Development and initial validation of the falls health literacy scale

(i) To develop the Falls Health Literacy Scale (FHLS), a health literacy tool specific to falls, (ii) to evaluate the FHLS's construct validity towards differentiating individuals with different fall-related health literacy, and (iii) to determine its reliability, construct validity and structure in an older population.

The initial FHLS, developed based on Sørensen et al.'s health literacy model, was first administered to 144 participants aged ≥18 years for feedback and scale improvement and preliminary analysis to determine the FHLS's construct validity in identifying individuals with different fall-related health literacy. After scale refinement, the FHLS was validated in 227 community-living people aged ≥65 years.

Adult participants with more fall prevention knowledge scored higher on the initial FHLS than those with less fall prevention knowledge (p≤0.001). The final FHLS includes a 25-item subjective and a 14-item objective scale. Older people with ≥1 fall in the past year reported lower FHLS-subjective scores than those who had no falls (Cohen's [d]=0.29, confidence interval [CI]:0.03-0.56, p=0.03). Older people with lower levels of education had lower FHLS-objective scores than their more educated counterparts (d=0.51, CI:0.38-1.43, p≤0.001). Factor analysis of the FHLS-subjective generated six subscales, with CFA showing adequate model fit (RMSEA=0.077, CFI=0.883 and χ2/df =2.35). FHLS-subjective (25-item) showed good reliability, with Cronbach's alpha=0.93, mean inter-item correlation=0.34 (range -0.03-0.81) and intra-class coefficient =0.86 (95% CI:0.69-0.93).

The novel, context-specific FHLS displayed good construct validity and reliability. The FHLS holds promise as a screening tool to differentiate individuals with different degrees of fall-related health literacy, which may help guide fall prevention interventions.