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. 2019 Apr 10;3(2):e91-e102.
doi: 10.3928/24748307-20190225-01. eCollection 2019 Apr.

Development and Validation of a New Short-Form Health Literacy Instrument (HLS-SF12) for the General Public in Six Asian Countries

Free PMC article

Development and Validation of a New Short-Form Health Literacy Instrument (HLS-SF12) for the General Public in Six Asian Countries

Tuyen V Duong et al. Health Lit Res Pract. .
Free PMC article


Background: No comprehensive short-form health literacy (HL) survey tool has been available for general use across Asia.

Objective: This study aimed to develop and validate a short-form HL instrument derived from the 47-item European Health Literacy Questionnaire (HLS-EU-Q47).

Methods: A population survey (N = 10,024) was conducted from 2013 to 2015 using the HLS-EU-Q47 in 1,029 participants from Indonesia, 1,845 from Kazakhstan, 462 from Malaysia, 1,600 from Myanmar, 3,015 from Taiwan, and 2,073 from Vietnam. Validation of the short form was evaluated by principle component analysis, internal consistency, Pearson correlation, and regression analysis.

Key results: Based on responses from six countries, a 12-item short-form HL questionnaire (HLS-SF12) was developed, retaining the conceptual framework of the HLS-EU-Q47 and accounting for the high variance of the full-form (i.e., 90% in Indonesia, 91% in Myanmar, 93% in Malaysia, 94% in Taiwan, and 95% in both Kazakhstan and Vietnam). The HLS-SF12 was demonstrated to have adequate psychometric properties, including high reliability (Cronbach's alpha = .85), good criterion-related validity, a moderate and high level of item-scale convergent validity, no floor or ceiling effect, and good model-data-fit throughout the populations in these countries.

Conclusions: The HLS-SF12 was shown to be a valid and reliable tool for HL surveys in the general public in six Asian countries. [HLRP: Health Literacy Research and Practice. 2019;3(2):e90-e102.].

Plain language summary: A health literacy survey was conducted from 2013 to 2015 in six Asian countries using the European Health Literacy Questionnaire (HLS-EU-Q47). The collected data were used to develop and validate a comprehensive short-form questionnaire. A health literacy questionnaire with 12 items (HLS-SF12) that retains the original conceptual framework of the HLS-EU-Q47 was demonstrated to be reliable and valid.


Figure 1.
Figure 1.
Flow chart of statistic strategies to develop and validate the 12-Item Short-Form Health Literacy Instrument in six Asian countries.
Figure 2.
Figure 2.
Structure equation model of health literacy with 12 selected items from 12 conceptual components loading into three domains of health (health care, disease prevention, health promotion) in six Asian countries. Note. 2_2, 2_6, 2_10, 2_15, 2_18, 2_23, 2_26, 2_30, 2_33, 2_39, 2_43, and 2_45 are selected questions from the 47-item European Health Literacy Questionnaire (HLS-EU Consortium, 2012) and pose the following questions: On a scale from very easy to very difficult, how easy would you say it is to:

2_2 …find information on treatments of illnesses that concern you?

2_6 …understand the leaflets that come with your medicine?

2_10 …judge the advantages and disadvantages of different treatment options?

2_15 …call an ambulance in an emergency?

2_18 …find information on how to manage mental health problems like stress or depression?

2_23 …understand why you need health screenings (such as breast exam, blood sugar test, blood pressure)?

2_26 …judge which vaccinations you may need?

2_30 …decide how you can protect yourself from illness based on advice from family and friends?

2_33 …find out about activities (such as meditation, exercise, walking, Pilates etc.) that are good for your mental well-being?

2_39 …understand information in the media (such as Internet, newspaper, magazines) on how to get healthier?

2_43 …judge which everyday behavior (such as drinking and eating habits, exercise etc.) is related to your health?

2_45 … join a sports club or exercise class if you want to?

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