Cultural Adaptation and Validity Testing of the Portuguese Version of the Health Literacy Questionnaire (HLQ)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting and Participants
2.2. Data Collection
Self-Reported Health Status (SRHS)
2.3. Translation and Cultural Adaption
2.4. Data Analysis
3. Results
3.1. Cognitive Testing
3.2. Missing Values
3.3. Sociodemographic Characteristics of Participants
3.4. Psychometrics Properties
3.5. Item Difficulty
3.6. Scales Scores
3.7. Health Literacy Dimensions, Social and Clinical Variables, and Health Status
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Low Level of the Construct | High Level of the Construct |
---|---|
1. Feeling understood and supported by healthcare providers | |
People who are low on this domain are unable to engage with doctors and other healthcare providers. They don’t have a regular healthcare provider and/or have difficulty trusting healthcare providers as a source of information and/or advice. | Has an established relationship with at least one healthcare provider who knows them well and who they trust to provide useful advice and information and to assist them to understand information and make decisions about their health. |
2. Having sufficient information to manage my health | |
Feels that there are many gaps in their knowledge and that they don’t have the information they need to live with and manage their health concerns. | Feels confident that they have all the information that they need to live with and manage their condition and to make decisions. |
3. Actively managing my health | |
People with low levels don’t see their health as their responsibility, they are not engaged in their healthcare and regard healthcare as something that is done to them. | Recognise the importance and are able to take responsibility for their own health. They proactively engage in their own care and make their own decisions about their health. They make health a priority. |
4. Social support for health | |
Completely alone and unsupported for health. | A person’s social system provides them with all the support they want or need for health. |
5. Appraisal of health information | |
No matter how hard they try, they cannot understand most health information and get confused when there is conflicting information. | Able to identify good information and reliable sources of information. They can resolve conflicting information by themselves or with help from others. |
6. Ability to actively engage with healthcare providers | |
Are passive in their approach to healthcare, inactive i.e., they do not proactively seek or clarify information and advice and/or service options. They accept information without question. Unable to ask questions to get information or to clarify what they do not understand. They accept what is offered without seeking to ensure that it meets their needs. Feel unable to share concerns. The do not have a sense of agency in interactions with providers. | Is proactive about their health and feels in control in relationships with healthcare providers. Is able to seek advice from additional healthcare providers when necessary. They keep going until they get what they want. Empowered. |
7. Navigating the healthcare system | |
Unable to advocate on their own behalf and unable to find someone who can help them use the healthcare system to address their health needs. Do not look beyond obvious resources and have a limited understanding of what is available and what they are entitled to. | Able to find out about services and supports so they get all their needs met. Able to advocate on their own behalf at the system and service level. |
8. Ability to find good health information | |
Cannot access health information when required. Is dependent on others to offer information. | Is an ‘information explorer’. Actively uses a diverse range of sources to find information and is up to date. |
9. Understanding health information well enough to know what to do | |
Has problems understanding any written health information or instructions about treatments or medications. Unable to read or write well enough to complete medical forms. | Is able to understand all written information (including numerical information) in relation to their health and able to write appropriately on forms where required. |
Characteristic | Percentage * | n |
---|---|---|
Age, years median (IQR) | 61 (18) | 453 |
Age, years (max-min) | 22–96 | |
Sex (%) | 453 | |
Female | 48.8 | 221 |
Cohabitation status (%) | 450 | |
Live alone | 15.9 | 72 |
Employment status (%) | 452 | |
Employed | 40.6 | 184 |
Unemployed | 47.0 | 213 |
Other | 12.1 | 45 |
Education level (%) | 451 | |
<4 years | 29.8 | 135 |
4–9 years | 21.9 | 99 |
10–12 years | 23.8 | 108 |
University | 24.1 | 109 |
Self-reported health status | ||
Excellent | 1.3 | 6 |
Very good | 13.1 | 14 |
Good | 21.4 | 97 |
Fair | 53.6 | 243 |
Poor | 20.1 | 91 |
Type of diabetes | ||
Type 1 Diabetes | 23.0 | 104 |
Type 2 Diabetes | 74.6 | 338 |
Other type | 2.4 | 11 |
Years living with diabetes | 453 | |
<10 years | 23.8 | 108 |
10–19 years | 37.1 | 168 |
>20 years | 39.1 | 177 |
Metabolic control HbA1c medium (IQR) | 7.9 (2.0) | 441 |
Metabolic control HbA1c (max-min) | 5.1–14.2 | 441 |
Factor Loading (95% CI) | R2 | Cronbach Alpha | Composite Reliability (95% CI) | |
---|---|---|---|---|
1. Feeling understood and supported by healthcare providers | 0.81 | 0.79 (0.77–0.84) | ||
I have at least one healthcare provider who… | 0.79 (0.74–0.84) | 0.62 | 0.74 (0.72–0.80) | |
I have at least one healthcare provider I can… | 0.79 (0.75–0.84) | 0.63 | 0.73 (0.71–0.79) | |
I have the healthcare providers I need… | 0.77 (0.73–0.81) | 0.59 | 0.75 (0.74–0.81) | |
I can rely on at least one healthcare provider | 0.86 (0.82–0.91) | 0.75 | 0.70 (0.68–0.77) | |
Model fit − χ2wlsmv (2) = 5.859, p = 0.0534, CFI = 0.998, TLI = 0.995, RMSEA = 0.065, WRMR = 0.359 | ||||
2. Having sufficient information to manage my health | 0.80 | 0.80 (0.77–0.83) | ||
I feel I have good information… | 0.69 (0.64–0.75) | 0.48 | 0.79 (0.76–0.82) | |
I have enough information to help me deal… | 0.86 (0.81–0.90) | 0.73 | 0.74 (0.70–0.78) | |
I am sure I have all the information I… | 0.80 (0.76–0.85) | 0.64 | 0.74 (0.70–0.78) | |
I have all the information I… | 0.82 (0.77–0.86) | 0.66 | 0.75 (0.71–0.79) | |
Model fit − χ2wlsmv (2) = 7.853, p = 0.0197, CFI = 0.997, TLI = 0.992, RMSEA = 0.080, WRMR = 0.461 | ||||
3. Actively managing my health | 0.79 | 0.79 (0.76–0.82) | ||
I spend quite a lot of time actively… | 0.71 (0.65–0.77) | 0.51 | 0.76 (0.73–0.80) | |
I make plans for what I… | 0.70 (0.64–0.75) | 0.48 | 0.75 (0.72–0.79) | |
Despite other things in my life, I… | 0.80 (0.76–0.85) | 0.65 | 0.75 (0.71–0.78) | |
I set my own goals about health… | 0.68 (0.61–0.74) | 0.46 | 0.76 (0.72–0.80) | |
There are things that I do regularly… | 0.74 (0.69–0.80) | 0.55 | 0.76 (0.72–0.79) | |
Fit with 1 correlated residual − χ2wlsmv (4) = 4.152, p = 0.0197, CFI = 1.000, TLI = 1.000, RMSEA = 0.009, WRMR = 0.257 | ||||
4. Social support for health | 0.74 | 0.74 (0.71–0.78) | ||
I can get access to several people who… | 0.70 (0.64–0.77) | 0.49 | 0.70 (0.65–0.74) | |
When I feel ill, the people around me… | 0.57 (0.50–0.65) | 0.33 | 0.73 (0.69–0.77 | |
If I need help, I have plenty of people… | 0.83 (0.78–0.88) | 0.69 | 0.66 (0.61–0.71) | |
I have at least one person who can come-… | 0.51 (0.43–0.59) | 0.26 | 0.73 (0.69–0.77) | |
I have strong support from family… | 0.70 (0.64–0.76) | 0.49 | 0.68 (0.64–0.73) | |
Fit with 1 correlated residual- χ2wlsmv (4) = 10.007, p = 0.0403, CFI = 0.995, TLI = 0.987, RMSEA = 0.058, WRMR = 0.453 | ||||
5. Appraisal of health information | 0.76 | 0.77 (0.73–0.80) | ||
I compare health information from… | 0.78 (0.73–0.83) | 0.60 | 0.70 (0.66–0.75) | |
When I see new information about health, I… | 0.73 (0.70–0.79) | 0.53 | 0.72 (0.67–0.76) | |
I always compare health information from… | 0.84 (0.79–0.89) | 0.70 | 0.69 (0.64–0.73) | |
I know how to find out if the health information… | 0.55 (0.47–0.62) | 0.30 | 0.75 (0.72–0.79) | |
I ask healthcare providers about the quality… | 0.53 (0.46–0.61) | 0.28 | 0.76 (0.72–0.79) | |
Fit with 1 correlated residual- χ2wlsmv (4) = 23.483, p = 0.0001, CFI = 0.987, TLI = 0.968, RMSEA = 0.104, WRMR = 0.623 | ||||
PART2-Scale 6–9: | ||||
6. Ability to actively engage with healthcare providers | 0.83 | 0.83 (0.80–0.85) | ||
Make sure that healthcare providers understand… | 0.70 (0.64–0.76) | 0.49 | 0.81 (0.79–0.84) | |
Feel able to discuss your health concerns with… | 0.74 (0.68–0.79) | 0.55 | 0.81 (0.78–0.83) | |
Have good discussions about your health… | 0.80 (0.75–0.85) | 0.64 | 0.79 (0.76–0.82) | |
Discuss things with healthcare providers… | 0.76 (0.70–0.81) | 0.57 | 0.79 (0.76–0.82) | |
Ask healthcare providers questions to get… | 0.80 (0.75–0.86) | 0.65 | 0.78 (0.75–0.81) | |
Fit with 1 correlated residual − χ2wlsmv (4) = 6.002, p = 0.1990, CFI = 0.999, TLI = 0.998, RMSEA = 0.033, WRMR = 0.294 | ||||
7. Navigating the healthcare system | 0.80 | 0.81 (0.78–0.83) | ||
Find the right health care | 0.57 (0.49–0.64) | 0.32 | 0.80 (0.77–0.83) | |
Get to see the healthcare providers you… | 0.73 (0.68–0.76) | 0.53 | 0.77 (0.74–0.80) | |
Decide which healthcare provider you need… | 0.74 (0.69–0.79) | 0.55 | 0.77 (0.73–0.80) | |
Make sure you find the right place to get the… | 0.82 (0.79–0.86) | 0.68 | 0.75 (0.71–0.79) | |
Find out which healthcare services you are… | 0.69 (0.64–0.75) | 0.48 | 0.78 (0.74–0.81) | |
Work out what the best care is… | 0.60 (0.54–0.66) | 0.36 | 0.79 (0.76–0.82) | |
Model fit − χ2wlsmv (9) = 4.736, p = 0.8567, CFI = 1.000, TLI = 1.003, RMSEA = 0.000, WRMR = 0.235 | ||||
8. Ability to find good health information | 0.82 | 0.82 (0.79–0.84) | ||
Find information about health… | 0.75 (0.70–0.80) | 0.56 | 0.79 (0.75–0.82) | |
Find health information from several… | 0.77 (0.72–0.82) | 0.59 | 0.77 (0.74–0.81) | |
Get information about health so you are up… | 0.72 (0.65–0.78) | 0.51 | 0.78 (0.75–0.82) | |
Get health information in words you understand… | 0.70 (0.64–0.75) | 0.49 | 0.79 (0.76–0.82) | |
Get health information by yourself | 0.76 (0.71–0.81) | 0.58 | 0.78 (0.75–0.81) | |
Model fit − χ2wlsmv (5) = 12.8289, p = 0.0250, CFI = 0.996, TLI = 0.992, RMSEA = 0.059, WRMR = 0.422 | ||||
9. Understanding health information well enough to know what to do | 0.75 | 0.79 (0.76–0.82) | ||
Confidently fill medical forms in the… | 0.70 (0,64–0,76) | 0.49 | 0.75 (0.71–0.79) | |
Accurately follow instructions from… | 0.26 (0.18–0.35) | 0.07 | 0.81 (0.78–0.84) | |
Read and understand written health… | 0.88 (0.84–0.90) | 0.78 | 0.67 (0.62–0.72) | |
Read and understand all the information… | 0.82 (0.76–0.84) | 0.67 | 0.70 (0.66–0.75) | |
Understand what healthcare providers… | 0.57 (0.51–0.64) | 0.33 | 0.78 (0.74–0.81) | |
Fit with 1 correlated residual- χ2wlsmv (4) = 5.027. p = 0.2845. CFI = 0.999. TLI = 0.999, RMSEA = 0.024, WRMR = 0.279 |
Part 1 | Part 2 | |||||||
---|---|---|---|---|---|---|---|---|
Scale | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
2. Having sufficient information to manage my health | 0.762 | |||||||
3. Actively managing my health | 0.439 | 0.549 | ||||||
4. Social support for health | 0.752 | 0.674 | 0.412 | |||||
5. Appraisal of health information | 0.548 | 0.659 | 0.646 | 0.479 | ||||
6. Ability to actively engage with healthcare providers | 0.654 | 0.554 | 0.347 | 0.540 | 0.390 | |||
7. Navigating the healthcare system | 0.616 | 0.620 | 0.367 | 0.540 | 0.450 | 0.891 | ||
8. Ability to find good health information | 0.465 | 0.614 | 0.283 | 0.412 | 0.581 | 0.718 | 0.888 | |
9. Understanding health information well enough to know what to do | 0.419 | 0552 | 0.321 | 0.398 | 0.423 | 0.762 | 0.814 | 0.889 |
Obs (n = 453) | Missing n (%) | Median | Mean (SD) | Difficult Level % (95% CI) a | |
---|---|---|---|---|---|
Part 1: How strongly you disagree or agree with the following statements (Strong disagree, disagree, agree, strongly agree) | |||||
1-Feeling understood and supported by healthcare providers | |||||
I have at least one healthcare provider who… | 453 | 0 | 3 | 3.21 (0.62) | 9.7 (7.1–12.8) |
I have at least one healthcare provider I can… | 453 | 0 | 3 | 3.22 (0.54) | 7.3 (5.1–10.1) |
I have the healthcare providers I need… | 453 | 0 | 3 | 3.19 (0.52) | 7.1 (4.9–9.8) |
I can rely on at least one… | 453 | 0 | 3 | 3.20 (0.58) | 6.8 (4.7–9.6) |
2-Having sufficient information to manage my health | |||||
I feel I have good information… | 450 | 3 (0.7) | 3 | 3.05 (0.58) | 11.8 (8.9–15.1) |
I have enough information to help me deal… | 453 | 0 | 3 | 3.09 (0.60) | 15.7 (12.4–19.4) |
I am sure I have all the information I… | 453 | 0 | 3 | 2.88 (0.62) | 24.3 (20.4–28.4) |
I have all the information I… | 453 | 0 | 3 | 3.04 (0.60) | 20.5 (16.9–24.5) |
3-Actively managing my health | |||||
I spend quite a lot of time actively… | 451 | 2 (0.4) | 3 | 2.75 (0.72) | 33.7 (29.3–38.3) |
I make plans for what I… | 453 | 0 | 3 | 2.85 (0.59) | 24.9 (21.0–29.2) |
Despite other things in my life... | 453 | 0 | 3 | 2.80 (0.59) | 26.7 (22.7–31.0) |
I set my own goals about health… | 449 | 4 (0.9) | 3 | 2.87 (0.68) | 28.7 (24.6–33.2) |
There are things that I do regularly… | 453 | 0 | 3 | 2.92 (0.60) | 21.2 (17.5–25.2) |
4-Social support for health | |||||
I can get access to several people who… | 453 | 0 | 3 | 3.15 (0.62) | 11.0 (8.3–14.3) |
When I feel ill, the people around me… | 451 | 2 (0.4) | 3 | 2.94 (0.68) | 21.1 (17.4–25.1) |
If I need help, I have plenty of people… | 453 | 0 | 3 | 3.03 (0.72) | 18.3 (14.9–22.2) |
I have at least one person who can come… | 453 | 0 | 3 | 3.06 (0.78) | 17.7 (14.3–21.5) |
I have strong support from family… | 453 | 0 | 3 | 3.20 (0.73) | 11.9 (9.1–15.3) |
5-Appraisal of health information | |||||
I compare health information from… | 453 | 0 | 3 | 2.74 (0.68) | 32.7 (28.4–37.2) |
When I see new information about health. I… | 453 | 0 | 3 | 2.91 (0.66) | 22.7 (19.0–26.9) |
I always compare health information from… | 453 | 0 | 3 | 2.72 (0.65) | 34.9 (30.5–39.5) |
I know how to find out if the health… | 453 | 0 | 3 | 2.81 (0.65) | 28.9 (24.8–33.3) |
I ask healthcare providers about the quality… | 453 | 0 | 3 | 2.87 (0.68) | 26.5 (22.5–30.8) |
Obs (n = 453) | Missing n (%) | Median | Mean (SD) | Difficult Level % (95% CI) b | |
Part 2: How easy or difficult the following tasks are for you to do now (cannot do, very difficult, quite difficult, quite easy, very easy) | |||||
6-Ability to actively engage with healthcare providers | |||||
Make sure that healthcare providers understand… | 453 | 0 | 4 | 3.81 (0.77) | 27.2 (23.2–31.5) |
Feel able to discuss your health concerns with… | 453 | 0 | 4 | 4.03 (0.75) | 16.8 (13.5–20.5) |
Have good discussions about your health… | 453 | 0 | 4 | 3.85 (0.80) | 23.8 (20.0–28.0) |
Discuss things with healthcare providers… | 453 | 0 | 4 | 3.79 (0.75) | 28.3 (24.2–32.6) |
Ask healthcare providers questions to get… | 453 | 0 | 4 | 3.80 (0.78) | 24.9 (21.0–29.2) |
7-Navigating the healthcare system | |||||
Find the right health care | 453 | 0 | 4 | 3.49 (0.81) | 47.5 (42.8–52.2) |
Get to see the healthcare providers you… | 453 | 0 | 4 | 3.64 (0.86) | 38.9 (34.4–43.4) |
Decide which healthcare provider you need… | 453 | 0 | 4 | 3.70 (0.81) | 32.9 (28.7–37.4) |
Make sure you find the right place to get the… | 453 | 0 | 4 | 3.64 (0.82) | 37.7 (33.4–42.3) |
Find out which healthcare services you are… | 453 | 0 | 4 | 3.44 (0.85) | 50.1 (45.4–54.8) |
Work out what the best care is… | 453 | 0 | 4 | 3.664 (0.79) | 35.3 (30.9–39.9) |
8-Ability to find good health information | |||||
Find information about health… | 453 | 0 | 4 | 3.65 (0.77) | 35.8 (31.3–40.4) |
Find health information from several… | 453 | 0 | 4 | 3.43 (0.91) | 49.2 (44.5–53.9) |
Get information about health so you are up… | 453 | 0 | 4 | 3.63 (0.80) | 36.4 (32.0–41.0) |
Get health information in words you understand… | 453 | 0 | 4 | 3.53 (0.89) | 44.4 (30.7–49.1) |
Get health information by yourself | 453 | 0 | 4 | 3.40 (0.98) | 46.1 (41.5–50.9) |
9-Understanding health information well enough to know what to do | |||||
Confidently fill medical forms in the… | 453 | 0 | 4 | 3.74 (0.98) | 28.3 (24.2–32.6) |
Accurately follow instructions from… | 453 | 0 | 4 | 3.68 (0.74) | 38.4 (33.9–43.1) |
Read and understand written health… | 453 | 0 | 4 | 3.56 (0.95) | 37.3 (32.8–41.9) |
Read and understand all the information… | 453 | 0 | 4 | 3.45 (1.02) | 44.8 (40.2–49.5) |
Understand what healthcare providers… | 453 | 0 | 4 | 4.02 (0.66) | 14.1 (11.1–17.7) |
Mean Score (SD) | Min Score | Max Score | (95% CI) | |
---|---|---|---|---|
Part 1-Range 1 (lowest) to 4 (highest) | ||||
1. Feeling understood and supported by healthcare providers | 3.21 (0.47) | 1.75 | 4.00 | 3.16–3.25 |
2. Having sufficient information to manage my health | 2.98 (0.48) | 1.50 | 4.00 | 2.94–3.03 |
3. Actively managing my health | 2.83 (0.46) | 1.20 | 4.00 | 2.78–2.87 |
4. Social support for health | 3.08 (0.50) | 1.20 | 4.00 | 3.03–3.12 |
5. Appraisal of health information | 2.81 (0.47) | 1.00 | 4.00 | 2.77–2.86 |
Part 2-Range 1 (lowest) to 5 (highest) | ||||
6. Ability to actively engage with healthcare providers | 3.86 (0.59) | 2.00 | 5.00 | 3.80–3.91 |
7. Navigating the healthcare system | 3.60 (0.58) | 1.83 | 5.00 | 3.55–3.60 |
8. Ability to find good health information | 3.53 (0.66) | 1.20 | 5.00 | 3.46–3.59 |
9. Understand health information well enough to know what to do | 3.69 (0.62) | 1.40 | 5.00 | 3.63–3.75 |
Variable | 1-Feeling Understood and Supported by Healthcare Providers | 2-Having Sufficient Information to Manage My Health | 3-Actively Managing My Health | 4-Social Support for Health | 5-Appraisal of Health Information | 6-Ability to Actively Engage with Healthcare Providers | 7-Navigating the Healthcare System | 8-Ability to Find Good Health Information | 9-Understand Health Information Well Enough to Know What to Do | |
---|---|---|---|---|---|---|---|---|---|---|
Simple Size (n) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | |
Sex | 453 | |||||||||
Female | 221 | 3.20 (0.48) | 3.21 (0.45) | 2.83 (0.46) | 3.04 (0.53) | 2.80 (0.49) | 3.82 (0.63) | 3.58 (0.6) | 3.49 (071) | 3.67 (0.66) |
Male | 232 | 3.21 (0.45) | 2.97 (0.47) | 2.82 (0.46) | 3.11 (0.46) | 2.82 (0.46) | 3.89 (0.55) | 3.61 (0.55) | 3.56 (0.60) | 3.70 (0.59) |
ANOVA F (p value) | 0.063 (0.802) | 0.698 (0.493) | 0.263 (0.793) | −1.316 (1.189) | −0.364 (0.716) | −1.042 (0.98) | −0.601 (0.548) | −1.018 (0.309) | −0.528 (0.598) | |
ES (95% CI) a | 0.00 (0.00–0.00) | 0.001 (0.000–0.002) | 0.00 (0.000–0.000) | 0.004 (0.002–0.008) | 0.000 (0.000–0.000) | 0.002 (0.001–0.005) | 0.001 (0.000–0.002) | 0.002 (0.001–0.005) | 0.001 (0.000–0.001) | |
Age | 453 | |||||||||
18–44 | 77 | 3.42 (0.47) | 3.21 (0.48) | 2.92 (0.48) | 3.24 (0.45) | 3.05 (0.44) | 3.99 (0.50) | 3.83 (0.48) | 3.91 (0.421) | 3.92 (0.43) |
45–64 | 198 | 3.15 (0.45) | 2.94 (0.45) | 2.77 (0.48) | 3.02 (0.48) | 2.88 (0.46) | 3.84 (0.63) | 3.51 (0.61) | 3.54 (0.68) | 3.72 (0.64) |
≥65 | 178 | 3.17 (0.46) | 2.93 (0.49) | 2.85 (0.43) | 3.07 (0.50) | 2.73 (0.47) | 3.81 (0.58) | 3.54 (0.57) | 3.34 (0.65) | 3.56 (0.64) |
ANOVA F (p value) | 10.452 (0.000) ** | 10.401 (0.000) ** | 3.475 (0.032) * | 5.254 (0.006) * | 13.816 (0.000) ** | 2.761 (0.064) | 8.308 (0.000) ** | 21.539 (0.000) ** | 9.876 (0.000) ** | |
ES (95% CI) a | 0.044 (0.013–0.084) | 0.045 (0.011–0.044) | 0.015 (0.004–0.015) | 0.023 (0.006–0.022) | 0.058 (0.015–0.058) | 0.012 (0.003–0.012) | 0.036 (0.009–0.035) | 0.087 (0.02–0.087) | 0.042 (0.011–0.042) | |
Education level | 451 | |||||||||
<4 years of school | 135 | 3.18 (0.42) | 2.92 (0.45) | 2.84 (0.45) | 3.02 (0.52) | 2.69 (0.41) | 3.78 (0.58) | 3.44 (0.56) | 3.19 (0.67) | 3.36 (0.66) |
4–9 years of school | 99 | 3.11 (0.46) | 2.93 (0.46) | 2.78 (0.43) | 3.04 (0.47) | 2.74 (0.44) | 3.81 (0.66) | 3.52 (0.68) | 3.47 (0.66) | 3.96 (0.60) |
10–12 years of school | 108 | 3.20 (0.49) | 2.99 (0.50) | 2.76 (0.47) | 3.09 (0.51) | 2.88 (0.48) | 3.91 (0.57) | 3.67 (0.55) | 3.63 (0.57) | 3.81 (0.56) |
University | 109 | 3.32 (0.47) | 3.09 (0.50) | 2.92 (0.49) | 3.16 (0.48) | 2.94 (0.45) | 3.93 (0.57) | 3.77 (0.50) | 3.89 (0.52) | 3.97 (0.46) |
ANOVA F (p value) | 3.776 (0.011) * | 3.047 (0.029) * | 2.716 (0.044) * | 1.738 (0.158) | 7.369 (0.000) ** | 1.805 (0.145) | 7.954 (0.000) ** | 27.610 (0.000) ** | 24.052 (0.000) ** | |
ES (95% CI) a | 0.025 (0.004–0.028) | 0.020 (0.003–0.013) | 0.018 (0.003–0.012) | 0.012 (0.002–0.008) | 0.048 (0.008–0.031) | 0.012 (0.002–0.008) | 0.051 (0.087–0.034) | 0.156 (0.03–0.109) | 0.139 (0.029–0.097) | |
Employment status | 452 | |||||||||
Employed | 184 | 3.23 (0.47) | 3.00 (0.49) | 2.79 (0.46) | 3.14 (0.45 | 2.84 (0.47) | 3.93 (0.57) | 3.68 (0.55) | 3.68 (0.60) | 3.81 (0.59) |
Retired | 213 | 3.19 (0.47) | 2.96 (0.47) | 2.86 (0.46) | 3.07 (0.52) | 2.75 (0.48) | 3.80 (0.60) | 3.51 (0.59) | 3.36 (0.69) | 3.55 (0.66) |
Other | 45 | 3.15 (0.44) | 3.00 (0.46) | 2.89 (0.46) | 2.91 (0.52) | 2.91 (0.48) | 3.80 (0.59) | 3.59 (0.60) | 3.68 (0.58) | 3.80 (0.48) |
ANOVA F (p value) | 0.627 (0.535) | 0.453 (0.636) | 1.279 (0.279) | 4.831 (0.008) * | 2.984 (0.052) | 2.775 (0.063) | 4.436 (0.012) * | 13.867 (0.000) ** | 10.565 (0.000) ** | |
ES (95% CI) a | 0.015 (0.001–0.005) | 0.004 (0.000–0.002) | 0.015 (0.002–0.006) | 0.023 (0.003–0.016) | 0.017 (0.001–0.007) | 0.026 (0.003–0.010) | 0.022 (0.002–0.009) | 0.060 (0.006–0.025) | 0.046 (0.005–0.019) | |
Cohabitation | ||||||||||
Living with others | 377 | 3.20 (0.46) | 2.99 (0.47) | 2.82 (0.45) | 3.11 (0.52) | 2.81 (0.47) | 3.87 (0.63) | 3.61 (0.63) | 3.55 (0.61) | 3.72 (0.59) |
Living alone | 72 | 3.21 (0.49) | 2.91 (0.55) | 2.86 (0.52) | 2.90 (0.64) | 2.80 (0.51) | 3.77 (0.63) | 3.50 (0.61) | 3.40 (0.76) | 3.55 (0.75) |
ANOVA F (p value) | 0.00 (0.999) | 1.503 (0.059) | −0.722 (0.372) | 3.342 (0.001) * | 0.218 (0.946) | 1.324 (0.232) | 1.428 (0.408) | 1.734 (0.020) * | 2.131 (0.08) | |
ES (95% CI) a | 0.00 (0.000–0.000) | 0.008 (0.002–0.008) | 0.002 (0.000–0.001) | 0.041 (0.011–0.041) | 0.001 (0.000–0.001) | 0.005 (0.001–0.005) | 0.005 (0.001–0.005) | 0.007 (0.002–0.007) | 0.012 (0.003–0.012) | |
Type of Diabetes | ||||||||||
Type 1 Diabetes | 104 | 3.35 (0.45) | 3.15 (0.49) | 2.92 (0.46) | 3.19 (0.48) | 2.93 (0.455) | 3.97 (0.51) | 3.73 (0.53) | 3.79 (0.55) | 3.84 (0.48) |
Type 2 Diabetes | 338 | 3.16 (0.47) | 2.93 (0.47) | 2.80 (0.46) | 3.04 (0.50) | 2.77 (0.47) | 3.82 (0.61) | 3.55 (0.59) | 3.45 (0.67) | 3.64 (0.65) |
Other types Diabetes | 11 | 3.02 (0.47) | 2.98 (0.42) | 2.60 (0.43) | 3.00 (0.379) | 2.89 (0.56) | 3.74 (0.49) | 3.47 (0.63) | 3.38 (0.67) | 3.70 (0.36) |
ANOVA F (p value) | 7.503 (0.001) * | 8.455 (0.000) ** | 3.779 (0.24) * | 3.815 (0.023) * | 4.972 (0.007) * | 2.956 (0.053) | 4.206 (0.016) * | 11.236 (0.000) ** | 4.486 (0.012) * | |
ES (95% CI) a | 0.032 (0.008–0.032) | 0.037 (0.009–0.036) | 0.017 (0.004–0.016) | 0.017 (0.004–0.017) | 0.022 (0.006–0.022) | 0.013 (0.003–0.013) | 0.012 (0.005–0.018) | 0.048 (0.012–0.047) | 0.020 (0.005–0.019) | |
Hemoglobin glycated (A1c) | ||||||||||
<6.5% | 57 | 3.31 (0.47) | 3.06 (0.51) | 2.95 (0.52) | 3.24 (0.41) | 2.87 (0.43) | 2.95 (0.53) | 3.68 (0.59) | 3.64 (0.60) | 3.70 (0.67) |
6.5–7.4% | 114 | 3.21 (0.51) | 3.02 (0.47) | 2.92 (0.46) | 3.06 (0.53) | 2.89 (0.51) | 2.92 (0.47) | 3.61 (0.57) | 3.58 (0.68) | 3.79 (0.56) |
7.5–8.4% | 114 | 3.24 (0.44) | 2.99 (0.47) | 2.81 (0.41) | 3.09 (0.46) | 2.79 (0.50) | 3.83 (0.41) | 3.54 (0.55) | 3.51 (0.61) | 3.64 (0.63) |
≥8.5% | 156 | 3.12 (0.45) | 2.92 (0.48) | 2.72 (0.46) | 3.03 (0.49) | 2.75 (0.45) | 2.72 (0.46) | 3.58 (0.60) | 3.47 (0.68) | 3.67 (0.62) |
ANOVA: F (p value) | 2.823 (0.038) * | 1.480 (0.219) | 5.849 (0.001) * | 2.660 (0.048) * | 2.366 (0.070) | 0.252 (0.860) | 0.798 (0.496) | 1.130 (0.336) | 1.204 (0.308) | |
ES (95% CI) a | 0.010 (0.02–0.010) | 0.005 (0.001–0.005) | 0.026 (0.007–0.026) | 0.016 (0.004–0.016) | 0.008 (0.002–0.008) | 0.001 (0.000–0.001) | 0.003 (0.000–0.003) | 0.007 (0.002–0.007) | 0.007 (0.002–0.006) | |
Years living with diabetes | 453 | |||||||||
<10 | 108 | 3.24 (0.49) | 2.93 (0.48) | 2.86 (0.53) | 3.05 (0.56) | 2.86 (0.52) | 3.89 (0.57) | 3.68 (0.56) | 3.64 (0.65) | 3.78 (0.65) |
10–20 | 168 | 3.15 (0.43) | 2.95 (0.47) | 2.74 (0.44) | 3.03 (0.45) | 2.75 (0.45) | 3.84 (0.57) | 3.55 (0.55) | 3.74 (0.64) | 3.67 (0.57) |
>20 | 177 | 3.25 (0.49) | 3.05 (0.48) | 2.90 (0.43) | 3.15 (0.50) | 2.84 (0.47) | 3.85 (0.63) | 3.58 (0.63) | 3.51 (0.68) | 3.65 (0.65) |
Mean (SD) | 3.25 (0.49) | 3.05 (0.48) | 2.90 (0.43) | 3.15 (0.50) | 2.84 (0.47) | 3.85 (0.63) | 3.58 (0.63) | 3.51 (0.68) | 3.65 (0.65) | |
ANOVA: F (p value) | 2.523 (0.081) | 2.633 (0.073) | 5.478 (0.004) * | 2.624 (0.074) | 2.296 (0.102) | 2.296 (0.754) | 1.673 (0.189) | 2.191 (0.113) | 1.420 (0.243) | |
ES (95% CI) a | 0.011 (0.003–0.011) | 0.016 (0.003–0.011) | 0.024 (0.006–0.023) | 0.012 (0.00–0.012) | 0.010 (0.003–0.01) | 0.005 (0.000–0.003) | 0.009 (0.002–0.006) | 0.010 (0.002–0.010) | 0.006 (0.002–0.006) | |
Self-reported health status | ||||||||||
Good | 117 | 3.28 (0.47) | 3..10 (0.50) | 2.99 (0.47) | 3.17 (0.50) | 2.95 (0.48) | 3.99 (0.54) | 3.83 (0.54) | 3.81 (0.62) | 3.97 (0.51) |
Fair | 243 | 3.17 (0.45) | 2.97 (0.46) | 2.79 (0.44) | 3.06 (0.48) | 2.77 (0.45) | 3.86 (0.59) | 3.56 (0.56) | 3.50 (0.63) | 3.67 (0.60) |
Poor | 91 | 3.16 (0.49) | 2.85 (0.47) | 2.71 (0.44) | 2.97 (0.51) | 2.72 (0.46) | 3.66 (0.61) | 3.36 (0.58) | 3.22 (0.67) | 3.67 (0.40) |
ANOVA: F (p value) | 2.486 (0.084) | 7.353 (0.001) * | 11.374 (0.000) ** | 4.420 (0.013) * | 7.864 (0.000) ** | 8.333 (0.000) ** | 18.090 (0.000) ** | 22.932 (0.000) ** | 23.740 (0.000) ** | |
ES (95% CI) a | 0.011 (0.003–0.010) | 0.032 (0.008–0.031) | 0.049 (0.012–0.049) | 0.019 (0.005–0.019) | 0.034 (0.009–0.034) | 0.036 (0.009–0.036) | 0.075 (0.012–0.074) | 0.093 (0.025–0.092) | 0.107 (0.029–0.106) |
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Do Ó, D.N.; Goes, A.R.; Elsworth, G.; Raposo, J.F.; Loureiro, I.; Osborne, R.H. Cultural Adaptation and Validity Testing of the Portuguese Version of the Health Literacy Questionnaire (HLQ). Int. J. Environ. Res. Public Health 2022, 19, 6465. https://doi.org/10.3390/ijerph19116465
Do Ó DN, Goes AR, Elsworth G, Raposo JF, Loureiro I, Osborne RH. Cultural Adaptation and Validity Testing of the Portuguese Version of the Health Literacy Questionnaire (HLQ). International Journal of Environmental Research and Public Health. 2022; 19(11):6465. https://doi.org/10.3390/ijerph19116465
Chicago/Turabian StyleDo Ó, Dulce Nascimento, Ana Rita Goes, Gerald Elsworth, João F. Raposo, Isabel Loureiro, and Richard H. Osborne. 2022. "Cultural Adaptation and Validity Testing of the Portuguese Version of the Health Literacy Questionnaire (HLQ)" International Journal of Environmental Research and Public Health 19, no. 11: 6465. https://doi.org/10.3390/ijerph19116465