian context and to investigate its psychometric properties.DesignWe conducted a cross-sectional household survey using a stratified random sample and household face-to-face interviews.Setting and participantsWe conducted 1200 interviews with sixth to ninth graders in the Ramallah and al-Bireh district of the West Bank, Palestine in 2017.MethodsWe translated and adapted HAS-A to be sensitive to the Palestinian context and tested its psychometric properties. We evaluated face and content validity during the back-translation process and checked for construct validity through exploratory factor analysis (EFA). We tested for internal consistency using Cronbach’s alpha, MacDonald’s omega test and the greatest lower bound (GLB). Furthermore, we calculated the scale’s average inter-item correlation.ResultsEFA revealed that HAS-A-AR has a similar structure to the original HAS-A. It extracted three factors (communication, confusion and functional health literacy) whose eigenvalues were >1. Together they explained 57% of the total variance. The proportions of adolescents with high levels of communication, confusion and functional health literacy were 45%, 68% and 80%, respectively. Cronbach’s alpha, MacDonald’s omega and the GLB values for communication subscale were 0.87, 0.88 and 0.90, and they were 0.78, 0.77 and 0.79 for confusion subscale, while they were 0.77, 0.77 and 0.80, respectively, for functional healthy literacy subscale. The average inter-item correlation for the subscales ranged between 0.36 and 0.59.ConclusionHAS-A-AR is a valid and reliable health literacy measuring instrument with appropriate psychometric properties. HAS-A-AR is currently available for use among adolescents in Palestine and the surrounding Arab countries with similar characteristics as Palestine, including language, culture and political instability.

Health literacy as a key to improving weight status among Palestinian adolescents living in chronic conflict conditions: a cross-sectional study

“…Second, the HAS-A-AR was chosen because it measures three important health literacy-related constructs: communication with a healthcare professional, confusion about receiving information, and functional ability to read and understand numbers. 25 This scale was initially used in clinical and community settings. It was chosen because it is short, easy to administer and covers various age groups.…”

“…This 15-item scale has three subscales: communication, confusion and functional health literacy. 25 The communication subscale’s main concern is oral communication and comfort while dealing with healthcare professionals and asking them questions during consultations. The confusion subscale measures adolescents’ level of confusion regarding the health information they receive from healthcare professionals.…”

“…An additional option was added to each item during the adaptation of the scale that was previously published. 25 For example, the option ‘I am not the one who describes my health problem to the doctor’ was added to the question, ‘How often can you easily describe a health problem you have to your doctor?’ In terms of calculating the scores for the three subscales, all the added options were treated similar to ‘never’ (added option=0). 25 This was intended to reflect adolescents’ lower involvement with healthcare professionals regarding their own health problems.…”

“…This probability resulted from the multiplication of the probabilities for selecting a block within each locality, choosing a household from the block, selecting a household including at least one age-eligible adolescent and selecting a child from the household. 25 Variables Outcome variable: weight status Body weight and height were measured according to the WHO guidelines reported in the STEPS Surveillance Manual. 27 Height was measured in centimetres using a mobile stadiometer, Seca 217, and body weight was recorded in kilograms using the Seca 876 scale.…”

“…In terms of calculating the scores for the three subscales, all the added options were treated similar to 'never' (added option=0). 25 This was intended to reflect adolescents' lower involvement with healthcare professionals regarding their own health problems. Higher scores on the communication subscale indicated higher health literacy.…”