Wångdahl Josefin, Jaensson Maria, Dahlberg Karina, Bergman Lina, Keller Celeste Roger, Doheny Megan, Agerholm Janne
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.
Division of Nursing, Department of Neurobiology, Care Sciences and Society, Alfred Nobels Allé 23, C2, 141 52 Huddinge, Sweden.
Health Promot Int. 2025 Jul 1;40(4). doi: 10.1093/heapro/daaf132.
Health literacy (HL) is a critical determinant of health, as it affects health behavior and outcomes, in addition to equity in health. This study aimed to translate, culturally adapt, and validate the Swedish version of HLS19-Q12 (HLS19-Q12-SE). The HLS19-Q12 is a widely used instrument that consists of 12-items and is often used to assess HL in Europe. A convergent mixed-methods design was applied, including cognitive interviews (n = 8) and psychometric testing with a survey sample (n = 374) and test-retest group (n = 28). The instrument was forward and backwards translated and culturally adapted. Data was analyzed using confirmatory and exploratory factor analysis, correlation testing, and reliability assessments. Cognitive interviews explored the clarity, interpretation, and contextual relevance of the items. Participants found the HLS19-Q12-SE clear and easy to understand, though some reported difficulties with unfamiliar health situations and uncertainty of the term "health information." Based on the interviews, the examples for one of the items were culturally adapted. Psychometric testing showed good feasibility, no floor or ceiling effects on scale level, and moderate positive correlations with other HL instruments, supporting internal and external validity. Structural validity was confirmed, and internal consistency and test-retest reliability were satisfactory. However, ceiling effects were observed at the dichotomous item level, and correlations with self-rated health and social status were low. The HLS19-Q12-SE is a reliable and valid instrument for assessing general HL in Sweden. While psychometric properties were strong overall, future research should address ceiling effects on item level and explore the instrument's performance in more diverse populations.
健康素养（HL）是健康的关键决定因素，因为它不仅影响健康公平性，还会影响健康行为和结果。本研究旨在翻译、进行文化调适并验证瑞典语版的HLS19-Q12（HLS19-Q12-SE）。HLS19-Q12是一种广泛使用的工具，由12个项目组成，常用于欧洲评估健康素养。本研究采用了收敛性混合方法设计，包括认知访谈（n = 8）以及对一个调查样本（n = 374）和重测组（n = 28）进行心理测量测试。该工具进行了正向和反向翻译，并进行了文化调适。使用验证性和探索性因素分析、相关性测试以及可靠性评估对数据进行了分析。认知访谈探讨了项目的清晰度、解释以及情境相关性。参与者认为HLS19-Q12-SE清晰易懂，不过一些人表示在面对不熟悉的健康状况以及“健康信息”一词的不确定性方面存在困难。基于访谈结果，对其中一个项目的示例进行了文化调适。心理测量测试显示出良好的可行性，在量表层面没有地板效应或天花板效应，并且与其他健康素养工具存在中度正相关，支持了内部和外部效度。结构效度得到了确认，内部一致性和重测信度令人满意。然而，在二分法项目层面观察到了天花板效应，并且与自评健康和社会地位的相关性较低。HLS19-Q12-SE是评估瑞典一般健康素养的可靠且有效的工具。虽然心理测量特性总体上很强，但未来的研究应解决项目层面的天花板效应，并探索该工具在更多样化人群中的表现。
