Ha Dinh Thi Thuy, Bonner Ann
School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.
School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia.
BMC Public Health. 2025 Jan 6;25(1):44. doi: 10.1186/s12889-024-21156-7.
The Health Literacy Questionnaire (HLQ) is an increasingly used health literacy instrument that has been translated into many languages. The HLQ has 44 items and comprises 9 scales assessing the multidimensional construct of health literacy. This study reports the HLQ reliability and construct validity tested in people with chronic diseases living in Vietnam.
Adults (n = 600) hospitalized with chronic disease in Vietnam completed the HLQ. Floor and ceiling effects, item, and scale difficulty levels were assessed. Generalized linear models with backward modeling techniques were performed to test key variables associated with each HL domain. Confirmatory factor analyses (CFA) testing nine one-factor models were fitted to test the structure of each scale, and a nine-factor model tested the hypothesized structure of the HLQ, followed by the calculation of scale reliability using Cronbach's alpha.
No item had floor effects, and only eight items showed ceiling effects. Two scales that had the most difficult tasks to complete (highest difficulty level) were 8 "Ability to find good information" and 9 "Understanding enough to know what to do". Variables associated with health literacy were education, income, age, residential area, main support persons and comorbidity index (associated with 7, 7, 4, 3, 2 and 2 out of 9 scales, respectively). Each HLQ scale demonstrated a robust unidimensional construct with all CFI ≥ 0.95, RMSEA varied from 0 to 0.07. The nine-factor CFA model demonstrated satisfactory fit indices: X2 = 5537.4, 866 df, p < 0.001, CFI = 0.98, NFI = 0.98, RMSEA = 0.09, 90% CI (0.093, 0.097), PCLOSE < 0.001. The highest scores were rated on scales 4 "Social support for health" and 6 "Ability to engage with healthcare providers". The reliability of all nine scales ranged from 0.81 to 0.89.
The Vietnamese version of the HLQ demonstrated psychometrically robust properties with high reliability and satisfactory construct validity indexes. This instrument will enable researchers, clinicians, and policymakers to assess health literacy abilities in Vietnam which could inform improvements in healthcare services and clinician practice.
健康素养问卷（HLQ）是一种使用越来越广泛的健康素养工具，已被翻译成多种语言。HLQ有44个条目，包括9个量表，用于评估健康素养的多维度结构。本研究报告了在越南慢性病患者中测试的HLQ的信度和结构效度。
越南600名因慢性病住院的成年人完成了HLQ。评估地板效应和天花板效应、条目及量表难度水平。采用具有向后建模技术的广义线性模型来测试与每个HL领域相关的关键变量。拟合九个单因素模型的验证性因子分析（CFA）以测试每个量表的结构，一个九因素模型测试HLQ的假设结构，随后使用Cronbach's alpha计算量表信度。
没有条目存在地板效应，只有8个条目显示出天花板效应。完成任务难度最大（难度水平最高）的两个量表是8“获取优质信息的能力”和9“理解程度足以知道该怎么做”。与健康素养相关的变量有教育程度、收入、年龄、居住地区、主要支持人员和合并症指数（分别与9个量表中的7个、7个、4个、3个、2个和2个相关）。每个HLQ量表都表现出强大的单维结构，所有CFI≥0.95，RMSEA在0到0.07之间变化。九因素CFA模型显示出令人满意的拟合指数：X2 = 5537.4，866 df，p < 0.001，CFI = 0.98，NFI = 0.98，RMSEA = 0.09，90% CI（0.093，0.097），PCLOSE < 0.001。得分最高的是量表4“健康的社会支持”和6“与医疗服务提供者互动的能力”。所有九个量表的信度范围为0.81至0.89。
越南版HLQ在心理测量学上具有强大的特性，具有高信度和令人满意的结构效度指标。该工具将使研究人员、临床医生和政策制定者能够评估越南的健康素养能力，为改善医疗服务和临床医生实践提供参考。
