German translation, cultural adaptation, and validation of the Health Literacy Questionnaire (HLQ)

Abstract

The Health Literacy Questionnaire (HLQ), developed in Australia in 2012 using a ‘validity-driven’ approach, has been rapidly adopted and is being applied in many countries and languages. It is a multidimensional measure comprising nine distinct domains that may be used for surveys, needs assessment, evaluation and outcomes assessment as well as for informing service improvement and the development of interventions. The aim of this paper is to describe the German translation of the HLQ and to present the results of the validation of the culturally adapted version. The HLQ comprises 44 items, which were translated and culturally adapted to the German context. This study uses data collected from a sample of 1,058 persons with chronic conditions. Statistical analyses include descriptive and confirmatory factor analyses. In one-factor congeneric models, all scales demonstrated good fit after few model adjustments. In a single, highly restrictive nine-factor model (no cross-loadings, no correlated errors) replication of the original English-language version was achieved with fit indices and psychometric properties similar to the original HLQ. Reliability for all scales was excellent, with a Cronbach’s Alpha of at least 0.77. High to very high correlations between some HLQ factors were observed, suggesting that higher order factors may be present. Our rigorous development and validation protocol, as well as strict adaptation processes, have generated a remarkable reproduction of the HLQ in German. The results of this validation provide evidence that the HLQ is robust and can be recommended for use in German-speaking populations.Trial Registration: German Clinical Trial Registration (DRKS): DRKS00000584. Registered 23 March 2011.

Health literacy: a new piece of the puzzle in psoriasis care? A cross‐sectional study

“…The questionnaire has no total score, as that could potentially mask individual needs in specific HL domains . The HLQ appears robust for its intended purpose of assessing HL in a range of settings and has shown excellent reliability …”

Barriers to Breast Cancer Screening among Diverse Cultural Groups in Melbourne, Australia

“…A four-point response scale is used to assess domains 1 to 5 (strongly disagree to strongly agree), and a five-point scale is used to assess domains 6 to 9 (cannot do or always difficult to always easy). The HLQ has a strong and reproducible theoretical structure that has been found to be robust in several studies [33,34,35,36]. The HLQ was translated using a formal forward and (blind) back translation procedure, with the forward translators guided by a detailed item intent document.…”

Health literacy of undergraduate health profession students in Australia: A comparison of the island state of Tasmania and other Australian universities

“…Repeat administration of the HLQ after implementation of the health literacy module(s) within health profession courses will provide further information about what needs to be reviewed, and updated as part of a quality assurance cycle [20]. The HLQ survey is being culturally adapted and validated within European countries [13,14], enabling comparison of the health literacy of health profession students across continents. This will provide opportunities for international collaboration in the development of health literacy resources [21,28].…”

“…Communication with consumers of health, providing health information to healthcare recipients, and delivering quality care are fundamental to students becoming work-ready health professionals by the time of graduation [3,[9][10][11]. The development of the Health Literacy Questionnaire (HLQ), has been shown to have excellent psychometric properties with high reliability and acceptability and has been used to explore health literacy across a range of populations world-wide [12][13][14]. The HLQ is designed to cover the extent of an individual's strengths and limitations of health literacy [9,10,15], with recent research demonstrating levels are varied [3, 9-11, 16, 17].…”