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The COVID-19 vaccination health literacy questionnaire (CVHL-Q): Design and validation according to classic

Carmen Rodríguez-Blázquez¹, Alba Ayala², Pilar Bas-Sarmiento³

¹National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain.

|July 3, 2025

Abstract

Objectives:

This study aimed to describe the COVID-19 vaccination health literacy questionnaire (CVHL-Q) and test its psychometric properties in the Spanish general population using Classic Test Theory (CTT) and Rasch measurement analysis.

Study Design:

A cross-sectional, observational study was conducted among the Spanish general population in February 2022.

Methods:

An online survey was administered to a nationally representative sample of 1067 people aged 18 years or older. To measure COVID-19 Vaccination Health Literacy (CVHL) a short questionnaire was developed by the research team. The psychometric properties of the CVHL-Q were explored using Rasch analysis and CTT, following recommended practices for validation of rating scales.

Results:

The CVHL index mean was 34.3 (SD: 11.6, range: 0-50) with 39.7 % of participants showing limited COVID-19 vaccine literacy (score ≤33 points). The instrument exhibited satisfactory internal consistency. Regarding discriminative validity, not all the a-priori hypotheses were confirmed: younger individuals had lower CVHL-Q scores, and no association was found with education level. A final model based on a random subsample of 300 participants showed a good fit to the Rasch model (χ² = 31.9, p = 0.044 with Benferroni correction) and satisfactory reliability (PSI = 0.718). All items displayed ordered thresholds and acceptable residual fit.

Conclusions:

The CVHL-Q is a short, questionnaire with robust measurement properties that allow assessing the ability of population to find, understand, use and appraise the information on COVID-19 vaccines. It might be useful in designing communication campaigns and to assess pandemic preparedness.

Keywords:

COVID-19 Health literacy Psychometrics Vaccine literacy

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