Psychometric validation of Swedish and Arabic versions of two health literacy questionnaires, eHEALS and HLS-EU-Q16, for use in a Swedish context: a study protocol

Abstract

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 χ2and 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.

Arabic Version of the Electronic Health Literacy Scale in Arabic-Speaking Individuals in Sweden: Prospective Psychometric Evaluation Study

“…This was a prospective psychometric evaluation study that included 3 phases: translation, content validity testing, and psychometric evaluation. Data collection for phases 1 and 2 took place in April 2019, and data collection for phase 3 took place from May to September 2019 [ 32 ]. The project was approved by the Regional Ethical Review Board in Stockholm, Sweden (No.…”

“…A sum score (ranging from 0 to 16) was calculated, and self-perceived comprehensive health literacy was classified into 3 levels: 0-8, inadequate, 9-12, problematic, and 13-16, sufficient [ 40 ]. The general self-perceived health question “How do you assess your overall health status?” had “very poor, poor, fair, good, or very good” as response options [ 14 , 32 , 41 , 42 ]; the question “How useful is the Internet in helping you make decisions about your health?” had “not useful at all, not useful, unsure, useful, or very useful” as response options and was used to measure the usability of the internet. Importance of the internet was measured by the question “How important is it for you to be able to access health resources on the Internet?” with “not important at all, not important, unsure, important, and very important” as response options [ 15 , 17 ].…”

The Sociodemographic Determinants of Health Literacy in the Ethnic Hungarian Mothers of Young Children in Eastern Europe

“…The HLS-EU-16 questionnaire was validated in several European countries: in the Catalan population [ 18 ], Italy [ 38 ], Spain [ 39 ], Iceland [ 40 ], France [ 41 ], Belgium [ 42 ], as well as on a sample of the low-health-literate Dutch population [ 43 ]. It was also validated in European immigrant populations, in an Arabic population in Sweden [ 44 ] and in Somali women in Norway [ 45 ]. In Eastern Europe, the scale was validated on a representative sample of the general parent population in Hungary [ 46 ] and in the adult population of Poland [ 9 ].…”

Person-Centered Interactive Self-Management Support in Primary Health Care for People with Type 2 Diabetes: Protocol for a Randomized Controlled Trial

“…eHealth literacy will be measured by the shorter Swedish version of the European Health Literacy Survey Questionnaire. The Swedish version of European Health Literacy Survey Questionnaire will be used at baseline and follow-up [39,40]. The instrument consists of 16 items focusing on the following 4 dimensions of health literacy: the ability to access and obtain health information, ability to understand health information (not only in written form), ability to process and appraise health information, and ability to apply and use health information.…”