Measuring health literacy in the Indian population: A psychometric review

Health literacy plays a pivotal role in shaping health outcomes, yet its measurement in the Indian context remains limited and challenging. Various psychometric instruments have been developed and validated to measure health literacy; however, their applicability remains underexplored. This review aimed to consolidate the psychometric properties of health literacy instruments used among the Indian population.

The study followed a psychometric systematic review design.

A systematic review was conducted following PRISMA guidelines. PubMed, Web of Science, and Scopus were searched for studies from 1973 to June 2024, focusing on psychometric evaluations of health literacy tools developed, translated, or validated for the Indian population. The quality assessment of the studies was conducted using the Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist.

Thirty studies reported using 33 health literacy instruments to measure various health literacy constructs. Of these, only four studies reported using health literacy instruments that were originally developed for the Indian population. Reliability measures demonstrated high internal consistency for tools developed, translated or validated for use among the Indian population, with Cronbach's alpha values ranging from 0.70 to 0.99. Notable tools include the Orthodontic Health Literacy Tool with strong content validity (CVI = 0.98), the Eastern-Middle Eastern-Adult Health Literacy Questionnaire (EMAHL 13) with high internal consistency (α = 0.85), and the All Aspect of Health Literacy Scale (AAHLS) with excellent reliability (α = 0.99, ICC = 0.88-1.00). Six of the health literacy instruments validated for the Indian population demonstrated good methodological quality.

The findings emphasize the need for robust, India-specific instruments that accurately assess health literacy beyond basic awareness and knowledge, ensuring reliable data for health policy and intervention development.