Designing and Investigating the Validity and Reliability of the Health Literacy Questionnaire in Iran: Recognizing the Risk Factors for Cardiovascular Diseases, Diabetes, and Cancer

Fatemeh Rajabi, Azar Pirdehghan, Zahra Sanaie, Laleh Ghadirian, Azadeh Sayarifard, Farzaneh Esna‑Ashari


Background: Health literacy (HL) has been recognized as an important concept in patient education and disease prevention. The rising burden of noncommunicable diseases (NCDs) in Iran is significant. Hence, we designed and validated an HL questionnaire on the most important domains of NCDs, including cardiovascular diseases, diabetes, and cancer.

Methods: Literature review was conducted to examine the definition and dimensions of HL. After reaching consensus about the HL dimensions and conceptual models in focus group discussions with experts, they designed questions in each domain. Then, face, content, and construct validity as well as reliability were determined by a pilot study on 72 participants.
At the end, a cross‑sectional study was implemented on 206 Hamedan university employees, to finalize the questionnaire.

Results: After doing the pilot study and analyzing the collected data and according to the Bartlett’s test of sphericity and Kaiser–Meyer–Olkin = 0.421 with P < 0.001, factor analysis was used. Considering the eigenvalue >1.4, a 27‑item questionnaire in seven domains was obtained which included attitude toward health, understanding information, social support, socioeconomic conditions, access to health services, and application of health information. Cronbach’s alpha was more than 0.70 in all domains except the last one (0.47). The second phase showed that overall 75.2% of the individuals had inadequate HL with lowest scores in the application of health information.

Conclusions: The designed tool seems appropriate for measuring the HL level among the Iranian population in the field of prevention of cardiovascular disease, cancer, and diabetes. The results can help policy makers to improve health promotion interventions.


Health literacy questionnaire; Iran; reliability; validity

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