Developing a Health System Literacy Measure for Chinese Immigrants in Canada: Adapting the HLS₁₉-NAV Scale

Area of Science:

• Health Services Research
• Health Literacy
• Immigrant Health

Background:

• Health system literacy is vital for immigrants to access Canadian healthcare.
• Understanding immigrant health system navigation in Canada is limited.
• A validated tool is needed to assess health system literacy among immigrants.

Purpose of the Study:

• To adapt and validate a health system literacy scale for the Canadian context (HSL-CAN).
• To evaluate the psychometric properties of the HSL-CAN in a Chinese immigrant population in Canada.

Main Methods:

• Cross-sectional online survey of Chinese immigrants (aged 30+) in Canada.
• Adaptation of the European Health Literacy Population Survey (HLS19-NAV) and translation into Chinese.
• Content validity, exploratory and confirmatory factor analyses (EFA/CFA), reliability, and validity testing (convergent, discriminant, known-groups).

Main Results:

• The HSL-CAN demonstrated good structural validity with a one-factor model (CFA fit indices: CFI=0.960, TLI=0.955, SRMR=0.033, RMSEA=0.025).
• The scale showed strong internal reliability (Cronbach's alpha=0.81; composite reliability=0.812).
• HSL-CAN correlated highly with healthcare constructs and showed significant known-groups validity across demographic and health variables.

Conclusions:

• The HSL-CAN is the first validated instrument for assessing health system literacy in the Chinese population in Canada.
• The scale possesses strong validity and reliability, suitable for research and practice.
• Further refinement is recommended for broader application to the general Canadian population.