HLS19-NAV-Validation of a New Instrument Measuring Navigational Health Literacy in Eight European Countries

Lennert Griese; Hanne S Finbråten; Rita Francisco; Saskia M De Gani; Robert Griebler; Øystein Guttersrud; Rebecca Jaks; Christopher Le; Thomas Link; Andreia Silva da Costa; Miguel Telo de Arriaga; Rajae Touzani; Mitja Vrdelja; Jürgen M Pelikan; Doris Schaeffer; HLS19 Consortium

doi:10.3390/ijerph192113863

HLS₁₉-NAV-Validation of a New Instrument Measuring Navigational Health Literacy in Eight European Countries

Int J Environ Res Public Health. 2022 Oct 25;19(21):13863. doi: 10.3390/ijerph192113863.

Authors

Lennert Griese¹, Hanne S Finbråten², Rita Francisco³, Saskia M De Gani^{4

5}, Robert Griebler⁶, Øystein Guttersrud⁷, Rebecca Jaks⁴, Christopher Le^{2

8}, Thomas Link⁹, Andreia Silva da Costa^{10

11}, Miguel Telo de Arriaga^{3

12}, Rajae Touzani^{13

14}, Mitja Vrdelja¹⁵, Jürgen M Pelikan¹⁶, Doris Schaeffer¹; HLS19 Consortium

Affiliations

¹ School of Public Health, Bielefeld University, 33615 Bielefeld, Germany.
² Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, 2418 Elverum, Norway.
³ Católica Research Centre for Psychological, Family and Social Well-Being, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal.
⁴ Careum Foundation, Careum Center for Health Literacy, 8032 Zurich, Switzerland.
⁵ Careum School of Health, Kalaidos University of Applied Sciences, 8006 Zurich, Switzerland.
⁶ Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria.
⁷ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway.
⁸ Department of Social Determinants of Health, Division of Prevention and Public Health, Norwegian Directorate of Health, 0213 Oslo, Norway.
⁹ Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, A-1010 Vienna, Austria.
¹⁰ Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1049-005 Lisboa, Portugal.
¹¹ Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisboa, Portugal.
¹² Direção-Geral da Saúde, 1049-005 Lisboa, Portugal.
¹³ Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Equipe CANBIOS Labellisée Ligue 2019, 13009 Marseille, France.
¹⁴ Institut Paoli-Calmettes, SESSTIM U1252, 13009 Marseille, France.
¹⁵ Communication Unit, National Institute of Public Health, 1000 Ljubljana, Slovenia.
¹⁶ WHO-CC Health Promotion in Hospitals and Health Care, Austrian National Public Health Institute, A-1010 Vienna, Austria.

Abstract

To manoeuvre a complex and fragmented health care system, people need sufficient navigational health literacy (NAV-HL). The objective of this study was to validate the HLS₁₉-NAV measurement scale applied in the European Health Literacy Population Survey 2019-2021 (HLS₁₉). From December 2019 to January 2021, data on NAV-HL was collected in eight European countries. The HLS₁₉-NAV was translated into seven languages and successfully applied in and validated for eight countries, where language and survey method differed. The psychometric properties of the scale were assessed using confirmatory factor analysis (CFA) and Rasch modelling. The tested CFA models sufficiently well described the observed correlation structures. In most countries, the NAV-HL data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). For some countries, some items showed poor data-model fit when tested against the PCM, and some items displayed differential item functioning for selected person factors. The HLS₁₉-NAV demonstrated high internal consistency. To ensure content validity, the HLS₁₉-NAV was developed based on a conceptual framework. As an estimate of discriminant validity, the Pearson correlations between the NAV-HL and general health literacy (GEN-HL) scales were computed. Concurrent predictive validity was estimated by testing whether the HLS₁₉-NAV, like general HL measures, follows a social gradient and whether it forms a predictor of general health status as a health-related outcome of general HL. In some countries, adjustments at the item level may be beneficial.

Keywords: HLS19 survey; Rasch modelling; confirmatory factor analysis; health care system; health information; health literacy; instrument; navigation; questionnaire; validation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Factor Analysis, Statistical
Health Literacy*
Humans
Psychometrics
Reproducibility of Results
Surveys and Questionnaires

Grants and funding

This research received no external funding, but data collection was supported either by ministries of health, universities, public health institutes, or insurance funds in the respective countries. AT: The Austrian Health Literacy Survey was commissioned and financed by the Austrian Federal Health Agency and the Federation of Austrian Social Insurance Institutions. BE: The data collection for Belgium (NL and FR) was funded by the Union Nationale des Mutualités Libres (MLOZ). CH: The national HL survey was funded by the Swiss Federal Office of Public Health (FOPH). CZ: Data collection was jointly funded by (all seven) Czech health insurance funds. DE: The German study was funded by the German Federal Ministry of Health, grant number: Kapitel 1504 Titel 54401, ZMV I 1-2518 004 (HLS-GER 2). FR: The research was supported by the National Public Health agency (Santé Publique France, 21DPPA040-0) and by Ligue contre le cancer (LIGUE2019). NO: The Norwegian HLS₁₉ was commissioned and financed by the Norwegian Ministry of Health and Care Services. The Norwegian Directorate of Health funded the data collection and the administrative costs for the whole project, while Oslo Metropolitan University and Inland Norway University of Applied Sciences contributed with the scientific workforce. PT: This research received no external funding, but the data collection was supported by the Directorate General for Health. SI: The national survey of Health literacy in Slovenia took place within the framework of the project Increasing health literacy in Slovenia-ZaPiS, which is co-financed by the Republic of Slovenia in the amount of 20% and the European Union from the European Social Fund in the amount of 80% (grant number: C2711-19-031040).