Validation of health literacy questionnaires in Hungarian adult sample

Abstract

Introduction: Accessing health information adapted to one’s health literacy level is a prerequisite for effective healing, rehabilitation, health education, and health promotion. Objective: This research aimed to validate the Hungarian version of two instruments measuring health literacy: the performance-based Newest Vital Sign and the self-reported Brief Health Literacy Screening Tool. These short instruments, which are frequently used in international surveys, can be applied to measure health literacy among the general population. Method: The two instruments were tested in a nationwide cross-sectional study in the general population. The questionnaires’ reliability and validity were evaluated using Cronbach-α, Spearman–Brown, corrected item-total correlation coefficients, and exploratory factor analysis (principal components analysis, varimax rotation). Results: The internal consistency measured by the Cronbach-α was 0.72 for the Newest Vital Sign and 0.87 for the Brief Health Literacy Screening Tool, and the split-half reliabilities calculated with the Spearman–Brown correlation were 0.76 and 0.88, respectively. The correlation coefficients obtained during the item-total correlation analysis proved to be higher than the expected 0.3 value in all cases. Exploring the factor structure revealed that the two tests measure different dimensions of health literacy. Discussion: Both tests proved to be reliable; the internal validity of the Brief Health Literacy Screening Tool is higher than that of the original questionnaire. Based on the factor analysis, their application is possible together if the goal is to examine subjective and objective health literacy together. Conclusion: Using the validated Hungarian version of these questionnaires is recommended as part of health literacy surveys conducted by interviewers.