The health literacy questionnaire among the aged in Changsha, China: confirmatory factor analysis

Health literacy is defined as the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health. A Health Literacy Questionnaire (HLQ) is a toolkit with good reliability and validity. Accordingly, this study administered HLQ among older adults in China to examine its factor structure, reliability, homogeneity, and discriminant validity for use in understanding better the health literacy of older adults and determining corresponding measures.

Psychometric properties were examined based on the data collected via face-to-face interviews (N = 343). Tests included the difficulty level, composite scale reliability, confirmatory factor analysis (CFA), and Bayesian structural equation modeling (BSEM).

The easiest scale to obtain a high score was "Social support for health" and the hardest, "Navigating the health care system" and "Appraisal of health information." Two one-factor models fitted well with no correlated residuals allowed. After model modification, the CFA fit statistics of the other seven scales were good. All HLQ scales were found to be homogenous, with a composite reliability ranging from 0.74 to 0.85. The nine-factor Bayesian structural equation model fitted the data well (Posterior-Predictive-P value = 0.670; 95% Confidence Interval for the difference between the observed and replicated Chi-square values = - 163.320, 102.750).

The Chinese version of the HLQ has strong construct and content validity and high composite reliability when applied to older adults in Changsha City, China. Therefore, the nine-scale HLQ can now be administered to Chinese older adults, thereby providing a powerful approach to understanding the multidimensional area of health literacy.