Measuring Comprehensive, General Health Literacy in the General Adult Population: The Development and Validation of the HLS19-Q12 Instrument in Seventeen Countries

Background: For improving health literacy (HL) by national and international public health policy, measuring population HL by a comprehensive instrument is needed. A short instrument, the HLS19-Q12 based on the HLS-EU-Q47, was developed, translated, applied, and validated in 17 countries in the WHO European Region. Methods: For factorial validity/dimensionality, Cronbach alphas, confirmatory factor analysis (CFA), Rasch model (RM), and Partial Credit Model (PCM) were used. For discriminant validity, correlation analysis, and for concurrent predictive validity, linear regression analysis were carried out. Results: The Cronbach alpha coefficients are above 0.7. The fit indices for the single-factor CFAs indicate a good model fit. Some items show differential item functioning in certain country data sets. The regression analyses demonstrate an association of the HLS19-Q12 score with social determinants and selected consequences of HL. The HLS19-Q12 score correlates sufficiently highly (r ≥ 0.897) with the equivalent score for the HLS19-Q47 long form. Conclusions: The HLS19-Q12, based on a comprehensive understanding of HL, shows acceptable psychometric and validity characteristics for different languages, country contexts, and methods of data collection, and is suitable for measuring HL in general, national, adult populations. There are also indications for further improvement of the instrument

Measuring Comprehensive, General Health Literacy in the General Adult Population:The Development and Validation of the HLS19-Q12 Instrument in Seventeen Countries

Background: For improving health literacy (HL) by national and international public health policy, measuring population HL by a comprehensive instrument is needed. A short instrument, the HLS(19)-Q12 based on the HLS-EU-Q47, was developed, translated, applied, and validated in 17 countries in the WHO European Region. Methods: For factorial validity/dimensionality, Cronbach alphas, confirmatory factor analysis (CFA), Rasch model (RM), and Partial Credit Model (PCM) were used. For discriminant validity, correlation analysis, and for concurrent predictive validity, linear regression analysis were carried out. Results: The Cronbach alpha coefficients are above 0.7. The fit indices for the single-factor CFAs indicate a good model fit. Some items show differential item functioning in certain country data sets. The regression analyses demonstrate an association of the HLS(19)-Q12 score with social determinants and selected consequences of HL. The HLS(19)-Q12 score correlates sufficiently highly (r ≥ 0.897) with the equivalent score for the HLS(19)-Q47 long form. Conclusions: The HLS(19)-Q12, based on a comprehensive understanding of HL, shows acceptable psychometric and validity characteristics for different languages, country contexts, and methods of data collection, and is suitable for measuring HL in general, national, adult populations. There are also indications for further improvement of the instrument

The HLS19-COM-P, a New Instrument for Measuring Communicative Health Literacy in Interaction with Physicians: Development and Validation in Nine European Countries

Background: Sufficient communicative health literacy (COM-HL) is important for patients actively participating in dialogue with physicians, expressing their needs and desires for treatment, and asking clarifying questions. There is a lack of instruments combining communication and HL proficiency. Hence, the aim was to establish an instrument with sufficient psychometric properties for measuring COM-HL. Methods: The HLS19-COM-P instrument was developed based on a conceptual framework integrating HL with central communicative tasks. Data were collected using different data collection modes in nine countries from December 2019 to January 2021 (n = 18,674). Psychometric properties were assessed using Rasch analysis and confirmatory factor analysis. Cronbach’s alpha and Person separation index were considered for reliability. Results: The 11-item version (HLS19-COM-P-Q11) and its short version of six items (HLS19-COM-P-Q6) fit sufficiently the unidimensional partial credit Rasch model, obtained acceptable goodness-of-fit indices and high reliability. Two items tend to under-discriminate. Few items displayed differential item functioning (DIF) across person factors, and there was no consistent pattern in DIF across countries. All items had ordered response categories. Conclusions: The HLS19-COM-P instrument was well accepted in nine countries, in different data collection modes, and could be used to measure COM-HL.publishedVersio

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

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.publishedVersio

Navigational health literacy

info:eu-repo/semantics/publishedVersio

The influence of trust and afective and cognitive factors on communication of mothers in relation to vaccination

Doktorska disertacija obravnava komuniciranje cepljenja – temo, ki je aktualna bolj kot kadarkoli prej. Raziskovalni fokus je usmerjen v proučevanje vprašanja, kako in zakaj se matere majhnih otrok vključujejo oziroma ne vključujejo v komuniciranje na področju cepljenja. Pri tem poglobljeno proučujemo njihove značilnosti, stališča in smo pozorni na razlike med njimi. Še posebej pozorni smo na komunikacijske aktivnosti mater majhnih otrok v povezavi z afektivno in kognitivno vpletenostjo v problemsko situacijo v povezavi s cepljenjem ter z zaupanjem v zdravnika, zdravstveni sistem in znanost. Za raziskovanje smo uporabili kvantitativne podatke iz anketne raziskave na reprezentativnem slučajnostnem vzorcu med materami majhnih otrok, ki smo jih dopolnili s kvalitativno raziskavo na proučevani javnosti. Pri tem smo uporabili poglobljeni intervju z glasnim razmišljanjem. Kombinacija kvalitativne in kvantitativne raziskave predstavlja pomembno raziskovalno vrednost disertacije. Ugotovitve kažejo, da so slovenske matere majhnih otrok različno komunikacijsko aktivne v povezavi s cepljenjem tako pri pridobivanju in prenosu kot izbiranju oziroma selekciji informacij. Pri tem uporabljajo različne komunikacijske kanale. Glede cepljenja so manj komunikacijsko aktivne v povezavi s tradicionalnimi mediji (televizija, radio, tiskani mediji), še vedno pa uporabljajo bolj klasična komunikacijska orodja, kot so tiskane brošure in letaki. So pa precej bolj komunikacijsko aktivne glede spletnih virov informacij pri vseh treh oblikah komunikacijske aktivnosti. Spletni viri so od vseh komunikacijskih kanalov najpomembnejši način, s pomočjo katerega matere majhnih otrok iščejo informacije v povezavi s cepljenjem. Disertacija predstavlja pomemben doprinos k znanosti na teoretični ravni, saj ponuja razvit konceptualni okvir, ki omogoča nadaljnje raziskovanje na tem področju. Hkrati predstavlja prvo uporabo STOPS/CAPS v Sloveniji in eno redkih uporab v Evropi. Z uporabo in razširitvijo tega teoretičnega modela disertacija tudi empirično prispeva k znanosti na področju odnosov z javnostmi in zdravstvenega komuniciranja ter tudi k praksi komuniciranja cepljenja v Sloveniji.The doctoral dissertation deals with the communication of vaccination – a topic that is currently relevant more than ever before. The research focuses on studying the question of how and why are or aren’t mothers of small children involved in communication of vaccination. In this respect, we thoroughly studied their characteristics, properties, views and paid attention to differences between them. We particularly focus on communication activities of mothers of small children in connection with affective and cognitive involvement in a problematic situation in relation to vaccinationwith trust in doctors, (health) system, and science.. In our research, we used quantitative data from a survey on a representative (random) sample of mothers of small children, which we supplemented with a qualitative research on the studied public. We used an in-depth think-aloud interview. The combination of qualitative and quantitative research represents an important research value of the dissertation. The findings show that Slovenian mothers of small children are communicatively active in different ways in relation to vaccination, namely in information selection, information transmission and information acquisition. In doing so, they use different communication channels. Regarding vaccination, they are less communicatively active in relation to traditional media (television, radio, print media), but still use more classic communication tools, such as (printed) brochures and leaflets. They are, however, much more communicatively active on online sources of information in all three forms of communication activity. Online resources are the most important of all communication channels for the mothers of small children who are seeking information related to vaccination. The dissertation represents an important contribution to science on the theoretical level, as it offers a developed conceptual framework enabling further research in this area. At the same time, it represents the first use of STOPS/CAPS in Slovenia and one of the few in Europe. By using and expanding this theoretical model, the dissertation also contributes empirically to science in the field of public relations and health communication, as well as to the practice of vaccination communication in Slovenia

Facing the Growing COVID-19 Infodemic: Digital Health Literacy and Information-Seeking Behaviour of University Students in Slovenia

The entire world is faced with the COVID-19 pandemic, which is also accompanied by an infodemic. This refers to the rapid spread of (accurate and false) information, mainly through internet usage increasing. Digital health literacy (DHL) is therefore important for addressing challenges related to online health information and services, as well as for navigation through the complex information landscape with huge amounts of different (and conflicting) information about COVID-19. The aim of this study is to examine the level of DHL in relation to COVID-19 in Slovenian university students and to determine online information-seeking behaviour in order to plan and prepare effective communication interventions for this sub-population. A cross-sectional survey, administered by an online questionnaire, was conducted to collect data on DHL. A total of 3621 students participated, of whom 70% were female and the average age was 22.65 years (SD = 4.65). Bivariate analyses were performed to assess the association of key characteristics with DHL. Overall, the results show that the level of DHL among students is sufficient. Most difficulties were reported in assessing the reliability of information (n = 1484, 49.3%). Approximately one third of the students (n = 847, 27.9%) reported having problems in finding information of their interest, and somewhat more (n = 900, 29.6%) reported difficulties in making a selection among all the information found. Students with a sufficient level of DHL are more likely to seek information through search engines and websites of official institutions, while students with a limited level of DHL more frequently reported using social media for health information searches. It is necessary to establish interventions for a systematic lift of the DHL and health literacy (HL) of all population groups

Exploring the inherent heterogeneity of vaccine hesitancy

Vaccine hesitancy and its determinants have been previously widely researched. Vaccine hesitancy has been defined as a continuum of attitudes, ranging from accepting vaccines with doubts to rejecting them. The present study aims to explore the heterogeneity of a childhood-vaccine-hesitant group by using a person-oriented approach-latent profile analysis. A non-representative cross-sectional sample of vaccine-hesitant Slovenians (N = 421, Mage = 35.21, 82.9% women) was used to identify differences based on their reliance on personal research (“self” researching instead of relying on science), overconfidence in knowledge, endorsement of conspiracy theories, complementary and alternative medicine, and trust in the healthcare system. The analysis revealed three profiles of vaccine-hesitant individuals. The most hesitant profile-vaccine rejecting-expressed the greatest reliance on personal research, expressed the highest endorsement of conspiracy theories and complementary and alternative medicine, showed moderate overconfidence in their knowledge, and expressed the highest levels of distrust in the healthcare system. We further found differences in sociodemographic structure and that the identified profiles differed in their attitudes regarding MMR, HPV, and Seasonal Influenza vaccinations. The present study demonstrates the heterogeneity of the vaccine-hesitant community and offers insights into some of the traits, which are crucial for designing pro-vaccine campaigns