Jessup Rebecca L, Beauchamp Alison, Osborne Richard H, Hawkins Melanie, Buchbinder Rachelle
Victorian Centre for Virtual Health Research, Northern Health, 185 Cooper Street, Melbourne, Vic 3075, Australia; and School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, Vic 3086, Australia.
School of Rural Health, Monash University, Sargeant Street, Warragul, Vic 3820, Australia.
Aust J Prim Health. 2024 Dec;30. doi: 10.1071/PY22280.
Background Health literacy has evolved from a focus on individual skills to an interactive process influenced by relationships and the health system. Various instruments measure health literacy, developed from different conceptions and often for different measurement purposes. The aim of this study was to compare the properties of four widely used health literacy instruments: Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), European Health Literacy Survey (HLS-EU-Q47), and Health Literacy Questionnaire (HLQ). Methods This was a within-subject study comparing instrument performance. Composite reliability and Cronbach's alpha was used to measure internal consistency, floor/ceiling effects determined discriminate ability across low-to-high score ranges, and Spearman's R correlation coefficient was used to assess the relationship between instruments, particularly scales aiming to measure similar constructs. Results Fifty-nine patients consented, with 43 completing all four instruments. Internal consistency was high for all scales (composite reliability range 0.76-0.95). Floor and ceiling effects were observed, with TOFHLA demonstrating the largest ceiling effect (>62) and NVS the only floor effect (18%). Only moderate correlations were found between TOFHLA and NVS (r =0.60) and between HLS-EU-Q47 and HLQ scales (r ~0.6). Conclusion Our study found low to moderate correlations between the instruments, indicating they measure different constructs of health literacy. Clinicians and researchers should consider the intended measurement purpose and constructs when choosing an instrument. If the purpose of measurement is to understand reading, comprehension, and numeracy skills in individuals and populations, then performance based functional health literacy instruments such as the TOFHLA and NVS will be suitable. However, if the purpose is to generate insights into broader elements of health literacy, including social supports and relationships with health providers, then the HLS-EU and HLQ may be useful. The findings highlight the need for careful instrument selection to ensure meaningful and appropriate data interpretation. As improving population health literacy is a national priority in many countries, it is important that clinicians and researchers understand the measurement differences offered by different instruments to assist them to choose the right instrument for their measurement purpose.
背景 健康素养已从关注个体技能演变为受人际关系和卫生系统影响的互动过程。各种工具用于测量健康素养，这些工具基于不同的概念开发，且通常用于不同的测量目的。本研究的目的是比较四种广泛使用的健康素养工具的特性：成人功能性健康素养测试（TOFHLA）、最新生命体征（NVS）、欧洲健康素养调查（HLS-EU-Q47）和健康素养问卷（HLQ）。方法 这是一项比较工具性能的受试者内研究。使用综合信度和克朗巴哈系数来测量内部一致性，通过地板效应/天花板效应确定在低到高分数范围内的区分能力，并使用斯皮尔曼相关系数来评估工具之间的关系，特别是旨在测量相似结构的量表之间的关系。结果 59名患者同意参与，43名完成了所有四种工具的测试。所有量表的内部一致性都很高（综合信度范围为0.76 - 0.95）。观察到了地板效应和天花板效应，TOFHLA表现出最大的天花板效应（>62），NVS表现出唯一的地板效应（18%）。TOFHLA与NVS之间（r = 0.60）以及HLS-EU-Q47与HLQ量表之间（r ~ 0.6）仅发现中等程度的相关性。结论 我们的研究发现这些工具之间的相关性较低到中等，表明它们测量的是健康素养的不同结构。临床医生和研究人员在选择工具时应考虑预期的测量目的和结构。如果测量目的是了解个体和人群的阅读、理解和计算技能，那么基于表现的功能性健康素养工具，如TOFHLA和NVS将是合适的。然而，如果目的是深入了解健康素养的更广泛要素，包括社会支持以及与医疗服务提供者的关系，那么HLS-EU和HLQ可能会有用。研究结果强调了仔细选择工具以确保进行有意义和恰当的数据解读的必要性。由于提高人群健康素养是许多国家的国家优先事项，临床医生和研究人员了解不同工具提供的测量差异以帮助他们选择适合其测量目的的正确工具非常重要。
