Evaluating the European Health Literacy Survey Questionnaire in Patients with Stroke: A Latent Trait Analysis Using Rasch Modeling

Huang, Yijing; Chen, Cheng Te; Lin, Gong Hong; Wu, Tzong‐Chen; Chen, Sheng Shiung; Li, Lin; Hou, Wen Hsuan; Hsieh, Ching-Lin

doi:10.1007/s40271-017-0267-3

Cited by 19 publications

(23 citation statements)

References 30 publications

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“…The European Health Literacy Survey Questionnaire (HLS-EU-Q47) was developed on the basis of this framework [2,38,39]. However, Finbråten et al [40] and Huang et al [41] have revealed several psychometric weaknesses of the HLS-EU-Q47 when validated in people with T2DM and in people with stroke, respectively. The newly developed and shortened version of this instrument, the HLS-Q12, which has enhanced psychometric properties [42,43], was well-suited for HL screenings in the study sample of people with T2DM.…”

Section: Introductionmentioning

confidence: 99%

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Explaining variance in health literacy among people with type 2 diabetes: the association between health literacy and health behaviour and empowerment

et al. 2020

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Background: To reflect the health literacy (HL) skills needed for managing type 2 diabetes (T2DM) in everyday life, HL in people with T2DM should be measured from a broader perspective than basic skills, such as proficiency in reading and writing. The HLS-Q12, based on the European Health Literacy Survey Questionnaire (HLS-EU-Q47), assesses four cognitive domains across three health domains. International studies on people with T2DM show inconsistent results regarding the association between HL and general health and the association between HL and glycaemic control. Moreover, knowledge is needed related to the link between HL and empowerment for those with T2DM. The aims of this study were to examine the association between i) HL and general health and diabetes outcomes, ii) HL and health behaviours and iii) HL and empowerment in people with T2DM. Methods: During March and April 2015, 388 adults with T2DM responded to a paper-and-pencil self-administered questionnaire. A sequential multiple regression analysis was applied to explore the association between HL, as measured by the HLS-Q12, and health conditions, HbA1c, health behaviours and empowerment. Results: For people with T2DM, higher levels of HL were associated with higher levels of education, better overall health conditions and higher self-perceived empowerment. No empirical evidence strengthening either the link between HL and glycaemic control or the link between HL and health behaviours was found. Conclusions: The independent variables education level, overall health condition and empowerment explained about one-third of the total observed variance in HL.

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Section: Introductionmentioning

confidence: 99%

“…Health literacy across levels of person factors, general health, diabetes outcome, health behaviours and empowerment HL: person-location estimates (logit values) of health literacy by means of the HLS-Q12 of Finbråten et al[41]. Higher values indicate higher HL…”

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confidence: 99%

Explaining variance in health literacy among people with type 2 diabetes: the association between health literacy and health behaviour and empowerment

et al. 2020

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“…The survey was initiated by the Action Network on applied in a population study in eight European countries in 2011 [1] and in Norway in 2014-2015 [6,7]. An accumulated body of corroborating evidence showed that the HLS-EU-Q47 data is not unidimensional [6][7][8][9][10][11], which gave rise to a controversy that led to the publication of the HLS-Q12 short form [7]. Subsequent to its publication, there has been an international request to establish the HLS-Q12 cutoff scores for different HL levels.…”

Section: Introductionmentioning

confidence: 99%

Towards a progression of health literacy skills: Establishing the HLS-Q12 cutoff scores

Guttersrud¹,

Le²,

Pettersen³

et al. 2019

Preprint

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Background The self-reported European Health Literacy Survey Questionnaire (HLS-EU-Q47) is a widely used measure for population health literacy. Based on confirmatory factor analyses and Rasch modelling, the short form HLS-Q12 was developed to meet the Rasch unidimensional measurement model expectations. After its publication, there was a worldwide call to identify HLS-Q12 cutoff scores and establish clearly delineated standards regarding the skills assessed. This study therefore aims to identify the HLS-Q12 scores associated with statistically distinct levels of proficiency and to construct a proficiency scale that may indicate what individuals typically know and can do at increasingly sophisticated levels of health literacy. Methods We applied the unidimensional Rasch measurement model for polytomous items to responses from 900 randomly sampled individuals and 388 individuals with type 2 diabetes. Using Rasch based item calibration, we constructed a proficiency scale by locating the ordered item thresholds along the scale. By applying Wright’s method for the maximum number of strata, we determined the cutoff scores for significantly different levels. By directly referring to item content that people who achieved the cutoff scores viewed as ‘easy’, we suggested what these gradually more advanced levels of health literacy might mean in terms of item content. Results Analysing the population sample, we identified statistically distinct levels of health literacy at the empirically identified cutoff scores 27, 33 and 39. We confirmed them by analysing the responses from individuals with diabetes. Using item calibration, the resulting HLS-Q12 proficiency scale expresses typical knowledge and skills at these three statistically distinct levels. The scale’s cumulative nature indicates what it may mean qualitatively to move from low to high health literacy. Conclusions By identifying levels of health literacy, we may initiate the improvement of current models of health literacy. Determining how to adapt information to patients’ health literacy level is a possible clinical outcome. A substantial methodological outcome is the inevitability of Rasch modelling in measurement. We found that Wright’s method identified rating scale cutoff scores consistently across independent samples. To reveal sources of potential biases, threats to validity and imprecision of benchmarks, replication of our study in other contexts is required

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“…In spite of the advantages that item response theory (IRT) models, and Rasch models in particular, have over classical test theory (CTT), few health-related and health literacy scales have been evaluated using IRT and Rasch models (see, for example, Davidson, Keating & Eyres, 2004;Escobar et al, 2015;Huang et al 2018;Nguyen, Paasche-Orlow, Kim, Han and Chan, 2015). One such advantage is concerned with the assumption of item-sample independence, which is strongly emphasized in IRT and Rasch models.…”

Section: Introductionmentioning

confidence: 99%

Assessing adolescent self-efficacy in ‘body and health’ - Exploring the psychometric properties of the SEBH scale

Naigaga

Pettersen²,

Guttersud

et al. 2019

NorDiNa

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Self-efficacy beliefs are significant predictors of achievement in education. However, majority of existing self-efficacy measures are rather ‘general’ and assess aggregated perceptions of students’ proficiencies within broad academic disciplines. Applying Rasch analysis, the present study explored the psychometric properties of the five-item ‘self-efficacy in body and health’ (SEBH) scale as administered to 1622 tenth-graders aged 15-16years in Norway. Based on our sample, the SEBH scale stood out as well targeted and reliable with acceptable overall fit to the partial credit parameterization of the polytomous unidimensional Rasch model. Except for a slightly reversed threshold in item 1, which could be explained by few persons located at low levels of self-efficacy, the locally independent items had ordered response categories and functioned in the same way for the different levels of relevant person factors. Adapting this scale to different fields of education would contribute to development of more specific measures of perceived capability.

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Evaluating the European Health Literacy Survey Questionnaire in Patients with Stroke: A Latent Trait Analysis Using Rasch Modeling

Cited by 19 publications

References 30 publications

Explaining variance in health literacy among people with type 2 diabetes: the association between health literacy and health behaviour and empowerment

Explaining variance in health literacy among people with type 2 diabetes: the association between health literacy and health behaviour and empowerment

Towards a progression of health literacy skills: Establishing the HLS-Q12 cutoff scores

Assessing adolescent self-efficacy in ‘body and health’ - Exploring the psychometric properties of the SEBH scale

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