Validation of the Short-Form Health Literacy Questionnaire (HLS-SF12) and Its Determinants among People Living in Rural Areas in Vietnam

Tuyen Van Duong, Thao T P Nguyen, Khue M Pham, Kien T Nguyen, Manh H Giap, Tung D X Tran, Chi X Nguyen, Shwu-Huey Yang, Chien-Tien Su, Tuyen Van Duong, Thao T P Nguyen, Khue M Pham, Kien T Nguyen, Manh H Giap, Tung D X Tran, Chi X Nguyen, Shwu-Huey Yang, Chien-Tien Su

Abstract

Background: Health literacy (HL) is an important factor in improving health inequalities in poor and marginalized groups. Assessing comprehensive HL is critical. In this study, we validated the use of a comprehensive short-form HL survey tool (HLS-SF12) and examined the determinants of HL among people in rural areas. Methods: A cross-sectional study was conducted in July 2019 on 440 people residing in mountainous areas in Vietnam. Health literacy was measured using the HLS-SF12. Personal characteristics were also collected. We analyzed data using confirmatory factor analysis, internal consistency analysis, and regression analysis. Results: The questionnaire demonstrated a good construct validity with satisfactory goodness-of-fit indices and item-scale convergent validity. The tool was reliable and homogeneous with Cronbach's alpha = 0.79, with no floor/ceiling effects. People who were married had lower HL (regression coefficient B = -3.12; 95% confidence interval (CI) = -5.69, -0.56; p = 0.017) compared with those who never married. Higher education attainment (B = 3.41 to 10.44; p < 0.001), a better ability to pay for medication (B = 4.17 to 9.89; p < 0.001), and a tendency to view health-related TV/radio more often (B = 5.23 to 6.15; p < 0.001) were associated with higher HL. Conclusions: The HLS-SF12 is a valid survey tool for the evaluation of HL in rural populations. A number of personal characteristics were strongly associated with HL.

Keywords: HLS-SF12; Vietnam; ability to pay for medication; determinant; education; health literacy; health-related TV; mountaineer; rural areas; validation.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Structure equation model of the HLS-SF12 with 12 items loading into three domains of health (health care, disease prevention, health promotion). The questions from B1 to B12 of the HLS-SF12 are stated below. On a scale from very easy to very difficult, how easy would you say it is to: B1…find information on treatments of illnesses that concern you? B2…understand the leaflets that come with your medicine? B3…judge the advantages and disadvantages of different treatment options? B4…call an ambulance in an emergency? B5…find information on how to manage mental health problems like stress or depression? B6…understand why you need health screenings (such as breast exam, blood sugar test, blood pressure)? B7…judge which vaccinations you may need? B8…decide how you can protect yourself from illness based on advice from family and friends? B9…find out about activities (such as meditation, exercise, walking, Pilates, etc…) that are good for your mental well-being? B10…understand information in the media (such as Internet, newspaper, magazines) on how to get healthier? B11…judge which everyday behavior (such as drinking and eating habits, exercise, etc…) is related to your health? B12… join a sports club or exercise class if you want to?

References

    1. United Nations Development Group . United Nations; 2015. [(accessed on 31 December 2015)]. Transforming our world: The 2030 Agenda for Sustainable Development. Available online: .
    1. Wagner D.A. Learning, Literacy and Sustainable Development: Inclusion, Vulnerability and the SDGs. In: Battro A.M., Léna P., Sánchez Sorondo M., Von Braun J., editors. Children and Sustainable Development: Ecological Education in a Globalized World. Springer International Publishing; Cham, Switzerland: 2017. pp. 45–65.
    1. Rowlands G., Dodson S., Leung A., Levin-Zamir D. Global health systems and policy development: Implications for health literacy research, theory and practice. Stud. Health Technol. Inform. 2017;240:359–391.
    1. Sørensen K., Van den Broucke S., Brand H., Fullam J., Doyle G., Pelikan J., Slonszka Z. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012;12:80. doi: 10.1186/1471-2458-12-80.
    1. Nhung N.T.T., Long T.K., Linh B.N., Vos T., Huong N.T., Anh N.D. Estimation of Vietnam national burden of disease 2008. Asia Pac. J. Public Health. 2014;26:527–535. doi: 10.1177/1010539513510556.
    1. Roth G.A., Abate D., Abate K.H., Abay S.M., Abbafati C., Abbasi N., Abbastabar H., Abd-Allah F., Abdela J., Abdelalim A., et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: A systematic analysis for the Global burden of disease study 2017. Lancet. 2018;392:1736–1788. doi: 10.1016/S0140-6736(18)32203-7.
    1. Nugent R., Bertram M.Y., Jan S., Niessen L.W., Sassi F., Jamison D.T., Pier E.G., Beaglehole R. Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals. Lancet. 2018;391:2029–2035. doi: 10.1016/S0140-6736(18)30667-6.
    1. Niessen L.W., Mohan D., Akuoku J.K., Mirelman A.J., Ahmed S., Koehlmoos T.P., Trujillo A., Khan J., Peters D.H. Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda. Lancet. 2018;391:2036–2046. doi: 10.1016/S0140-6736(18)30482-3.
    1. Son P.T., Quang N.N., Viet N.L., Khai P.G., Wall S., Weinehall L., Bonita R., Byass P. Prevalence, awareness, treatment and control of hypertension in Vietnam—Results from a national survey. J. Hum. Hypertens. 2012;26:268. doi: 10.1038/jhh.2011.18.
    1. Nguyen Q.N., Pham S.T., Nguyen V.L., Weinehall L., Bonita R., Byass P., Wall S. Time Trends in blood pressure, body mass index and smoking in the Vietnamese population: A meta-analysis from multiple cross-sectional surveys. PLoS ONE. 2012;7:e42825. doi: 10.1371/journal.pone.0042825.
    1. The World Bank . Country Profile: Vietnam. World Bank Group; Washington, DC, USA: 2018. [(accessed on 8 August 2019)]. Available online: .
    1. Hoa N.P., Rao C., Hoy D.G., Hinh N.D., Chuc N.T.K., Ngo D.A. Mortality measures from sample-based surveillance: Evidence of the epidemiological transition in Viet Nam. Bull. World Health Organ. 2012;90:764–772.
    1. Meiqari L., Nguyen T.-P.-L., Essink D., Zweekhorst M., Wright P., Scheele F. Access to hypertension care and services in primary health-care settings in Vietnam: A systematic narrative review of existing literature. Glob. Health Action. 2019;12:1610253. doi: 10.1080/16549716.2019.1610253.
    1. Nguyen T.-P.-L., Schuiling-Veninga C.C.M., Nguyen T.B.Y., Vu T.-H., Wright E.P., Postma M.J. Adherence to hypertension medication: Quantitative and qualitative investigations in a rural Northern Vietnamese community. PLoS ONE. 2017;12:e0171203. doi: 10.1371/journal.pone.0171203.
    1. Meiqari L., Essink D., Wright P., Scheele F. Prevalence of hypertension in Vietnam: A systematic review and meta-analysis. Asia Pac. J. Public Health. 2019;31:101–112. doi: 10.1177/1010539518824810.
    1. Hien H.A., Tam N.M., Tam V., Derese A., Devroey D. Prevalence, Awareness, Treatment, and Control of Hypertension and Its Risk Factors in (Central) Vietnam. Int. J. Hypertens. 2018;2018:12. doi: 10.1155/2018/6326984.
    1. Guntzviller L.M., King A.J., Jensen J.D., Davis L.A. Self-efficacy, health literacy, and nutrition and exercise behaviors in a low-income, Hispanic population. J. Immigr. Minor. Health. 2016;19:489–493. doi: 10.1007/s10903-016-0384-4.
    1. Yokokawa H., Fukuda H., Yuasa M., Sanada H., Hisaoka T., Naito T. Association between health literacy and metabolic syndrome or healthy lifestyle characteristics among community-dwelling Japanese people. Diabetol. Metab. Syndr. 2016;8:30. doi: 10.1186/s13098-016-0142-8.
    1. Duong T.V., Sørensen K., Pelikan J., Van den Broucke S., Lin I.F., Lin Y.-C., Huang H.-L., Chang P.W. Health-related behaviors moderate the association between age and self-reported health literacy among Taiwanese women. Women Health. 2017;58:632–646. doi: 10.1080/03630242.2017.1333074.
    1. Mackert M. Introduction to a colloquium: Challenges and opportunities in advancing health literacy research. Health Commun. 2015;30:1159–1160. doi: 10.1080/10410236.2015.1037427.
    1. Pelikan J.M., Ganahl K., Roethlin F. Health literacy as a determinant, mediator and/or moderator of health: empirical models using the European Health Literacy Survey dataset. Glob. Health Promot. 2018;25:57–66. doi: 10.1177/1757975918788300.
    1. Truman E., Bischoff M., Elliott C. Which literacy for health promotion: Health, food, nutrition or media? Health Promot. Int. 2019 doi: 10.1093/heapro/daz007. [Epub ahead of print]
    1. İlgün G., Turaç İ.S., Orak S. Health literacy. Procedia Soc. Behav. Sci. 2015;174:2629–2633. doi: 10.1016/j.sbspro.2015.01.944.
    1. Mackey L.M., Doody C., Werner E.L., Fullen B. Self-management skills in chronic disease management: What role does health literacy have? Med. Decis. Mak. 2016;36:741–759. doi: 10.1177/0272989X16638330.
    1. Rasu R.S., Bawa W.A., Suminski R., Snella K., Warady B. Health literacy impact on national healthcare utilization and expenditure. Int. J. Health Policy Manag. 2015;4:747–755. doi: 10.15171/ijhpm.2015.151.
    1. Haun J.N., Patel N.R., French D.D., Campbell R.R., Bradham D.D., Lapcevic W.A. Association between health literacy and medical care costs in an integrated healthcare system: A regional population based study. BMC Health Serv. Res. 2015;15:249. doi: 10.1186/s12913-015-0887-z.
    1. Wang C., Lang J., Xuan L., Li X., Zhang L. The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study. Int. J. Equity Health. 2017;16:58. doi: 10.1186/s12939-017-0551-9.
    1. Moser D.K., Robinson S., Biddle M.J., Pelter M.M., Nesbitt T.S., Southard J., Cooper L., Dracup K. Health literacy predicts morbidity and mortality in rural patients with heart failure. J. Card. Fail. 2015;21:612–618. doi: 10.1016/j.cardfail.2015.04.004.
    1. Duong T.V., Aringazina A., Baisunova G., Nurjanah, Pham T.V., Pham K.M., Truong T.Q., Nguyen K.T., Oo W.M., Mohamad E., et al. Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries. J. Epidemiol. 2017;27:80–86. doi: 10.1016/j.je.2016.09.005.
    1. Sørensen K., Pelikan J.M., Röthlin F., Ganahl K., Slonska Z., Doyle G., Fullam J., Kondilis B., Agrafiotis D., Uiters E., et al. Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU) Eur. J. Public Health. 2015;25:1053–1058. doi: 10.1093/eurpub/ckv043.
    1. Nakayama K., Osaka W., Togari T., Ishikawa H., Yonekura Y., Sekido A., Matsumoto M. Comprehensive health literacy in Japan is lower than in Europe: A validated Japanese-language assessment of health literacy. BMC Public Health. 2015;15:505. doi: 10.1186/s12889-015-1835-x.
    1. Duong T.V., Aringazina A., Baisunova G., Nurjanah N., Pham T.V., Pham K.M., Truong T.Q., Nguyen K.T., Oo W.M., Su T.T., et al. Development and validation of a new short-form health literacy instrument (HLS-SF12) for the general public in six Asian countries. Health Lit. Res. Pract. 2019;3:e91–e102. doi: 10.3928/24748307-20190225-01.
    1. Li X., Ning N., Hao Y., Sun H., Gao L., Jiao M., Wu Q., Quan H. Health literacy in rural areas of China: Hypertension knowledge survey. Int. J. Environ. Res. Public Health. 2013;10:1125–1138. doi: 10.3390/ijerph10031125.
    1. Kline R.B. Principles and Practices of Structural Equation Modeling. 4th ed. The Guilford Press; New York, NY, USA: 2015.
    1. Faul F., Erdfelder E., Lang A.-G., Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods. 2007;39:175–191. doi: 10.3758/BF03193146.
    1. Pourhoseingholi M.A., Vahedi M., Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol. Hepatol. Bed Bench. 2013;6:14–17.
    1. HLS-EU Consortium . Comparative Report of Health Literacy in Eight EU Member States. The European Health Literacy Project 2009–2012. Maastricht University; Maastricht, The Netherlands: 2012. [(accessed on 22 October 2012)]. Available online: .
    1. Kline R.B. Applied Quantitative Analysis in the Social Sciences. Routledge; New York, NY, USA: 2013. Exploratory and confirmatory factor analysis; pp. 171–207.
    1. Hays R.D., Hayashi T. Beyond internal consistency reliability: Rationale and user’s guide for multitrait analysis program on the microcomputer. Behav. Res. Methods Instr. Comput. 1990;22:167–175. doi: 10.3758/BF03203140.
    1. Cronbach L.J., Shavelson R.J. My current thoughts on coefficient alpha and successor procedures. Educ. Psychol. Meas. 2004;64:391–418. doi: 10.1177/0013164404266386.
    1. Hays R.D., Anderson R.T., Revicki D. Quality of Life Assessment in Clinical Trials: Methods and Practice. Oxford University Press; New York, NY, USA: 1998. Assessing reliability and validity of measurement in clinical trials; pp. 169–182.
    1. Tsai T.-I., Lee S.-Y.D., Tsai Y.-W., Kuo K.N. Methodology and Validation of health literacy scale development in Taiwan. J. Health. Commun. 2010;16:50–61. doi: 10.1080/10810730.2010.529488.
    1. Terwee C.B., Bot S.D.M., de Boer M.R., van der Windt D.A.W.M., Knol D.L., Dekker J., Bouter L.M., de Vet H.C.W. Quality criteria were proposed for measurement properties of health status questionnaires. J. Clin. Epidemiol. 2007;60:34–42. doi: 10.1016/j.jclinepi.2006.03.012.
    1. IBM SPSS . IBM SPSS Statistics for Windows, Version 20.0. IBM Corp; New York, NY, USA: 2011.
    1. Floyd F.J., Widaman K.F. Factor analysis in the development and refinement of clinical assessment instruments. Psychol. Assess. 1995;7:286–299. doi: 10.1037/1040-3590.7.3.286.
    1. Taylor R. Interpretation of the correlation coefficient: A basic review. J. Diagn. Med. Sonogr. 1990;6:35–39. doi: 10.1177/875647939000600106.
    1. Duong T.V., Lin I.-F., Sørensen K., Pelikan J.M., Van den Broucke S., Lin Y.-C., Chang P.W. Health literacy in Taiwan: A population-based study. Asia Pac. J. Public Health. 2015;27:871–880. doi: 10.1177/1010539515607962.
    1. Van der Heide I., Rademakers J., Schipper M., Droomers M., Sørensen K., Uiters E. Health literacy of Dutch adults: A cross sectional survey. BMC Public Health. 2013;13:1–11. doi: 10.1186/1471-2458-13-179.
    1. Paasche-Orlow M.K., Parker R.M., Gazmararian J.A., Nielsen-Bohlman L.T., Rudd R.R. The prevalence of limited health literacy. J. Gen. Intern. Med. 2005;20:175–184. doi: 10.1111/j.1525-1497.2005.40245.x.
    1. Rudd R.E. Health literacy skills of US adults. Am. J. Health Behav. 2007;31:S8–S18. doi: 10.5993/AJHB.31.s1.3.
    1. Rootman I., Gordon-El-Bihbety D. A Vision for a Health Literate Canada: Report of the Expert Panel on Health Literacy. Canadian Public Health Association; Ottawa, ON, Canada: 2008. [(accessed on 16 June 2017)]. Available online: .
    1. Liu Y.-B., Liu L., Li Y.-F., Chen Y.-L. Relationship between health literacy, health-related behaviors and health status: A survey of elderly Chinese. Int. J. Environ. Res. Public Health. 2015;12:9714–9725. doi: 10.3390/ijerph120809714.
    1. Kayupova G., Turdaliyeva B., Tulerayev K., Duong T.V., Chang P.W., Zagulova D. Health literacy among visitors of district polyclinics in Almaty, Kazakhstan. Iran. J. Public Health. 2017;46:1062–1070.
    1. Van der Gaag M., van der Heide I., Spreeuwenberg P.M.M., Brabers A.E.M., Rademakers J.J.D.J.M. Health literacy and primary health care use of ethnic minorities in the Netherlands. BMC Health Serv. Res. 2017;17:350. doi: 10.1186/s12913-017-2276-2.
    1. United Nations . The Sustainable Development Goals Report 2019. United Nations Statistics Division; New York, NY, USA: 2019. [(accessed on 30 June 2019)]. Available online: .

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