Measurement invariance of the Death Literacy Index across Flemish Belgium, The Netherlands, and Sweden

Death literacy is a construct conceptualizing experience-based knowledge and skills for end-of-life care, which is operationalized as a six-factor model in the 29-item Death Literacy Index (DLI). The DLI has gained international interest, but its validity across countries is yet unknown. This cross-sectional study therefore assessed its measurement invariance (psychometric equivalence), across Flemish Belgium, the Netherlands, and Sweden. Translated and adapted country-specific DLI versions were developed and completed by 1516 participants in total. Results from a series of multigroup confirmatory factor analyses showed that the DLI met the conditions for configural, scalar, and metric invariance. The findings demonstrate that the DLI measures death literacy in an invariant (equivalent) way across the national samples without systematic contextual bias. Our study provides support for cross-national use of the DLI. Its potential as an appropriate instrument for comparing and evaluating impact of community competence-building interventions is discussed.