Cent Eur J Public Health 2019, 27(4):320-325 | DOI: 10.21101/cejph.a4885

Measuring functional health literacy in Hungary: Validation of S-TOFHLA and Chew screening questions

Lilla Náfrádi1, Orsolya Papp-Zipernovszky2, Peter J. Schulz1, Márta Csabai2
1 Institute of Communication and Health, University of Lugano, Lugano, Switzerland
2 Institute of Psychology, University of Szeged, Szeged, Hungary

Objectives: The first efforts to measure health literacy have recently started in Hungary, thus there remains a need for tools that can be effectively used in the clinical setting. The goal of the present study was two-fold: to validate tools for measuring functional health literacy in Hungary using the Short Test of Functional Health Literacy (S-TOFHLA) and the Chew screening measure, and to provide an overview of the health literacy level of the Hungarian population.

Methods: The original English versions of both instruments were translated following the principles of cultural adaptation and standardized translation methods. The measures were administered to a random sample (N = 302) that was close to representative of the Hungarian population regarding age, gender and educational background. The Newest Vital Sign functional health literacy test and numerous socio-demographic variables (such as age, gender, education and income) were also administered to test convergent validity.

Results: The Hungarian version of the S-TOFHLA and the Chew questions showed adequate internal consistency. Lower functional health literacy scores showed the expected association with known predictors of health literacy: higher age, male gender and lower education. Especially people above 65 years of age and individuals with a low level of educational attainment or being chronically ill are vulnerable to have marginal health literacy.

Conclusion: The Hungarian version of the S-TOFHLA is a valid and reliable measure of health literacy. Moreover, the Hungarian version of the Chew screening questions provides a valid self-reported assessment, which is particularly useful to rapidly detect patients with inadequate health literacy in hospitals. It is expected that these health literacy measurements will be used for not only scientific purposes, but also serve as tools for developing public health policy, especially health education and campaigns reducing potential health disparities in Hungary.

Keywords: health literacy, measurement, validation, S-TOFHLA, Chew screening measure

Received: July 11, 2016; Revised: September 16, 2019; Accepted: September 16, 2019; Published: December 31, 2019  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Náfrádi L, Papp-Zipernovszky O, Schulz PJ, Csabai M. Measuring functional health literacy in Hungary: Validation of S-TOFHLA and Chew screening questions. Cent Eur J Public Health. 2019;27(4):320-325. doi: 10.21101/cejph.a4885. PubMed PMID: 31951692.
Download citation

References

  1. Ratzan SC, Parker RM. Introduction. In: Selden CR, Zorn M, Ratzan SC, Parker RM, editors. Health literacy. Current bibliographies in medicine, no. 2000-1. Bethesda: National Library of Medicine; 2000. p. V-VII.
  2. Berkman ND, Dewalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, et al. Literacy and health outcomes. Evid Rep Technol Assess (Summ). 2004 Jan;(87):1-8.
  3. Zhang NJ, Terry A, McHorney CA. Impact of health literacy on medication adherence: a systematic review and meta-analysis. Ann Pharmacother. 2014 Jun 1;48(6):741-51. Go to original source... Go to PubMed...
  4. Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998 Oct;114(4):1008-15. Go to original source... Go to PubMed...
  5. Davis TC, Long SW, Jackson RH, Mayeaux EJ, George RB, Murphy PW, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993 Jun;25(6):391-5. Go to PubMed...
  6. Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med. 1995 Oct;10(10):537-41. Go to original source... Go to PubMed...
  7. Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999 Sep;38(1):33-42. Go to original source... Go to PubMed...
  8. Connor M, Mantwill S, Schulz PJ. Functional health literacy in Switzerland - validation of a German, Italian, and French health literacy test. Patient Educ Couns. 2013 Jan;90(1):12-7. Go to original source... Go to PubMed...
  9. Carthery-Goulart MT, Anghinah R, Areza-Fegyveres R, Bahia VS, Brucki SM, Damin A, et al. Performance of a Brazilian population on the test of functional health literacy in adults. Rev Saude Publica. 2009 Aug;43(4):631-8. Go to original source... Go to PubMed...
  10. Baron-Epel O, Balin L, Daniely Z, Eidelman S. Validation of a Hebrew health literacy test. Patient Educ Couns. 2007 Jul;67(1-2):235-9. Go to original source... Go to PubMed...
  11. Jovic-Vranes A, Bjegovic-Mikanovic V, Marinkovic J. Functional health literacy among primary health-care patients: data from the Belgrade pilot study. J Public Health (Oxf). 2009 Dec;31(4):490-5. Go to original source... Go to PubMed...
  12. Eyüboğlu E, Schulz PJ. Validation of Turkish health literacy measures. Health Promot Int. 2016 Jun;31(2):355-62. Go to PubMed...
  13. Tsai TI, Lee SY, Tsai YW, Kuo KN. Methodology and validation of health literacy scale development in Taiwan. J Health Commun. 2011 Jan;16(1):50-61. Go to original source... Go to PubMed...
  14. Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, et al. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med. 2008 May;23(5):561-6. Go to original source... Go to PubMed...
  15. Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015 Dec;25(6):1053-8. Go to original source... Go to PubMed...
  16. Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame and health literacy: the unspoken connection. Patient Educ Couns. 1996 Jan;27(1):33-9. Go to original source... Go to PubMed...
  17. Von Wagner C, Knight K, Steptoe A, Wardle J. Functional health literacy and health-promoting behaviour in a national sample of British adults. J Epidemiol Community Health. 2007 Dec;61(12):1086-90. Go to original source... Go to PubMed...
  18. Kondilis BK, Kiriaze IJ, Athanasoulia AP, Falagas ME. Mapping health literacy research in the European Union: a bibliometric analysis. PLoS One. 2008 Jun 25;3(6):e2519. doi: 10.1371/journal.pone.0002519. Go to original source... Go to PubMed...
  19. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al; (HLS-EU) Consortium Health Literacy Project European. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012 Jan 25;12:80. doi: 10.1186/1471-2458-12-80. Go to original source... Go to PubMed...
  20. Kun E. Measuring the prevalence of health literacy in European countries: achievements and challenges - Hungary. In: 3rd European Health Literacy Conference; 2015 Nov 17-19; Brussels, Belgium.
  21. Kun E. Health literacy: What does the HLS-EU measure? Reflecting on the Hungarian results considering the international outcomes. In: Conference on measuring and improving health literacy; 2016; Szeged, Hungary. (In Hungarian.)
  22. Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, et al. Quick assessmnet of literacy in primary care: the newest vital sign. Ann Fam Med. 2005 Nov-Dec;3(6):514-22. Go to original source... Go to PubMed...
  23. Crowne DP, Marlowe D. A new scale of social desirability independent of psychopathology. J Consult Psychol. 1960 Aug;24:349-54. Go to original source... Go to PubMed...
  24. Beaton DE Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3186-91. Go to original source... Go to PubMed...
  25. Scholz U, Gutiérrez Doña B, Sud S, Schwarzer R. Is general self-efficacy a universal construct? Eur J Psychol Assess. 2002;18(3):242-51. Go to original source...
  26. Spreitzer GM. Psychological empowerment in the workplace: dimensions, measurement, and validation. Acad Manage J. 1995 Oct;38(5):1442-65. Go to original source...
  27. Mayer K, Lukács A, Pauler G. Hungarian adaptation of the 8-item Sensasition Seeking Scale. Mentálhigiéné és Pszichoszomatika. 2012 Sep;13(3):297-312. (In Hungarian.) Go to original source...
  28. Papp-Zipernovszky O, Náfrádi L, Schulz PJ, Csabai M. "So each patient comprehends": measuring health literacy in Hungary. Orv Hetil. 2016 Jun;157(23):905-15. (In Hungarian.) Go to original source... Go to PubMed...
  29. Alpert M, Raiffa H. A progress report on the training of probability assessors. In: Kahneman D, Slavic P, Tversky A, editors. Judgment under uncertainty: heuristics and biases. Cambridge: Cambridge University Press; 1982. p. 294-305. Go to original source...
  30. Kósa Z, Széles G, Kardos L, Kósa, K, Németh R, Országh S, et al. A comparative health survey of the inhabitants of Roma settlements in Hungary. Am J Public Health. 2007 May; 97(5):853-9. Go to original source... Go to PubMed...