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Designing and Investigating the Validity and Reliability of the Health Literacy Questionnaire in Iran: Recognizing the Risk Factors for Cardiovascular Diseases, Diabetes, and Cancer
Abstract
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.
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Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J,
Slonska Z, et al. Health literacy and public health: A systematic
review and integration of definitions and models. BMC Public
Health 2012;12:80.
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K.
Low health literacy and health outcomes: An updated systematic
review. Ann Intern Med 2011;155:97‑107.
Sayarifard A, Ghadirian L, Mohit A, Eftekhar M, Badpa M,
Rajabi F. Assessing mental health literacy: What medical
sciences students’ know about depression. Med J Islam Repub
Iran 2015;29:161.
Zhang XH, Li SC, Fong KY, Thumboo J. The impact of health
literacy on health‑related quality of life (HRQoL) and utility
assessment among patients with rheumatic diseases. Value Health
;12:S106‑9.
Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J.
Development of a brief test to measure functional health literacy.
Patient Educa Couns 1999;38:33‑42.
Baker DW. The meaning and the measure of health literacy.
J Gen Intern Med 2006;21: 878‑83.
Begoray DL, Kwan B. A Canadian exploratory study to
define a measure of health literacy. Health Promot Int
;27:23‑32.
Buchbinder R, Batterham R, Ciciriello S, Newman S, Horgan B,
Ueffing E, et al. Health literacy: What is it and why is it
important to measure? J Rheumatol 2011;38:1791‑7.
Chisolm DJ, Buchanan BAL. Measuring adolescent functional
health literacy: A pilot validation of the test of functional health
literacy in adults. J Adolesc Health 2007;41:312‑4.
Fransen MP, Twickler TB, Essink‑Bot ML. Health literacy
measures: Application and implication. Eur J Public Health
;20:269.
Ghanbari S, Ramezankhani A, Montazeri A, Mehrabi Y. Health
literacy measure for adolescents (HELMA): Development and
psychometric properties. PloS One 2016;11:e0149202.
Montazeri A, Tavousi M, Rakhshani F, Azin SA, Jahangiri K, Ebadi M, et al. Health Literacy for Iranian Adults (HELIA):
development and psychometric properties. J Iran Inst Health Sci
Res (Payesh) 2014;13:589‑99 [Persian].
Tavousi M, Ebadi M, Fattahi E, Jahangiry L, Hashemi A,
Hashemiparast M, et al. Health literacy measures: A systematic
review of the literature. J Iran Inst Health Sci Res (Payesh)
;14:485‑96.
Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H,
Mullany EC, et al. The global burden of injury: Incidence,
mortality, disability‑adjusted life years and time trends from the
global burden of disease study 2013. Inj Prev 2016;22:3‑18.
NCD Risk Factor Collaboration (NCD‑RisC). Trends in adult
body‑mass index in 200 countries from 1975 to 2014: A pooled
analysis of 1698 population‑based measurement studies with
2 million participants. Lancet 2016;387:1377‑96.
NCD Risk Factor Collaboration (NCD‑RisC). Worldwide
trends in diabetes since 1980: A pooled analysis of 751
population‑based studies with 4.4 million participants. Lancet
;387:1513‑30.
Non‑Communicable Diseases (NCD) Country Profiles. Geneva,
World Health Organization; 2014. Available from: http://who.int/
nmh/countries/irn_en. [Cited 2016 Sep 3].
Alwan A. The world health assembly responds to the global
challenge of noncommunicable diseases. East Mediterr Health J
;19:511‑2.
Global Action Plan for the Prevention and Control of
Noncommunicable Diseases 2013–2020. Geneva: World Health
Organization; 2013. Available from: who.int/nmh/events/ncd_
action_plan/en/. [Cited 2016 Sep 19].
Sustainable Development Goals. New York: The United Nations.
Available from: http://www.sustainabledevelopment.
un.org/?menu=1300. [Cited 2016 Oct 2].
Global Burden of Diseases. Washington, D.C.: Institute of Health
Metric and Evaluation; 2014. Available from: http://vizhub.
healthdata.org/gbd‑compare/. [Cited 2016 Sep 3].
Naghshtabrizi B, Moradi A, Amiri J, Aarabi S, Sanaei Z. An
evaluation of the numbers and locations of coronary artery
disease with some of the major atherosclerotic risk factors
in patients with coronary artery disease. J Clin Diagn Res
;11:OC21‑4
Esna Ashari F, Pirdehghan A, Rajabi F, Sayarifard A,
Ghadirian L, Rostami M, et al. The study of health literacy
of staff about risk factors of chronic diseases in 2014. Sci J
Hamadan Univ Med Sci 2015;22:248‑54 [Persian].
Ishikawa H, Takeuchi T, Yano E. Measuring functional,
communicative, and critical health literacy among diabetic
patients. Diabetes Care 2008;31:874‑9.
Ovhed I, Odeberg H, Troein M, Rastam L. Awareness and
treatment of cardiovascular disease risk factors among
middle‑aged Swedish men and women. Scand J Prim Health
Care 1998;16:165‑70.
Celentano A, Panico S, Palmieri V, Guillaro B, Brancati C,
Di Palma Esposito N, et al. Citizens and family doctors facing
awareness and management of traditional cardiovascular risk
factors: Results from the global cardiovascular risk reduction
project (Help Your Heart Stay Young Study). Nutr Metab
Cardiovasc Dis 2003;13:211‑7.
Tehrani Banihashemi SA, Amirkhani MA, Haghdoost AA,
Alavian SM, Asgharifard H, Baradaran H. Health literacy and
the influencing factors: A study in five provinces of Iran. J Med
Educ Dev Center 2007;4:1‑9 [Persian].
Khosravi A, Ahmadzadeh K, Arastoopoor S, Tahmasbi R.
Health literacy levels of diabetic patients referred to Shiraz
Health Centers and its effective factors. Health Inf Manage
;12:205 [Persian].
Duong TV, Aringazina A, Baisunova G, Pham TV, Pham KM,
Truong TQ, et al. Measuring health literacy in Asia: Validation of
the HLS‑EU‑Q47 survey tool in six Asian countries. J Epidemiol
;27:80‑6.
Maindal HT, Kayser L, Norgaard O, Bo A, Elsworth GR,
Osborne RH. Cultural adaptation and validation of the Health
Literacy Questionnaire (HLQ): Robust nine‑dimension Danish
language confirmatory factor model. SpringerPlus 2016;5:1232.