The HLS19-COM-P, a New Instrument for Measuring Communicative Health Literacy in Interaction with Physicians: Development and Validation in Nine European Countries

Abstract

Background: Sufficient communicative health literacy (COM-HL) is important for patients actively participating in dialogue with physicians, expressing their needs and desires for treatment, and asking clarifying questions. There is a lack of instruments combining communication and HL proficiency. Hence, the aim was to establish an instrument with sufficient psychometric properties for measuring COM-HL. Methods: The HLS19-COM-P instrument was developed based on a conceptual framework integrating HL with central communicative tasks. Data were collected using different data collection modes in nine countries from December 2019 to January 2021 (n = 18,674). Psychometric properties were assessed using Rasch analysis and confirmatory factor analysis. Cronbach’s alpha and Person separation index were considered for reliability. Results: The 11-item version (HLS19-COM-P-Q11) and its short version of six items (HLS19-COM-P-Q6) fit sufficiently the unidimensional partial credit Rasch model, obtained acceptable goodness-of-fit indices and high reliability. Two items tend to under-discriminate. Few items displayed differential item functioning (DIF) across person factors, and there was no consistent pattern in DIF across countries. All items had ordered response categories. Conclusions: The HLS19-COM-P instrument was well accepted in nine countries, in different data collection modes, and could be used to measure COM-HL.

HLS19-NAV—Validation of a New Instrument Measuring Navigational Health Literacy in Eight European Countries

“…Given that polytomous data also met these criteria, it is reasonable to assume that CFA describes the data sufficiently well for both polytomous and dichotomous responses. Considering that there were no problems with the four response categories of the HLS 19 -NAV and that the polytomous NAV-HL score tends to be more normally distributed than the dichotomous score across countries (Figgures S1 and S2), it may be beneficial in future studies to calculate a score based on polytomous data, since dichotomization always goes hand-in-hand with a loss of information and thus statistical power [ 42 , 75 , 76 ].…”

“…At the same time, it must be considered that these aspects go beyond NAV-HL and form overarching concepts. For this reason, it was decided at an early development phase of the HLS 19 -NAV to display interactive tasks only very cautiously and to develop a separate instrument with a general focus on communicative HL, the HLS 19 -COM-P [ 42 ]. In future studies, it is recommended to examine whether items on interactive and communicative HL could be added to the NAV-HL scale to better reflect the conceptual NAV-HL framework.…”

“…The items of the HLS 19 -COM-P may be used as a first starting point. Nevertheless, they have to be transferred to the specific field of navigating the HCS as they specifically measure general communicative HL in interaction with physicians [ 42 ].…”

“…It is reasonable to conclude that, with HLS 19 -NAV, new aspects in managing health information for the specific context of navigating the HCS were assessed, since the two measures correlate only to a certain extent. At the same time, the results point to overlaps between the two measures, leading to the assumption that NAV-HL belongs to a family of specific HL measures, introduced in the HLS 19 , which are all linked to GEN-HL [ 17 , 42 ].…”

“…This article is part of a series of already published [ 42 ] and upcoming papers introducing new HL tools that have been developed, applied, and tested, all in the HLS 19 study. In general, the aim of these articles is to use the data collected in HLS 19 to examine the psychometric properties of the newly developed HL tools and different aspects of its validity.…”