Validating the European Health Literacy Survey Questionnaire in people with type 2 diabetes: Latent trait analyses applying multidimensional Rasch modelling and confirmatory factor analysis

Finbråten, Hanne Søberg; Pettersen, Kjell Sverre; Wilde‐Larsson, Bodil; Nordström, Gun; Trollvik, Anne; Guttersrud, Øystein

doi:10.1111/jan.13342

Cited by 34 publications

(52 citation statements)

References 48 publications

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“…The questionnaire has already been used to test the literacy of specific groups of patients, such as adolescents [3], diabetics [3,24], and patients with heart failure [25]. We used the full version of the questionnaire with a cultural adaptation (linguistic validation) to the Serbian language.…”

Section: Methodsmentioning

confidence: 99%

Exploring the Importance of Health Literacy for the Quality of Life in Patients with Heart Failure

Jovanić

Zdravković

Stanisavljević

et al. 2018

IJERPH

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As with all other chronic noncommunicable diseases, adequate health literacy plays a key role in making the right decisions in the treatment of heart failure. Patients with heart failure and a lower health literacy have a reduced quality of life. A cross-sectional study among 200 patients with heart failure was conducted at a state university hospital in Belgrade, Serbia. The European Health Literacy Questionnaire, HLS-EU-Q47, was used to assess health literacy. Quality of life was measured with the generic SF-36 and the Minnesota Living with Heart Failure Questionnaire. Descriptive and analytical statistical analysis was applied. More than half of the respondents (64%) had limited health literacy. The lowest mean health literacy index (28.01 ± 9.34) was within the disease prevention dimension, where the largest number of respondents showed limited health literacy (70%). Our patients had a poorer quality of life in the physical dimension, and the best scores were identified in the emotional role and social functioning. Health literacy was highly statistically significant and an independent predictor of quality of life (physical, mental, and total quality of life). Improving health literacy can lead to better decisions in the treatment of disease and quality of life in heart failure patients.

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Section: Methodsmentioning

confidence: 99%

Exploring the Importance of Health Literacy for the Quality of Life in Patients with Heart Failure

Jovanić

Zdravković

Stanisavljević

et al. 2018

IJERPH

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“…The sample was drawn from the member list of the Norwegian Diabetes Association, who offered a geographically stratified sample that included the members' places of residence. In this paper, we base our analyses on the 12-item short form HLS-Q12 [6,7]. Finbråten et al [6,7] thoroghly describe the sampling procedures and sample characteristics.…”

Section: Methods Samplingmentioning

confidence: 99%

“…In this paper, we base our analyses on the 12-item short form HLS-Q12 [6,7]. Finbråten et al [6,7] thoroghly describe the sampling procedures and sample characteristics.…”

Section: Methods Samplingmentioning

confidence: 99%

“…Our study therefore aims to respond to this challenge. 6 The unidimensional Rasch measurement model for polytomously scored items Model requirements and properties: The concept of measurement implies a linear continuum of some kind, such as height and mass. Psychological performances result from measures that have neither an absolute zero point nor equal units of measurement.…”

Section: Definitions and Conceptual Models Of Health Literacymentioning

confidence: 99%

“…To support the strategy and provide knowledge-based policy and practice M-POHL is firmly committed to the continuing development of their comprehensive and widely used self-reported European Health Literacy Survey questionnaire (HLS-EU-Q47). The questionnaire was applied in a population study in eight European countries in 2011 [1] and later in Asian countries [5] and further European countries, such as Norway in 2014-2015 [6,7]. An accumulated body of corroborating evidence shows that the HLS-EU-Q47 data is not unidimensional [5][6][7][8][9][10][11], which gave rise to a controversy that led to the publication of the HLS-Q12 short form [7].…”

Section: Introductionmentioning

confidence: 99%

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Describing progression of health literacy skills: Establishing the HLS-Q12 cut-off 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 health literacy measure. 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 has been a worldwide call to identify HLS-Q12 cut-off scores and establish clearly delineated standards in terms of the skills assessed. This study therefore aims to identify the HLS-Q12 scores associated with statistically distinct levels of proficiency and construct a proficiency scale that expresses progression – what individuals typically know and can do at increasingly more 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 cut-off scores for significantly different levels. By directly referring to item content that people who reached the cut-off scores view as ‘easy’, we could describe these gradually more advanced levels of health literacy. Results We identified statistically distinct levels of health literacy at the empirically identified cut-off scores 27, 33 and 39 and confirmed them by analysing the responses from individuals with diabetes. Individuals who reach these cumulative benchmarks of marginal, intermediate and advanced literacy can typically access, appraise and apply information relevant to stay healthy, improve health and critically judge health claims and compare treatments, respectively. Conclusions By revealing progression in health literacy, we extended the current models of health literacy and inform policy-makers aiming to bridge literacy gaps. Determining how to best adapt information to patients’ literacy level and thereby assist them in managing their own health is a significant clinical outcome. A substantial methodological consequence is the inevitability of Rasch modelling in measurement. We also found that Wright’s method identified rating scale cut-off scores consistently across independent samples. To unveil sources of potential biases, threats to validity and imprecision of benchmarks, replicating our study in other contexts is required.

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Health literacy among long-term survivors of breast cancer; exploring associated factors in a nationwide sample

Vandraas

Reinertsen

Kiserud

et al. 2022

Support Care Cancer

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Background Poor health literacy may hamper health management and long-term outcomes in breast cancer survivorship. Knowledge of factors associated with poor health literacy is needed to identify survivors in need of additional support and to improve the quality of health care, but is currently scant. Here, we explore health literacy and associated factors in a nationwide sample of long-term survivors of breast cancer. Material and methods All survivors aged 20–65 years when diagnosed with stage I–III breast cancer in 2011 or 2012 were identified through the Norwegian Cancer Registry, and invited to participate in the Survivorship, Work and Sexual Health (SWEET) study. Health literacy was measured using The European Health Literacy Survey Questionnaire-12 (HLS-EU-Q12) and analyzed as a continuous and categorical variable. Associations between health literacy and socioeconomic, physical, and mental health variables, including the most common late effects after cancer treatment, were explored in uni- and multivariable linear regression models. Results The final sample consisted of 1355 survivors (48%) with a mean age of 60 years at survey (SD 8.7). Eight years had passed since diagnosis (SD.0.7), and the majority of survivors had high socioeconomic status. Advanced judgment calls concerning treatment and health risks were reported to be the most difficult for survivors to handle. Mean health literacy sum score was 36.2 (range 12–48, SD 5.4). Thirty-nine percent had intermediate, while 19.3% reported marginal or inadequate health literacy. Education, income, age at diagnosis, the personality trait neuroticism, and fear of cancer recurrence were significantly associated with health literacy in the multivariate model, explaining 12% of the variance in health literacy scores. Conclusion Low levels of health literacy were prevalent in this population-based sample of long-term survivors of breast cancer, despite high socioeconomic status. Communicating and interpreting risks seem to be especially challenging. Attention to health literacy at a societal and individual level is necessary in order to provide survivorship care of high quality.

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Validating the European Health Literacy Survey Questionnaire in people with type 2 diabetes: Latent trait analyses applying multidimensional Rasch modelling and confirmatory factor analysis

Cited by 34 publications

References 48 publications

Exploring the Importance of Health Literacy for the Quality of Life in Patients with Heart Failure

Exploring the Importance of Health Literacy for the Quality of Life in Patients with Heart Failure

Describing progression of health literacy skills: Establishing the HLS-Q12 cut-off scores

Health literacy among long-term survivors of breast cancer; exploring associated factors in a nationwide sample

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