Development and validation of a culture-sensitive generic health literacy scale in Turkish-speaking adults

Abstract

Background: improving health literacy has become one of the most important public health-related goals at the global level; however, there is no clear consensus on measurement of health literacy. Despite numerous health literacy scales available in Turkish, none of the existing scales was originally developed and validated at a national level. Objective: this study aimed to develop and validate a culturally appropriate original health literacy scale (HLS) to be used as a reference for the Turkish-speaking literate adult population in Turkey and abroad. Methods: two multidisciplinary workshops with more than 20 experts were conducted and a large item pool was developed. The first and second draft of the scale were pre-tested with 20 and 150 adults, respectively, from different age groups and socioeconomic levels in Ankara. The validity and reliability study of the revised scale (110 items plus 20 self-efficacy statements) was carried out with a household survey of 2,411 adults in 12 randomly selected provinces from 12 Nomenclature of Territorial Units for Statistics Re-gions in Turkey. Explanatory and confirmatory factor analysis were performed. The fit indices were obtained. The item analysis was applied, and Cronbach’s alpha statistics were obtained. Key results: the scale was found to be both a valid and a reliable measurement tool to assess health literacy. Cronbach’s alpha for two sub-dimensions (“disease prevention and health promotion” and “treatment and access to health services”) were 0.79 and 0.91, respectively. Construction validity indices were Root Mean Square Error of Approxima-tion (RMSEA) = 0.043, Goodness of Fit Index (GFI) = 0.96, Normed Fit Index (NFI) = 0.95, and Adjusted Goodness of Fit Index (AGFI) = 0.95. The scale includes “self-efficacy” as an additional dimension (Cronbach’s alpha = 0.83, RMSEA = 0.68, GFI = 0.94, NFI = 0.94, and AGFI) = 0.91). Conclusion: HLS is a valid and reliable measurement tool to assess health literacy of Turkish-speaking literate adults with a mixed (objective and subjective) assess-ment approach.