Health literacy measurement: a comparison of four widely used health literacy instruments (TOFHLA, NVS, HLS-EU and HLQ) and implications for practice.

Aust J Prim Health

Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic 3000, Australia.

Published: December 2024

AI Article Synopsis

  • The study examines four common health literacy instruments—TOFHLA, NVS, HLS-EU-Q47, and HLQ—to compare their effectiveness and reliability in measuring health literacy, noting that health literacy has become more about the interactive relationship between individuals and health systems rather than just individual skills.
  • Researchers found high internal consistency across all instruments, but observed notable floor and ceiling effects, with TOFHLA showing the highest ceiling effect and NVS the only floor effect.
  • The results indicated low to moderate correlations between the different instruments, suggesting they assess different aspects of health literacy; therefore, the choice of instrument should align with the specific goals of the measurement.

Article Abstract

Background Health literacy has evolved from a focus on individual skills to an interactive process influenced by relationships and the health system. Various instruments measure health literacy, developed from different conceptions and often for different measurement purposes. The aim of this study was to compare the properties of four widely used health literacy instruments: Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), European Health Literacy Survey (HLS-EU-Q47), and Health Literacy Questionnaire (HLQ). Methods This was a within-subject study comparing instrument performance. Composite reliability and Cronbach's alpha was used to measure internal consistency, floor/ceiling effects determined discriminate ability across low-to-high score ranges, and Spearman's R correlation coefficient was used to assess the relationship between instruments, particularly scales aiming to measure similar constructs. Results Fifty-nine patients consented, with 43 completing all four instruments. Internal consistency was high for all scales (composite reliability range 0.76-0.95). Floor and ceiling effects were observed, with TOFHLA demonstrating the largest ceiling effect (>62) and NVS the only floor effect (18%). Only moderate correlations were found between TOFHLA and NVS (r =0.60) and between HLS-EU-Q47 and HLQ scales (r ~0.6). Conclusion Our study found low to moderate correlations between the instruments, indicating they measure different constructs of health literacy. Clinicians and researchers should consider the intended measurement purpose and constructs when choosing an instrument. If the purpose of measurement is to understand reading, comprehension, and numeracy skills in individuals and populations, then performance based functional health literacy instruments such as the TOFHLA and NVS will be suitable. However, if the purpose is to generate insights into broader elements of health literacy, including social supports and relationships with health providers, then the HLS-EU and HLQ may be useful. The findings highlight the need for careful instrument selection to ensure meaningful and appropriate data interpretation. As improving population health literacy is a national priority in many countries, it is important that clinicians and researchers understand the measurement differences offered by different instruments to assist them to choose the right instrument for their measurement purpose.

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Source
http://dx.doi.org/10.1071/PY22280DOI Listing

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