Hawkins Melanie, Gill Stephen D, Batterham Roy, Elsworth Gerald R, Osborne Richard H
Faculty of Health, Centre for Population Health Research, Deakin University, Geelong, Australia.
Safety and Quality Unit, Barwon Health, Geelong, Australia.
BMC Health Serv Res. 2017 Apr 27;17(1):309. doi: 10.1186/s12913-017-2254-8.
The Health Literacy Questionnaire (HLQ) has nine scales that each measure an aspect of the multidimensional construct of health literacy. All scales have good psychometric properties. However, it is the interpretations of data within contexts that must be proven valid, not just the psychometric properties of a measurement instrument. The purpose of this study was to establish the extent of concordance and discordance between individual patient and clinician interpretations of HLQ data in the context of complex case management.
Sixteen patients with complex needs completed the HLQ and were interviewed to discuss the reasons for their answers. Also, the clinicians of each of these patients completed the HLQ about their patient, and were interviewed to discuss the reasons for their answers. Thematic analysis of HLQ scores and interview data determined the extent of concordance between patient and clinician HLQ responses, and the reasons for discordance.
Highest concordance (80%) between patient and clinician item-response pairs was seen in Scale 1 and highest discordance (56%) was seen in Scale 6. Four themes were identified to explain discordance: 1) Technical or literal meaning of specific words; 2) Patients' changing or evolving circumstances; 3) Different expectations and criteria for assigning HLQ scores; and 4) Different perspectives about a patient's reliance on healthcare providers.
This study shows that the HLQ can act as an adjunct to clinical practice to help clinicians understand a patient's health literacy challenges and strengths early in a clinical encounter. Importantly, clinicians can use the HLQ to detect differences between their own perspectives about a patient's health literacy and the patient's perspective, and to initiate discussion to explore this. Provision of training to better detect these differences may assist clinicians to provide improved care. The outcomes of this study contribute to the growing body of international validation evidence about the use of the HLQ in different contexts. More specifically, this study has shown that the HLQ has measurement veracity at the patient and clinician level and may support clinicians to understand patients' health literacy and enable a deeper engagement with healthcare services.
健康素养问卷（HLQ）有九个量表，每个量表测量健康素养多维度结构的一个方面。所有量表都具有良好的心理测量特性。然而，必须证明在具体情境中数据的解释是有效的，而不仅仅是测量工具的心理测量特性。本研究的目的是确定在复杂病例管理背景下，患者个体与临床医生对HLQ数据的解释之间一致和不一致的程度。
16名有复杂需求的患者完成了HLQ，并接受访谈以讨论他们答案的原因。此外，这些患者的每位临床医生也针对其患者完成了HLQ，并接受访谈以讨论他们答案的原因。对HLQ得分和访谈数据进行主题分析，以确定患者与临床医生HLQ回答之间的一致程度以及不一致的原因。
在量表1中，患者与临床医生项目反应对之间的一致性最高（80%），在量表6中不一致性最高（56%）。确定了四个主题来解释不一致性：1）特定词汇的技术或字面含义；2）患者不断变化或演变的情况；3）分配HLQ分数的不同期望和标准；4）关于患者对医疗服务提供者依赖程度的不同观点。
本研究表明，HLQ可作为临床实践的辅助工具，帮助临床医生在临床接触早期了解患者的健康素养挑战和优势。重要的是，临床医生可以使用HLQ来发现他们自己对患者健康素养的看法与患者看法之间的差异，并发起讨论以探讨这一点。提供更好地发现这些差异的培训可能有助于临床医生提供更好的护理。本研究结果为HLQ在不同背景下使用的国际验证证据的不断增加做出了贡献。更具体地说，本研究表明HLQ在患者和临床医生层面具有测量准确性，并可能支持临床医生理解患者的健康素养，并促进与医疗服务的更深入接触。
