Reliability and Validity Assessments of the Subjective End-Of-Life Health Literacy Scale in Community Older Adults

Subjective end-of-life health literacy investigates individuals' abilities in knowledge, communication and decision-making related to health during the end-of-life stage. This study aims to culturally adapt the Subjective End-of-Life Health Literacy Scale (S-EOL-HLS) for a Chinese context, including reliability and validity assessments among older adult community populations.

We translated, back-translated and cross-culturally adapted the English version (S-EOL-HLS) using Brislin's translation model. Subsequently, a survey was conducted among older adults in the community to assess the scale's reliability.

The content validity index for each item ranged from 0.714 to 1.000, with a total scale index of 0.928. Exploratory factor analysis identified three main factors with eigenvalues ≥ 1, contributing to a cumulative variance of 67.131%. Confirmatory factor analysis demonstrated that all fit indices met the required criteria, resulting in a Cronbach's α coefficient of 0.945. The half-split reliability was 0.956, and test-retest reliability reached 0.905. Validity evaluation using the HLS-EU-Q16 demonstrated a positive correlation with the scores of the Chinese End-of-Life Health Literacy Scale (r = 0.821, p < 0.001).

The Chinese version of the S-EOL-HLS exhibits strong reliability and validity among older individuals. It is suitable for evaluating end-of-life health literacy within the Chinese cultural context.