Development and Validation of a Chronic Obstructive Pulmonary Disease-Specific Health Literacy Scale (COPD-HLS)

Health literacy (HL) plays a crucial role in the management and self-care of patients with chronic obstructive pulmonary disease (COPD). However, there was a lack of a disease-specific, valid, and reliable instrument to assess the health literacy level of patients with COPD. This methodological study was conducted with patients with COPD. The initial item pool consisted of 32 items, which were reviewed by 10 experts for content validity. Sixteen items with I-CVI <0.78 were removed. For the remaining 16 items, I-CVI values ranged from 0.78 to 1.00, and the overall S-CVI/Ave was 0.91. Exploratory factor analysis (EFA) revealed a 3-factor structure: accessing and understanding information, using information and making decisions, and Self-Management of the Disease, explaining 67.21% of the total variance. Confirmatory factor analysis (CFA) indicated good model fit (RMSEA=0.060; CFI=0.985; TLI=0.981). Cronbach's alpha coefficients ranged from 0.75 to 0.93 for subscales, and 0.917 for the total scale. The intraclass correlation coefficient (ICC=0.813, P<0.001) demonstrated strong test-retest reliability. The COPD-HLS is a valid and reliable instrument for assessing HL in COPD patients. It can be used by nurses to identify patients with low health literacy and guide educational and self-management interventions.