Development and Validation of the HLS-Q12-OA Health Literacy Instrument for Older Adults: A Multidimensional Rasch...

Area of Science:

• Gerontology
• Health Literacy Research
• Psychometrics

Background:

• Health literacy (HL) is crucial for healthy aging.
• Existing HL instruments often have poor psychometric performance in older adults.
• There is a need for a concise, validated HL tool for this demographic.

Purpose of the Study:

• To develop and validate a brief health literacy instrument specifically for older adults.
• To evaluate the psychometric properties of the new instrument.
• To compare its performance against existing scales.

Main Methods:

• A cross-sectional survey of 957 Chinese adults (≥60 years) using the HLS-EU-Q47.
• Rasch analysis to refine items based on fit, differential item functioning (DIF), and local dependence.
• Exploratory and confirmatory factor analyses (EFA/CFA) for structure and model fit, with reliability assessments (Cronbach's α, McDonald's ω, PSR).

Main Results:

• The refined 12-item HLS-Q12-OA showed no floor/ceiling effects and excellent model fit in CFA (CFI=0.991, RMSEA=0.032).
• Satisfactory reliability was demonstrated (Cronbach's α=0.891, McDonald's ω=0.894, PSR=0.892).
• The HLS-Q12-OA outperformed the original HLS-EU-Q12 and showed no age-related DIF.

Conclusions:

• The HLS-Q12-OA is the first unidimensional short-form HL scale developed for older adults.
• It addresses psychometric limitations of the HLS-EU-Q47.
• It serves as a reliable, valid, and practical tool for HL screening in geriatric and community settings.