The Adaptation of Turkish Health Literacy Scale for Literate Syrian Adult Refugees Living in Turkey: A Reliability-Validity Study

Abstract

BackgroundThere is a big Syrian refugee population which counts more than 3.5 million since the year 2011, and continuously growing. This situation causes various problems, mainly while obtaining health services. In planning the migrant health services, for the policy makers of host countries, health literacy level of migrants is an important measure. Determination of health literacy level of Syrian refugees in Turkey would be supportive for planning some interventions to increase health services utilization, and health education and health communication programs. An “original health literacy scale" for 18–60 years of age Turkish literate adults (Hacettepe University Health literacy Scale-HLS) was developed to be used as a reference scale in 2018. It would be useful to compare the health literacy level of Turkish adults and Syrian adult refugees resided in Turkey with an originally developed scale. For this reason, it was aimed to adapt the HLS-Short Form in Syrian refugees.MethodsThis methodological study was carried out between 2019–2020 in three provinces of Turkey where the Syrians live intensively. The data was collected by pre-trained, Arabic speaking 12 interviewers and three supervisors via a questionnaire on household basis. At first, the original Scale and questionnaire were translated into Arabic and backtranslated. The questionnaire and the Scale was pre-tested on 30 Syrian refugees in Ankara Province. A total of 1254 refugees were participated to the main part of study; 47 health-worker participants were excluded from the validity-reliability analysis. Confirmatory factor analysis (CFA) was performed. Cronbach’s alpha and Spearman-Brown coefficients were calculated.ResultsOf the participants, 52.9% was male; 26.1% had secondary level or less; almost half of them had moderate economic level; 27.5% could not speak Turkish. The Cronbach’s Alpha was 0.75, Spearman-Brown Coefficient was 0.76; RMSEA = 0.073, CFI = 0.93, TLI = 0.92 and GFI = 0.95 for the Scale. The Cronbach’s Alpha was 0.76, Spearman-Brown Coefficient was 0.77; RMSEA = 0.085, CFI = 0.93, TLI = 0.91 and GFI = 0.95 for self-efficacy part.ConclusionIn conclusion, the adapted HLS would be a reliable instrument to evaluate the health-literacy level of Syrians living in Turkey and could give an opportunity to compare the host country’s HL with the refugees by using the same scale.