Validity and reliability of the Health Literacy Assessment Scale for adherence to drug treatment among diabetics

Cardoso, Maria Clara Lélis Ramos; Santos, Aline Soares Figueiredo; Fonseca, Adélia Dayane Guimarães; Silva-Junior, Renê Ferreira da; Carvalho, Priscilla Durães de; Martins, Andrea Maria Eleutério de Barros Lima

doi:10.31744/einstein_journal/2019AO4405

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ORIGINAL ARTICLE • Einstein (São Paulo) 17 (2) • 2019 • https://doi.org/10.31744/einstein_journal/2019AO4405 copy

Validity and reliability of the Health Literacy Assessment Scale for adherence to drug treatment among diabetics

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To prepare an instrument to evaluate health literacy with regard to adherence to drug treatment among diabetics, identify the validity of its content, and estimate its reliability.

Methods

Pilot study, with the following stages of instrument construction: literature review, content validation, reliability estimation (internal consistency/Cronbach’s alpha and reproducibility/Kappa).

Results

The validity of content was completed and presented alpha=0.77 and Kappa values ranged from 0.31 to 1.00.

Conclusion

The instrument was approved regarding content validity, presented acceptable internal consistency and reproducibility. However, when applied, measurement errors it can produce must be considered.

Health literacy; Diabetes mellitus; Medication adherence; Validation studies; Reproducibility of results

Variables	n (%)
Sex
Male	10 (16.1)
Female	52 (83.9)
Stratified age, years
20-39	4 (6.5)
40-59	37 (59.7)
60-79	21 (33.9)
Level of education, full years of schooling
0	5 (8.1)
1-4	25 (40.3)
5-8	19 (30.6)
9-11	10 (16.1)
≥12	3 (4.8)
Occupation
Homemaker	42 (67.7)
Retired	5 (8.1)
Recyclable waste picker	1 (1.6)
Hairdresser	1 (1.6)
Teacher	2 (3.2)
Retailer	1 (1.6)
Rural worker	1 (1.6)
Brick-layer	3 (4.8)
Small business owner	1 (1.6)
Seamstress	1 (1.6)
Lens surfacing technician	1 (1.6)
Merchant	2 (3.2)

Item	First version (words)		Last version (suggestions)
1	Insulin – Injectable/oral		Insulin – injection/food
2	Hyperglycemia – high glucose/sweating		High glucose – Hyperglycemia/sweating
3	Tablet – measurement/oral		Tablet – length/oral
4	Diabetes – salt/disease		Diabetes – pressure/disease
5	Glycemia – hypertension/test		Glycemia – hypertension/test
6	Hypoglycemia – malaise /iron		Hypoglycemia – malaise/anemia
7	Per oris – muscle/mouth		Per oris – mouth/leg
8	Medication – control/candy		Medication – tablet/candy
9	Glucose – salt/sugar		Glucose – flour/sugar
10	Dose – quantity/sweet		Dose – quantity/validity
11	Injectable – subcutaneous/plaster		Injectable – subcutaneous/foot
12	Package insert – cake/orientation		Package insert – advertising/orientation
13	Prescription – dessert/medical		Prescription – salt/medical prescription
14	Treatment – control/cure		Treatment – control/cure
15	Decompensated – expensive/altered		Decompensated – expensive/uncontrolled
16	Continuous use – uninterrupted/large		Continuous use – uninterrupted/long
17	Prescription – Medical/discretion		Prescription – Medical/discretion
18	Side-effect – lateral/unwanted		Side-effect – lateral/unwanted

Final version of ASAM-D

Main word	Association word		Points

1. Insulin	( ) Injection	( ) Food	( ) I don’t know
2. High glucose	( ) Hyperglycemia	( ) Sweating	( ) I don’t know
3. Tablet	( ) Length	( ) Oral	( ) I don’t know
4. Diabetes	( ) Pressure	( ) Disease	( ) I don’t know
5. Glycemia	( ) Hypertension	( ) Test	( ) I don’t know
6. Hypoglycemia	( ) Malaise	( ) Anemia	( ) I don’t know
7. Per oris	( ) Mouth	( ) Leg	( ) I don’t know
8. Medication	( ) Tablet	( ) Candy	( ) I don’t know
9. Glucose	( ) Flour	( ) Sugar	( ) I don’t know
10. Dose	( ) Quantity	( ) Validity	( ) I don’t know
11. Injectable	( ) Subcutaneous	( ) Foot	( ) I don’t know
12. Package insert	( ) Advertising	( ) Orientation	( ) I don’t know
13. Prescription	( ) Salt	( ) Medical prescription	( ) I don’t know
14. Treatment	( ) Control	( ) Cure	( ) I don’t know
15. Decompensated	( ) Expensive	( ) Uncontrolled	( ) I don’t know
16. Continuous use	( ) Uninterrupted	( ) Long	( ) I don’t know
17. Prescription	( ) Medical	( ) Discretion	( ) I don’t know
18. Side-effect	( ) Lateral	( ) Unwanted	( ) I don’t know

Example of the cards shown to participants

Insuline
Injection			Food

Main word	Association words		Kappa
1. Insulin	Injection	Food	0.77
2. High glucose	Hyperglycemia	Sweating	0.31
3. Tablet	Length	Oral	0.81
4. Diabetes	Pressure	Disease	0.70
5. Glycemia	Hypertension	Test	0.96
6. Hypoglycemia	Malaise	Anemia	0.95
7. Per oris	Mouth	Leg	0.91
8. Medication	Tablet	Candy	1.00
9. Glucose	Flour	Sugar	1.00
10. Dose	Quantity	Validity	0.93
11. Injectable	Subcutaneous	Foot	0.87
12. Insert	Advertising	Orientation	1.00
13. Prescription	Salt	Medical prescription	1.00
14. Treatment	Control	Cure	1.00
15. Decompensated	Expensive	Uncontrolled	0.79
16. Continuous use	Uninterrupted	Long	0.93
17. Prescription	Medical	Discretion	0.95
18. Side-effect	Lateral	Unwanted	1.00

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[1] Corresponding author. Andrea Maria Eleutério de Barros Lima Martins. Department of Dentistry, Universidade Estadual de Montes Claros Avenida Dr. Ruy Braga, S/N − Vila Mauriceia Zip code: 39401-089 – Montes Claros, MG, Brazil Phone: (55 38) 3229-8284 E-mail: martins.andreamebl@gmail.com