Psychometric properties of the health literacy questionnaire tested in Vietnamese adults with chronic diseases
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Bonner, Ann
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BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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BMC Public Health
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25
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© The Author(s). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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Epidemiology
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Dinh, TTH; Bonner, A, Psychometric properties of the health literacy questionnaire tested in Vietnamese adults with chronic diseases, BMC Public Health, 2025, 25, pp. 44