Validation of the Health Literacy Questionnaire (HLQ) to brazilian portuguese

We used the protocol established by the original authors of the instrument for transcultural adaptation and validation of the psychometric properties of the Brazilian version of the Health Literacy Questionnaire (HLQ-Br). The HLQ-Br was answered by 794 adults from three regions of Brazil. Confirmatory Factor Analysis was performed by means of the Diagonally Weighted Least Squares and reliability was verified by Cronbach’s Alpha and Composite Reliability indicators.

Results:

Cognitive evaluation of the HLQ-Br showed that the items of the instrument were easily understood by the participants. The confirmatory analysis presented satisfactory fit indices: χ2WLSMV (866 df) = 1698.53, p <0.0001; CFI = 0.978; TLI = 0.976, and RMSEA = 0.035 [0.032; 0.037, 90%CI]. Cronbach’s Alpha and Composite Reliability > 0.76 on eight of the nine scales of the instrument.

Conclusion:

The HLQ-Br presented equivalence to the original version and satisfactory psychometric properties. It can be applied in the evaluation of Brazilian population HL in clinical practice, teaching and research. The use of HLQ-Br in health practices can aid in the incorporation of health literacy into health care practices in Brazil.

Keywords
Health literacy; Validation studies; Psychometrics

Characteristics		n(%)
Sex
	Female	536(67,51)
Age in years
	Mean ± SD	52,40 ± 17,59
Age group (years)
	18-40	208(26,20)
	41-53	192(24,18)
	54-66	204(25,70)
	>66	190(23,92)
Cohabitation
	Lives with someone	706(89,48)
Years of education
	No schooling	70(8,81)
	1-3	121(15,24)
	4-8	217 27,32)
	9	40(5,03)
	10-11	126 15,90)
	≥ 12	220 27,70)
Household income (R$ - Real)^*
	0- 937	210(26,45)
	938 - 1874	287(36,15)
	1875 – 2811	140(17,63)
	> 2812	157(19,77)
Region of the country
	Midwest	299(37,66)
	Northeast	250(31,49)
	Southeast	245(30,85)
Private health insurance plan
	No	644(81,10)
Health condition
	Hypertension	230(29,00)
	Oncology	179(22,50)
	Chronic renal	157(19,80)
	Healthy	118(14,90)
	Hypertension and Diabetes	75(9,40)
	Diabetes	20(2,50)
	Others	15(1,90)

Scale/ Question	Factor loading	M.C.L.¹ 1 MCL - Maximum cross-factor loadings;	Cronbach’s Alpha / Composite Reliability	Dim² 2 DIM - Dimensionality;	AVE³ 3 AVE - Average Variance Extracted.
PART 1
*1. Feeling understood and supported by healthcare providers*			0,77 / 0,77	1	0,46
I have at least one healthcare provider who…	0,58	0,42
I have at least one healthcare provider I can…	0,64	0,35
I have the healthcare providers I need…	0,72	0,46
I can rely on at least one…	0,77	0,46
*2. Having sufficient information to manage my health*			0,77 / 0,77	1	0,46
I feel I have good information about health…	0,56	0,40
I have enough information to help me deal…	0,72	0,44
I am sure I have all the information I…	0,66	0,39
have all the information I need to	0,76	0,46
*3. Actively managing my health*			0,66 / 0,67	1	0,30
I spend quite a lot of time actively managing…	0,31	0,26
I make plans for what I need to do to be…	0,62	0,40
Despite other things in my life, I make time…	0,57	0,33
set my own goals about health and fitness	0,57	0,36
There are things that I do regularly…	0,60	0,35
*4. Social support for health*			0,77 / 0,78	1	0,42
I can get access to several people who…	0,76	0,38
When I feel ill, the people around me really…	0,60	0,30
If I need help, I have plenty of people I…	0,75	0,36
I have at least one person…	0,40	0,23
*5. Appraisal of health information*			0,76 / 0,76	1	0,39
I compare health information from different	0,47	0,33
When I see new information about health, I…	0,62	0,37
I always compare health information from…	0,60	0,39
I know how to find out if the health…	0,73	0,48
I ask healthcare providers about the quality…	0,66	0,40
PART 2
*6. Ability to actively engage with healthcare providers*			0,78 / 0,78	1	0,41
Make sure that healthcare providers understand…	0,56	0,43
Feel able to discuss your health concerns with a…	0,63	0,42
Have good discussions about your health…	0,62	0,43
Discuss things with healthcare providers…	0,71	0,52
Ask healthcare providers questions to get…	0,69	0,47
*7. Navigating the healthcare system*			0,82 / 0,82	1	0,43
Find the right healthcare	0,57	0,41
Get to see the healthcare providers I need to	0,62	0,45
Decide which healthcare provider you need…	0,66	0,51
Make sure you find the right place to get…	0,67	0,51
Find out what healthcare services you are…	0,71	0,57
Work out what is the best care for you	0,70	0,53
*8. Ability to find good health information*			0,81 / 0,81	1	0,47
Find information about health problems	0,64	0,51
Find health information from several…	0,70	0,55
Get information about health so you are…	0,75	0,56
Get health information in words you…	0,66	0,53
Get health information by yourself	0,66	0,61
*9. Understanding health information well enough to know what to do*			0,76 / 0,78	1	0,42
Confidently fill medical forms in the correct…	0,69	0,58
Accurately follow the instructions from…	0,42	0,34
Read and understand written health…	0,73	0,60
Read and understand all the information on…	0,67	0,57
Understand what healthcare providers are…	0,68	0,58

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Katarinne Lima Moraes, E-mail: katarinnemoraes@gmail.com

scale	Scales Part 1				Scales Part 2
scale	1	2	3	4	5	6	7	8
2	0,712
3	0,535	0,648
4	0,551	0,464	0,460
5	0,514	0,637	0,604	0,312
6	0,505	0,549	0,358	0,279	0,452
7	0,461	0,563	0,250	0,217	0,419	0,747
8	0,339	0,484	0,290	0,166	0,582	0,738	0,831
9	0,231	0,429	0,246	0,147	0,513	0,644	0,722	0,882