Dataset Information

Psychometric qualities of the HLS-EU-Q16 instrument for parental health literacy in Swedish multicultural settings.

ABSTRACT:

Background

Health literacy (HL) is important for individuals in terms of knowledge and competence to make decisions about healthcare, health promotion and disease prevention. Migrants generally demonstrate lower HL levels compared to the majority populations. HL interventions among migrants are rarely studied. Thus, there is a need to find useful HL measurements for multicultural settings. The importance of understanding parents' HL is related to their key role in providing and promoting the health of their children. This study aimed to add knowledge about the psychometric properties of the HLS-EU-Q16 instrument (Swedish version) among parents in Swedish multicultural settings.

Methods

A cross sectional design was used. Totally 193 first-time parents (N = 193) were recruited through two child healthcare centres in Stockholm. Parents were interviewed when their infants were < 2 months old using structured questionnaires including HLS-EU-Q16. For psychometric evaluation of HLS-EU-Q16 instrument, exploratory factor analyses (EFA) were used to test internal consistency (N = 164). HL levels in sub-groups were explored with Kruskal-Wallis/Chi2 tests. Participants' comments on HLS-EU-Q16 questionnaire were viewed to explore how the questions were perceived by the target population.

Results

One factor solution of EFA explained 37.3% of the total variance in HLS-EU-Q16. Statistically significant differences in HL levels were found in relation to migration including language difficulties and level of education of the study population and access to support in line with previous research. Challenges related to understanding HLS-EU-Q16 questionnaire were found among participants with migrant background.

Conclusions

The Swedish version of HLS-EU-Q16 could be used together with other instruments for measuring overall HL in multicultural settings. HLS-EU-Q16 appears to discriminate between different levels of HL in relation to migrant background and shorter education and limited access to support. However, other measures of HL which should be adapted to use in multicultural settings, need to be explored in further studies of parental HL and its relationship to child health in multicultural settings.

Trial registration

The study was retrospectively registered (18 February 2020) in the ISRCTN registry ( ISRCTN10336603 ).

SUBMITTER: Mekhail KT

PROVIDER: S-EPMC8841050 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Publications

Psychometric qualities of the HLS-EU-Q16 instrument for parental health literacy in Swedish multicultural settings.

Mekhail Kirsi Tiitinen KT Burström Bo B Marttila Anneli A Wångdahl Josefin J Lindberg Lene L

BMC public health 20220212 1

<h4>Background</h4>Health literacy (HL) is important for individuals in terms of knowledge and competence to make decisions about healthcare, health promotion and disease prevention. Migrants generally demonstrate lower HL levels compared to the majority populations. HL interventions among migrants are rarely studied. Thus, there is a need to find useful HL measurements for multicultural settings. The importance of understanding parents' HL is related to their key role in providing and promoting ...[more]

PMID: 35151303

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Project description:IntroductionEquity in health and access to healthcare regardless of gender, ethnicity or social position is a major political issue worldwide. Regardless of an individual's knowledge, motivation and competence, individuals are expected to be engaged and take responsibility of their own care. Migrants have been identified as a vulnerable population in healthcare, and an explanation for the inequity in health and in healthcare is limited health literacy. Furthermore, with increasing digitalisation in healthcare, it also puts demand on the individual to have digital or electronic health (eHealth) literacy.The overall aim of this study is to conduct a psychometric evaluation of the Swedish and Arabic versions of HLS-EU-Q16 and eHEALS and to compare Arabic and Swedish speakers' Health literacy and eHealth literacy levels in Sweden.Methods and analysisThis is a prospective, psychometric evaluation study with the intent of including 300 Arabic-speaking and 300 Swedish-speaking participants. Questionnaires: The Health Literacy Survey European Questionnaire (HLS-EU-Q16) includes 16 items measuring perceived personal skills of finding, understanding, judging and applying health information to maintain and improve their health. The eHealth literacy scale (eHEALS) is an 8-item scale measuring health literacy skills in relation to online information and applications.This study will be conducted in four phases. Phase 1: Translation of HLS-EU-Q16 and eHEALS from English to Swedish and Arabic versions following the principles of translation of questionnaires. Phase 2: Content validity testing of eHEALS, including face validity and interpretability, conducted with five Arabic and five Swedish-speaking participants. Phase 3: Psychometric testing including construct validity, reliability, feasibility and floor ceiling effects. Phase 4: Distribution and comparison of eHealth and HLS-EU-Q16 analysed with χ2 and Fisher's exact test as appropriate. To assess associations between HLS-EU-Q16, eHEALS and demographic variables, binary logistic regression analyses will be performed.Ethics and disseminationThe project has been approved by the regional ethical review board in Stockholm, Sweden (2019/5:1) and will follow the principles outlined in the 1964 Helsinki Declaration and its later amendments. Results from this study will be disseminated in peer-reviewed journals, scientific conferences and social media.

Project description:IntroductionHealth literacy is an important predictor of health behavior and self-rated health, playing a crucial role in shaping public health outcomes. Valid and reliable health literacy assessments are essential for effectively tailoring health interventions, particularly in different cultural contexts. Several questionnaires have been developed to measure health literacy, including the widely used 47-item Health Literacy Questionnaire and its shorter versions. However, the validity of these shorter and more time efficient HLS-EU versions, such as the 16-item HLS-EU-Q16, has been less extensively researched in different age subgroups. Given Slovenia's aging population and the differences in health literacy between adults and older adults, it is important to assess whether the HLS-EU-Q16 performs reliably across these groups. Therefore, the present study aimed to examine the validity and reliability of the 16-item health literacy questionnaire (HLS-EU-Q16) in Slovenia across two age groups: adults and older adults.MethodsWe analyzed representative Slovenian sample data from the Health Literacy of Adults study. The sample included 2,327 adults aged 23-64 years (53.7% women) and 876 older adults aged 65-99 years (55.7% women).ResultsConstruct validity revealed a modified three-factor structure of the HLS-EU-Q16 among adults, reflecting a broader conceptualization of health literacy that encompasses overlapping domains of health promotion, disease prevention, and health care. In contrast, a two-factor structure emerged among older adults, indicating a more consolidated approach where these domains are perceived as part of an integrated health management strategy. This suggests that adults may conceptualize health literacy across multiple, yet interconnected dimensions, while older adults approach it more holistically. Convergent validity, reliability, concurrent-predictive, concurrent, and discriminant validity results were satisfactory for both age groups. Predictive validity, however, provided somewhat inadequate results, as the tool poorly predicted certain health behaviors, such as smoking, alcohol consumption, and physical activity, in both age groups.ConclusionOverall, the HLS-EU-Q16 demonstrated adequate validity and reliability among both adults and older adults, indicating that it is an appropriate instrument for assessing health literacy in Slovenia.

Project description:BackgroundHealth literacy (HL) is defined as necessary competencies to make well-informed decisions. As patients' decision making is a key element of patient-centered health care, insight in patients' HL might help healthcare professionals to organize their care accordingly. This is particularly true for people in a vulnerable situation, potentially with limited HL, who are, for instance, at greater risk of having limited access to care [1, 2]. As HL correlates with education, instruments should allow inclusion of low literate people. To that end, the relatively new instrument, HLS-EU-Q47, was subjected to a comprehensibility test, its shorter version, HLS-EU-Q16, was not. Therefore, the goal of this study was to examine feasibility of HLS-EU-Q16 (in Dutch) for use in a population of people with low literacy.MethodsPurposive sampling of adults with low (yearly) income (< €16,965.47) and limited education (maximum high school), with Dutch language proficiency. Exclusion criteria were: psychiatric, neurodegenerative diseases or impairments. To determine suitability (length, comprehension and layout) participants were randomly distributed either HLS-EU-Q16 or a modified version and were interviewed directly afterwards by one researcher. To determine feasibility a qualitative approach was chosen: cognitive interviews were carried out using the verbal probing technique.ResultsThirteen participants completed HLS-EU-Q16 (n = 7) or the modified version (n = 6). Questions about 'disease prevention' or 'appraisal' of information are frequently reported to be incomprehensible. Difficulties are attributed to vocabulary, sentence structure and the decision process (abstraction, distinguishing 'appraising' from 'applying' information, indecisive on the appropriate response).ConclusionsHLS-EU-Q16 is a suitable instrument to determine HL in people with limited literacy. However, to facilitate the use and interpretation, some questions would benefit from minor adjustments: by simplifying wording or providing explanatory, contextual information.

Dataset Information

Psychometric qualities of the HLS-EU-Q16 instrument for parental health literacy in Swedish multicultural settings.

Background

Methods

Results

Conclusions

Trial registration

Publications

Psychometric qualities of the HLS-EU-Q16 instrument for parental health literacy in Swedish multicultural settings.

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