Translation and validation of the revised and short forms of the Death Literacy Index in the Chinese population

Death literacy has gained attention in recent years, and the use of the Death Literacy Index (DLI) has been increasing. It measures knowledge about the death system. After being translated and used in multiple countries, the original authors incorporated feedback from various countries and revised the DLI to become the DLI-R. A shorter version, the DLI-9, was also developed for practical use. This study aimed to validate the DLI-R and DLI-9 in the Chinese population.

The DLI was forward- and backward-translated into Chinese by two expert panels. A pilot test was conducted before the main survey. A total of 1,147 participants were recruited online from three cities in southern China (Shenzhen, Foshan, and Macao) to examine the factor structure, validity, and reliability of the translated DLI-R and DLI-9.

Exploratory factor analysis showed a five-factor structure. The Cronbach's alpha of the Chinese DLI-R was 0.92, and the five factors were between 0.78 and 0.95, accounting for 65.06% of cumulative variance. The Cronbach's alpha of the Chinese DLI-9 was 0.79, accounting for 52.56% of cumulative variance. The five-factor structure was confirmed by a confirmatory factor analysis. The overall scale and subscales showed high internal consistency reliability and satisfactory validity.

The Chinese DLI-R was shown to be a reliable and valid instrument for measuring death literacy among individuals in southern China and is suitable for both research and clinical use. Several demographic characteristics, cultural adaptation issues, and applicability considerations were also identified for the Chinese DLI-9.