The Death Literacy Index: translation, cultural adaptation, and validation of the Chinese version

Che, Sok Leng; Li, Xiang; Zhu, Mingxia; Ng, Wai I

doi:10.3389/fpubh.2023.1140475

Cited by 4 publications

(6 citation statements)

References 56 publications

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“…The results show evidence of cross-cultural validity of the DLI and confirm fit of the proposed six-factor model of DL. This supports other recent validation studies [ 7 – 9 ] as well as the potential of the DLI to be used to measure DL internationally.…”

Section: Discussionsupporting

confidence: 90%

“…The results show evidence of cross-cultural validity of the DLI and confirm fit of the proposed six-factor model of DL. This supports other recent validation studies [7][8][9] as well as the potential of the DLI to be used to measure DL internationally. Both I-CVI and S-CVI ratings exceed the recommended minimum set out by Polit et al [30], suggesting support for DLI-S' validity in terms of item clarity and relevance for the DL construct, which aligns with Turkish results [8].…”

Section: Discussionsupporting

confidence: 89%

“…This finding also points to differences between the Swedish and Australian context that appear as variation in item difficulty for these items [ 49 ]. The distinctiveness of the Swedish context is further emphasized as the Community capacity scale functions well in China and Turkey [ 8 , 9 ]. In addition, the confirmatory factor analysis showed that two factors ( Existing knowledge and Accessing help ) were highly correlated [ 41 ], suggesting that items in these scales may measure one, underlying, factor rather than two distinct dimensions of DL.…”

Section: Discussionmentioning

confidence: 99%

“…The proposed six-factor model in the original English-language DLI demonstrated satisfactory psychometric properties in Australia indicating good model fit overall (CFI = 0.955, TLI = 0.95, RMSEA = 0.049), and high reliability of the scales and sub-scales (Cronbach’s α ranging 0.82 to 0.95) [ 2 ], and the United Kingdom (CFI = 0.94, RMSEA = 0.07, SRMR = 0.07; Cronbach’s α for sub-scales ranging 0.76 to 0.93) [ 7 ]. Moreover, translated DLI versions have demonstrated acceptable reliability and validity in Turkey (total CVI = 0.91; CFI = 0.93, RMSEA = 0.053; Cronbach’s α ranging 0.68–0.90) [ 8 ] and China (CFI = 0.956, RMSEA = 0.055, SRMR = 0.051, Cronbach’s α for sub-scales ranging 0.76–0.97) [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

“…As such, the DLI may constitute a promising tool for appraising impact of health promoting activities in relation to EOL issues. To date, the DLI has primarily been used among adults in the Australian general public, although the questionnaire has garnered increasing interest internationally, and been validated in the United Kingdom [ 7 ], Turkey [ 8 ], and China [ 9 ]. However, the extent to which DL and its operationalization are comparable across cultures is unknown.…”

Section: Introduction and Aimmentioning

confidence: 99%

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Validation of a culturally adapted Swedish-language version of the Death Literacy Index

Johansson,

Olsson,

Tishelman

et al. 2023

PLoS ONE

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The death literacy index (DLI) was developed in Australia to measure death literacy, a set of experience-based knowledge needed to understand and act on end-of-life (EOL) care options but has not yet been validated outside its original context. The aim of this study was to develop a culturally adapted Swedish-language version of the DLI, the DLI-S, and assess sources of evidence for its validity in a Swedish context. The study involved a multi-step process of translation and cultural adaptation and two validation phases: examining first content and response process validity through expert review (n = 10) and cognitive interviews (n = 10); and second, internal structure validity of DLI-S data collected from an online cross-sectional survey (n = 503). The psychometric evaluation involved analysis of descriptive statistics on item and scale-level, internal consistency and test-retest reliability, and confirmatory factor analysis. During translation and adaptation, changes were made to adjust items to the Swedish context. Additional adjustments were made following findings from the expert review and cognitive interviews. The content validity index exceeded recommended thresholds (S-CVIAve = 0.926). The psychometric evaluation provided support for DLI-S’ validity. The hypothesized six-factor model showed good fit (χ2 = 1107.631 p<0.001, CFI = 0.993, TLI = 0.993, RMSEA = 0.064, SRMR = 0.054). High internal consistency reliability was demonstrated for the overall scale (Cronbach’s α = 0.94) and each sub-scale (α 0.81–0.92). Test-retest reliability was acceptable, ICC ranging between 0.66–0.85. Through a comprehensive assessment of several sources of evidence, we show that the DLI-S demonstrates satisfactory validity and acceptability to measure death literacy in the Swedish context. There are, however, indications that the sub-scales measuring community capacity perform worse in comparison to other sca and may function differently in Sweden than in the original context. The DLI-S has potential to contribute to research on community-based EOL interventions.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introduction and Aimmentioning

confidence: 99%

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Validation of a culturally adapted Swedish-language version of the Death Literacy Index

Johansson,

Olsson,

Tishelman

et al. 2023

PLoS ONE

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What we learnt from parents’ death experience: A cross-sectional study of death literacy and parent’s death quality among adult children in China

Li,

Che,

Zhu

et al. 2023

Pall Supp Care

Self Cite

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Objectives This study aims at investigating the current status of death literacy and parent’s death quality among adult children in China. A cross-sectional survey was conducted to explore the associations between death literacy and parent’s death quality and to provide evidence for developing public policies for improving the quality of death and end-of-life care for the population in the Greater Bay Area (GBA) of China. Methods A cross-sectional design was adopted. Participants who experienced their father’s and/or mother’s death were recruited from 5 cities in the GBA of China in 2022. The Good Death Inventory (GDI) and the Death Literacy Index (DLI) were used to investigate the perceived quality of death of the parents of the participants and the death literacy of the participants. Results A total of 511 participants were recruited. Participants with higher GDI scores were positively associated with DLI scores (p < 0.001). Adult children who had close relationships before their parents’ death also had higher levels of DLI. Significance of results This study investigated death literacy among bereaved adult children in China, filling a gap in the investigation of death literacy among Chinese residents. It found that parents’ death experience can have a significant impact on the death literacy of adult children, which may affect their understanding and preparation for their own eventual death. Promotion of family discussion on death, development of community palliative care, and improving public death literacy are urgently needed in China.

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Progressing the Death Literacy Index: the development of a revised version (DLI-R) and a short format (DLI-9)

Noonan,

Grindrod,

Shrestha

et al. 2024

Palliat�Care

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Background: Since the development of the Death Literacy Index (DLI) in 2019 in Australia, subsequent internationally validated versions have prompted rewording and refinement of the original survey questions. Use of the DLI in the community has also resulted in requests for a short format. Objectives: To examine and report on the psychometric properties of a revised version of the DLI-R and develop a short format DLI-9. Design: A cross-sectional national survey was conducted for the validation of the revised DLI. Methods: The DLI items were revised by the research team using the international literature. DLI data were collected from a representative online non-probability panel of 1202 Australian adults, based on age, gender, and geographical location. Confirmatory factor analysis (CFA) was conducted to ensure the revised version (DLI-R) was consistent with the original. To develop a short format version of the DLI (DLI-9), items were first removed based on face validity, followed by an exploratory factor analysis (EFA) and CFA. The internal reliability of the DLI-R and the DLI-9 was assessed using Cronbach’s alpha. The intraclass correlation coefficient was calculated to examine the inter-rater reliability between the DLI-R and DLI-9. Results: Twenty-four questions in the DLI were reworded for clarity. A CFA on the 29 items of this modified version of the DLI indicated a good model fit (Tucker-Lewis Index (TLI): 0.93; Comparative Fit Index (CFI): 0.93; root mean square of approximation (RMSEA): 0.06; standardized root mean residual (SRMR): 0.06), with six latent variables and an underlying latent variable “death literacy.” For the DLI-9, an EFA identified a nine-item, two-factor structure model (DLI-9). A subsequent CFA in a separate sample demonstrated a good model fit for the DLI-9 (TLI: 0.92; CFI: 0.94; RMSEA: 0.089; SRMR: 0.07). Excellent inter-rater reliability (0.98) was observed between DLI-9 and DLI-R. Cronbach’s alpha coefficients for DLI-R scales and subscales and the DLI-9 all exceeded 0.8, indicating high internal consistency. Conclusion: The DLI-R and the DLI-9 were found to have acceptable psychometric properties. The development of a shorter version of the DLI provides a valid measure of overall death literacy.

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The Death Literacy Index: translation, cultural adaptation, and validation of the Chinese version

Cited by 4 publications

References 56 publications

Validation of a culturally adapted Swedish-language version of the Death Literacy Index

Validation of a culturally adapted Swedish-language version of the Death Literacy Index

What we learnt from parents’ death experience: A cross-sectional study of death literacy and parent’s death quality among adult children in China

Progressing the Death Literacy Index: the development of a revised version (DLI-R) and a short format (DLI-9)

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