Psychometric qualities of the HLS-EU-Q16 instrument for parental health literacy in Swedish multicultural settings

BMC Public Health. 2022 Feb 12;22(1):293. doi: 10.1186/s12889-021-12346-8.


Background: Health literacy (HL) is important for individuals in terms of knowledge and competence to make decisions about healthcare, health promotion and disease prevention. Migrants generally demonstrate lower HL levels compared to the majority populations. HL interventions among migrants are rarely studied. Thus, there is a need to find useful HL measurements for multicultural settings. The importance of understanding parents' HL is related to their key role in providing and promoting the health of their children. This study aimed to add knowledge about the psychometric properties of the HLS-EU-Q16 instrument (Swedish version) among parents in Swedish multicultural settings.

Methods: A cross sectional design was used. Totally 193 first-time parents (N = 193) were recruited through two child healthcare centres in Stockholm. Parents were interviewed when their infants were < 2 months old using structured questionnaires including HLS-EU-Q16. For psychometric evaluation of HLS-EU-Q16 instrument, exploratory factor analyses (EFA) were used to test internal consistency (N = 164). HL levels in sub-groups were explored with Kruskal-Wallis/Chi2 tests. Participants' comments on HLS-EU-Q16 questionnaire were viewed to explore how the questions were perceived by the target population.

Results: One factor solution of EFA explained 37.3% of the total variance in HLS-EU-Q16. Statistically significant differences in HL levels were found in relation to migration including language difficulties and level of education of the study population and access to support in line with previous research. Challenges related to understanding HLS-EU-Q16 questionnaire were found among participants with migrant background.

Conclusions: The Swedish version of HLS-EU-Q16 could be used together with other instruments for measuring overall HL in multicultural settings. HLS-EU-Q16 appears to discriminate between different levels of HL in relation to migrant background and shorter education and limited access to support. However, other measures of HL which should be adapted to use in multicultural settings, need to be explored in further studies of parental HL and its relationship to child health in multicultural settings.

Trial registration: The study was retrospectively registered (18 February 2020) in the ISRCTN registry ( ISRCTN10336603 ).

Keywords: HLS-EU-Q16; Health literacy; Migrant; Multicultural; Parents; Psychometrics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Cross-Sectional Studies
  • Health Literacy*
  • Humans
  • Infant
  • Language
  • Parents
  • Psychometrics
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Sweden