Concordance between two instruments for health literacy assessment

Cangussú, Luana Resende; Alho, Eduardo Antonio Sartori; Cardoso, Felipe Esdras Lucas; Tenório, Adirlene Pontes de Oliveira; Barbosa, Romero Henrique de Almeida; Lopes, Johnnatas Mikael; Lopes, Matheus Rodrigues

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 30 (2) • 2021 • https://doi.org/10.1590/S1679-49742021000200004 copy

Concordance between two instruments for health literacy assessment ^* * Study financed with resources from the Research Support Foundation of the State of Bahia (Fapesb) - Processes No. 4452/2018 and No. 5111/2019 - and from the National Council for Scientific and Technological Development (CNPq) / Ministry of Science, Technology, Innovations and Communications (MCTIC) - Processes No. 156099/2017 and No. 147970/2018.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objetivo

To determine agreement between the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18) measurement instruments as a strategy for estimating concurrent validity.

Methods

This was a cross-sectional study conducted with users of the Brazilian National Health System. An agreement approach using a weighted Kappa test for qualitative data was applied in order to test for concurrent validity.

Results

372 individuals participated. It was found that 66% and 62% of them did not have an adequate level of literacy according to SAHLPA-18 and S-TOFHLA, respectively. There was strong correlation between the instruments (p<0.001; r=0.60), although the 65.3% agreement of correct answers found was considered weak (Kappa=0.35; p<0.001).

Conclusion

The SAHLPA-18 and S-TOFHLA instruments have different constructs and poor agreement. Use of different instruments is indicated in research intended to measure level of literacy, as is the development of instruments specific to health conditions that allow results close to the real context of individuals to be obtained.

Keywords:
Health Literacy; Public Health; Reproducibility of Results; Self Care; Noncommunicable Diseases; Health Education

Variables	n (%)	Adequate health literacy n (%)
Variables	n (%)	SAHLPA-18^a	S-TOFHLA^b
Sex
Female	271 (72.8)	103 (38.0)	113 (41.7)
Male	101 (27.2)	24 (23.8)	29 (28.7)
Age (years)
≤30	62 (16.7)	12 (19.4)	38 (61.3)
31-59	217 (58.3)	90 (33.2)	97 (44.7)
≥60	93 (25.0)	25 (26.9)	7 (7.5)
Education
Incomplete elementary education	146 (39.2)	19 (13.0)	16 (11.0)
Commplete elementary education	27 (7.3)	10 (37.0)	07 (25.9)
Incomplete high school	29 (7.8)	7 (24.1)	12 (41.4)
Complete high school	124 (33.3)	52 (41.9)	70 (56.5)
Incomplete higher school	10 (2.7)	7 (70.0)	9 (90.0)
Complete higher school	36 (9.7)	32 (88.9)	28 (77.8)
Economic Classification
A	7 (1.9)	6 (85.7)	3 (42.9)
B1	18 (4.8)	12 (66.7)	12 (66.7)
B2	66 (17.8)	34 (51.5)	38 (57.6)
C1	55 (14.8)	22 (40.0)	24 (43.6)
C2	118 (31.7)	38 (32.2)	46 (39.0)
D - E	108 (29.0)	15 (13.9)	19 (17.6)
Group
Without chronic disease	70 (18.8)	22 (31.4)	47 (67.1)
With chronic kidney disease	92 (24.7)	21 (22.8)	20 (21.7)
With systemic arterial hypertension	131 (35.2)	52 (36.7)	55 (42.0)
With diabetes	79 (21.3)	32 (40.5)	20 (25.3)

SAHLPA-18	S-TOFHLA			Total n (%)	Kappa	p-value^a
SAHLPA-18	Inadequate n (%)	Adequate n (%)	Borderline n (%)	Total n (%)	Kappa	p-value^a
Without previous disease
Inadequate	17 (24.3)	27 (38.6)	4 (5.7)	48 (68.6)	0,21	0.007
Adequate	2 (2.9)	20 (28.6)	-	22 (31.4)
Total	19 (27.1)	47 (67.1)	4 (5.7)	70 (100.0)
Kidney disease
Inadequate	52 (56.5)	10 (10.9)	9 (9.8)	71 (77.2)	0,27	0.001
Adequate	8 (8.7)	10 (10.9)	3 (3.3)	21 (22.8)
Total	60 (65.2)	20 (21.7)	12 (13.0)	92 (100.0)
Hypertension
Inadequate	46 (35.1)	15 (11.5)	18 (13.7)	79 (60.3)	0,40	<0.001
Adequate	9 (6.9)	40 (30.5)	3 (2.3)	52 (39.7)
Total	55 (42.0)	55 (42.0)	21 (16.0)	131 (100.0)
Diabetes
Inadequate	42 (53.2)	4 (5.1)	1 (1.3)	47 (59.5)	0,45	<0.001
Adequate	12 (15.2)	16 (20.3)	4 (5.1)	32 (40.5)
Total	54 (68.4)	20 (25.3)	5 (6.3)	79 (100.0)
Total
Inadequate	157 (42.2)	56 (15.1)	32 (8.6)	245 (65.9)	0,35	<0.001
Adequate	31 (8.3)	86 (23.1)	10 (2.7)	127 (34.1)
Total	188 (0.5)	142 (8.2)	42 11.3)	372 (100.0)

Age	Sex	Without/previous disease			Kidney disease			Hypertension			Diabetes
Age	Sex	Kappa	n	p-value^a	Kappa	n	p-value	Kappa	n	p-value	Kappa	n	p-value
Economic Classification: C, D e E
≤30	Female	0.11	33	0.100	-	9	-	0.14	4	0.240	-	1	-
	Male	0.20	4	0.500	0.11	5	0.360	-	1	-	-	-	-
	Total	0.12	37	0.070	0.11	14	0.170	0.13	5	0.170	-	1	-
31-59	Female	0.10	14	0.590	0.37	18	0.040	0.31	61	0.001	0.40	23	0.030
	Male	0.50	4	0.240	0.48	27	0.003	0.46	7	0.140	0.57	6	0.120
	Total	0.19	18	0.300	0.45	45	<0.001	0.32	68	0.001	0.43	29	0.010
≥60	Female	-	-	-	-	5	-	0.07	14	0.530	0.14	23	0.030
	Male	-	-	-	-	9	-	-	5	1.000	1.00	8	0.005
	Total	-	-	-	-	14	-	0.06	19	0.610	0.24	47	0.007
Total	Female	0.11	47	0.130	0.21	32	0.090	0.29	79	<0.001	0.27	47	0.010
	Male	0.33	8	0.200	0.44	41	<0.001	0.19	13	0.220	0.75	14	0.003
	Total	0.14	55	0.060	0.33	73	<0.001	0.27	92	<0.001	0.34	61	0.001
Economic Classification: A e B^b
31-59	Female	0.11	10	0.720	0.07	5	0.810	0.59	23	0.002	-	9	-
	Male	1.00	2	0.160	1.00	3	0.080	0.27	4	0.290	-	1	-
	Total	0.40	12	0.160	0.27	8	0.330	0.54	27	0.010	0.61	10	0.030
≥60	Female	-	-	-	0.14	4	0.500	0.66	6	0.080	0.57	6	0.120
	Male	-	-	-	-	6	-	0.58	5	0.050	-	2	-
	Total	-	-	-	0.08	4	0.490	0.53	11	0.010	0.33	8	0.120
Total	Female	0.11	13	0.650	0.07	9	0.730	0.66	29	<0.001	0.70	15	0.007
	Male	1.00	2	0.150	0.21	10	0.490	0.50	10	0.020	0.14	3	0.380
	Total	0.28	15	0.250	0.05	19	0.750	0.63	39	<0.001	0.55	18	0.009
Total
≤30	Female	0.14	36	0.050	-	9	-	0.14	4	0.240	-	1	-
	Male	0.20	4	0.500	0.07	6	0.430	0.33	2	0.150	-	-	-
	Total	0.15	40	0.040	0.09	15	0.200	0.20	6	0.080	-	1	-
31-59	Female	0.21	24	0.230	0.27	23	0.090	0.43	84	<0.001	0.58	7	0.080
	Male	0.66	6	0.080	0.55	30	<0.001	0.38	11	0.070	0.59	39	<0.001
	Total	0.33	30	0.040	0.42	53	<0.001	0.42	95	<0.001	0.21	29	0.010
≥60	Female	-	-	-	0.05	9	0.700	0.32	20	0.060	0.21	29	0.010
	Male	-	-	-	0.04	15	0.680	0.24	10	0.140	0.51	10	0.020
	Total	-	-	-	0.05	24	0.570	0.29	30	0.010	0.27	39	0.002
Total	Female	0.18	60	0.030	0.14	41	0.190	0.43	108	<0.001	0.43	62	<0.001
	Male	0.44	10	0.090	0.39	51	0.001	0.32	23	0.010	0.52	17	0.010
	Total	0.21	70	0.010	0.27	92	0.001	0.40	131	<0.001	0.45	79	<0.001

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Matheus Rodrigues Lopes - Universidade Federal do Vale do São Francisco, Campus Paulo Afonso, Rua da Aurora, S/N, Quadra 27, Lote 3, Paulo Afonso, BA, Brazil. Postcode: 48607-190. E-mail: matheuslopesbio@gmail.com