Development and Validation of a Culture-Sensitive Generic Health Literacy Scale in Turkish-Speaking Adults.

BACKGROUND: Improving health literacy has become one of the most important public health-related goals at the global level; however, there is no clear consensus on measurement of health literacy. Despite numerous health literacy scales available in Turkish, none of the existing scales was originally developed and validated at a national level. OBJECTIVE: This study aimed to develop and validate a culturally appropriate original health literacy scale (HLS) to be used as a reference for the Turkish-speaking literate adult population in Turkey and abroad. METHODS: Two multidisciplinary workshops with more than 20 experts were conducted and a large item pool was developed. The first and second draft of the scale were pre-tested with 20 and 150 adults, respectively, from different age groups and socioeconomic levels in Ankara. The validity and reliability study of the revised scale (110 items plus 20 self-efficacy statements) was carried out with a household survey of 2,411 adults in 12 randomly selected provinces from 12 Nomenclature of Territorial Units for Statistics Regions in Turkey. Explanatory and confirmatory factor analysis were performed. The fit indices were obtained. The item analysis was applied, and Cronbach's alpha statistics were obtained. KEY RESULTS: The scale was found to be both a valid and a reliable measurement tool to assess health literacy. Cronbach's alpha for two sub-dimensions ("disease prevention and health promotion" and "treatment and access to health services") were 0.79 and 0.91, respectively. Construction validity indices were Root Mean Square Error of Approximation (RMSEA) = 0.043, Goodness of Fit Index (GFI) = 0.96, Normed Fit Index (NFI) = 0.95, and Adjusted Goodness of Fit Index (AGFI) = 0.95. The scale includes "self-efficacy" as an additional dimension (Cronbach's alpha = 0.83, RMSEA = 0.68, GFI = 0.94, NFI = 0.94, and AGFI) = 0.91). CONCLUSION: HLS is a valid and reliable measurement tool to assess health literacy of Turkish-speaking literate adults with a mixed (objective and subjective) assessment approach. [HLRP: Health Literacy Research and Practice. 2022;6(1):e2-e11.] Plain Language Summary: This study aimed to develop and validate a culturally sensitive original health literacy scale to be used as a reference scale for the Turkish-speaking literate adult population in Turkey and abroad. Study findings showed that HLS is both a valid and a reliable measurement tool to assess health literacy of Turkish-speaking literate adults.

Examining Parameter Estimation when Treating Semi-Mixed Multidimensional Constructs as Unidimensional.

In this study, parameter estimation error was examined when three dimensional tests of a semi-mixed structure were estimated unidimensionally. Since previous studies have generally focused on two-dimensional mixed structured tests or three-dimensional approximately simple structured tests, this study adds to the literature by considering the impact of fitting a unidimensional model to multidimensional data using a test structure that has not previously been considered. Test structure, interdimensional correlation, difficulty of the test, and different underlying distributions of ability were considered. Test length was set at 30 items for all conditions. Although test length was fixed, the number of approximately simple and complex items varied. Under all conditions for both moderately difficult and difficult tests, the lowest error values for all discrimination parameters, with the exception of MDISC, were obtained, surprisingly, with a correlation of 0.00. The lowest RMSE values for the difficulty parameter were obtained for tests of medium difficulty when the underlying ability distribution was simulated as standard normal for all three dimensions. The estimation errors associated with the difficulty parameter were greatly impacted by differences in the underlying ability distributions. Ability estimation errors associated with the unidimensional estimate of ability decreased as the correlation between dimensions increased.