Translation and cross-cultural adaptation of the European Health Literacy Survey Questionnaire, HLS-EU-Q16: the Icelandic version

• Published in: BMC Public Health
• Main Authors: Sonja Stelly Gustafsdottir, Arun K. Sigurdardottir, Solveig A. Arnadottir, Gudmundur T. Heimisson, Lena Mårtensson
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2020
• Subjects: Health literacy; HLS-EU-Q16; Translation and adaptation; Cognitive interviewing; Validation; Instrument; Public aspects of medicine; RA1-1270; Iceland
• Online Access: https://doi.org/10.1186/s12889-020-8162-6; https://doaj.org/article/d1d0d2550a5a45e583f95a8f5cd473c3

Abstract Background Health literacy (HL) is defined as the knowledge and competences of people to meet the complex demands of health in modern society. It is an important factor in ensuring positive health outcomes, yet Iceland is one of many countries with limited knowledge of HL and no valid HL measurement. The aim of this study was to translate the European Health Literacy Survey Questionnaire- short version (HLS-EU-Q16) into Icelandic, adapt the version, explore its psychometric properties and establish preliminary norms. Methods The HLS-EU-Q16 translation model included three steps: 1) translation-back-translation of HLS-EU-Q16 including specialists’ review (n = 6); 2) cognitive interviewing of lay people (n = 17); and 3) psychometric analysis with survey participants. The HLS-EU-Q16 includes 16 items, with scores ranges from zero (low/no HL) to 16 (high HL). Statistics included were descriptive, internal consistency measured by Cronbach’s α, exploratory factor analysis, and multivariate linear regression. Results After the translation and cognitive interviewing, 11 of the HLS-EU-Q16 items were reworded to adapt the instrument to Icelandic culture while maintaining their conceptual objectives. Survey participants were 251. Internal consistency of the translated and adapted instrument was α = .88. Four factors with eigenvalues > 1.0 explained 62.6% of variance. Principal component analysis with Oblimin rotation presented four latent constructs, “Processing and Using Information from the Doctor” (4 items, α = .77), “Processing and Using Information from the Family and Media” (4 items, α = .85), “Processing Information in Connection to Healthy Lifestyle” (5 items, α = .76), and “Finding Information about Health Problems/Illnesses” (3 items, α = .73). Lower self-rated health was an independent predictor of lower HL (β = −.484, p = .008). Preliminary norms for HL ranged from five to 16 (M 13.7, SD ± 2.6) with 72.5% with sufficient HL (score 13–16), 22% with problematic HL (score 9–12) and 5.5% with inadequate ...