Establishing the HLS-Q12 short version of the European Health Literacy Survey Questionnaire: latent trait analyses applying Rasch modelling and confirmatory factor analysis

Finbråten, Hanne Søberg; Wilde-Larsson, Bodil; Nordström, Gun; Pettersen, Kjell Sverre; Trollvik, Anne; Guttersrud, Øystein

doi:10.1186/s12913-018-3275-7

Table 2 Single-item characteristics of the HLS-EU-Q47 given various analytical approaches

From: Establishing the HLS-Q12 short version of the European Health Literacy Survey Questionnaire: latent trait analyses applying Rasch modelling and confirmatory factor analysis

			One-dimensional approach						Three-dimensional approach				Consecutive three-dimensional approach		12-dimensional approach				Consecutive 12-dimensional approach
HD	CD	Item	Infit	CI		t	Ordered	DIF	Infit	CI		t	Ordered	DIF	Infit	CI		t	DIF
		On a scale from very difficult to very easy, how easy would you say it is to:
HC	A	1) find information about symptoms of illnesses that concern you?	1.01	0.90	1.10	0.3		Age, y > o	0.98	0.90	1.10	−0.4		Age, y > o	1.03	0.89	1.11	0.6
“	A	2) find information on treatments of illnesses that concern you?	0.99	0.90	1.10	−0.3			0.95	0.90	1.10	−1.0			0.99	0.90	1.10	−0.2
“	A	3) find out what to do in case of a medical emergency?	1.02	0.91	1.09	0.3			0.97	0.91	1.09	−0.7			1.07	0.90	1.10	1.4
“	A	4) find out where to get professional help when you are ill?	0.99	0.89	1.11	−0.1			0.96	0.89	1.11	−0.8			1.06	0.89	1.11	1.1
“	B	5) understand what your doctor says to you?	0.96	0.90	1.10	−0.7		Edu, h > l	0.91	0.90	1.10	−1.7		Edu, h > l	0.95	0.90	1.10	−0.9	Edu, h > l
“	B	6) understand the leaflets that come with your medicine?	1.06	0.90	1.10	1.3			1.04	0.90	1.10	0.9			1.03	0.90	1.10	0.6
“	B	7) understand what to do in a medical emergency?	1.00	0.91	1.09	0.1			0.96	0.91	1.09	−0.9			0.99	0.91	1.09	−0.1	Edu, h < l
“	B	8) understand your doctor’s or pharmacist’s instruction on how to take a prescribed medicine?	0.93	0.89	1.11	−1.3	No		0.89	0.89	1.11	−2.0^b	No		0.92	0.88	1.12	−1.3
“	C	9) judge how information from your doctor applies to you?	0.96	0.89	1.11	−0.6			0.94	0.89	1.11	−1.1			0.96	0.89	1.11	−0.7
“	C	10) judge the advantages and disadvantages of different treatment options?	0.96	0.90	1.10	−0.8			0.99	0.90	1.10	−0.2			0.92	0.90	1.10	−1.7
“	C	11) judge when you may need to get a second opinion from another doctor?	1.09	0.91	1.09	1.8		Age, y < o	1.14	0.90	1.10	2.7^a		Age, y < o Edu, h < l	1.06	0.90	1.10	1.1	Age, y < o
“	C	12) judge if the information about illness in the media is reliable?	1.16	0.90	1.10	3.1^a			1.25	0.90	1.10	4.7^a			1.10	0.90	1.10	2.0^a
“	D	13) use information the doctor gives you to make decisions about your illness?	0.92	0.90	1.10	−1.6		Gen, m > f	0.93	0.90	1.10	−1.4		Gen, m > f	0.93	0.90	1.10	−1.5	Age, y < o
“	D	14) follow the instructions on medication?	0.98	0.88	1.12	−0.3			0.97	0.88	1.12	−0.5			0.90	0.87	1.13	−1.6
“	D	15) call an ambulance in an emergency?	1.07	0.90	1.10	1.4	No	Gen, m > f Age, y > o	1.07	0.90	1.10	1.4	No	Gen, m > f Age, y > o	0.96	0.89	1.11	−0.7	Age, y > o
“	D	16) follow instructions from your doctor or pharmacist?	0.88	0.89	1.11	−2.1^b			0.89	0.89	1.11	−1.9			0.81	0.87	1.13	−2.9^b
DP	A	17) find information about how to manage unhealthy behaviour such as smoking, low physical activity and drinking too much?	0.93	0.90	1.10	−1.3		Edu, h > l	0.96	0.90	1.10	−0.7		Edu, h > l	1.06	0.90	1.10	1.2	Edu, h > l
“	A	18) find information on how to manage mental health problems like stress or depression?	0.95	0.91	1.09	−1.1			1.00	0.91	1.09	0.0			1.18	0.91	1.09	3.5^a
“	A	19) find information about vaccinations and health screenings that you should have?	0.89	0.91	1.09	−2.3^b			0.93	0.91	1.09	−1.4			1.13	0.91	1.09	2.6^a
“	A	20) find information on how to prevent or manage conditions like being overweight, high blood pressure or high cholesterol?	0.88	0.89	1.11	−2.2^b			0.91	0.89	1.11	−1.6			0.96	0.89	1.11	−0.7
“	B	21) understand health warnings about behaviour such as smoking, low physical activity and drinking too much?	0.94	0.89	1.11	−1.2	No	Edu, h > l	0.94	0.90	1.10	−1.1	No	Age, y > o Edu, h > l	0.90	0.89	1.11	−1.7
“	B	22) understand why you need vaccinations?	1.01	0.90	1.10	0.3		Age, y > o	1.03	0.90	1.10	0.6		Age, y > o	1.01	0.90	1.10	0.1	Edu^c
“	B	23) understand why you need health screenings?	0.94	0.89	1.11	−1.0			0.97	0.89	1.11	−0.5		Age, y > o	0.91	0.89	1.11	−1.5
“	C	24) judge how reliable health warnings are, such as smoking, low physical activity and drinking too much?	0.99	0.90	1.10	−0.1			1.01	0.90	1.10	0.2			1.06	0.90	1.10	1.2	Age, y > o
“	C	25) judge when you need to go to a doctor for a check-up?	0.98	0.91	1.09	−0.4		Age, y < o	1.03	0.91	1.09	0.7		Age, y < o Edu, h < l	1.00	0.91	1.09	0.1	Age, y < o Edu, h < l
“	C	26) judge which vaccinations you may need?	1.03	0.91	1.09	0.7			1.05	0.91	1.09	1.0			1.06	0.91	1.09	1.2
“	C	27) judge which health screenings you should have?	0.92	0.91	1.09	−1.9		Age, y < o	0.94	0.91	1.09	−1.4		Age, y < o	0.92	0.91	1.09	−1.8	Age, y < o
“	C	28) judge if the information on health risks in the media is reliable?	1.03	0.90	1.10	0.6			1.05	0.90	1.10	1.0			1.02	0.90	1.10	0.4	Age, y > o
“	D	29) decide if you should have a flu vaccination?	1.18	0.91	1.09	3.6^a		Age, y < o	1.24	0.91	1.09	4.7^a		Age, y < o	1.06	0.91	1.09	1.3	Age, y < o
“	D	30) decide how you can protect yourself from illness based on advice from family and friends?	1.06	0.91	1.09	1.3			1.12	0.91	1.09	2.5^a		Edu, h < l	1.00	0.91	1.09	0.0	Age, y > o Edu, h < l
“	D	31) decide how you can protect yourself from illness based on information in the media?	0.98	0.91	1.09	−0.3			1.01	0.91	1.09	0.3			0.93	0.91	1.09	−1.5
HP	A	32) find information on healthy activities such as exercise, healthy food and nutrition?	0.96	0.90	1.10	−0.7			0.96	0.90	1.10	−0.8			0.95	0.90	1.10	−1.0
“	A	33) find out about activities that are good for your mental well-being?	0.97	0.90	1.10	−0.6			0.93	0.90	1.10	−1.3			0.93	0.90	1.10	−1.5	Gen, m < f
“	A	34) find information on how your neighbourhood could be more health-friendly?	1.04	0.90	1.10	0.8			1.01	0.90	1.10	0.2			0.98	0.90	1.10	−0.4
“	A	35) find out about political changes that may affect health?	1.10	0.90	1.10	1.8			1.08	0.90	1.10	1.5			1.06	0.89	1.11	1.0
“	A	36) find out about efforts to promote your health at work?	1.02	0.91	1.09	0.3			1.02	0.91	1.09	0.5			1.02	0.91	1.09	0.3
“	B	37) understand advice on health from family members or friends?	1.06	0.90	1.10	1.2		Age, y > o	1.07	0.90	1.10	1.4		Age, y > o	1.06	0.90	1.10	1.1	Age, y > o
“	B	38) understand information on food packaging?	1.12	0.91	1.09	2.5^a			1.16	0.91	1.09	3.3^a		Age, y > o	1.12	0.91	1.09	2.5^a	Gen, m > f
“	B	39) understand information in the media on how to get healthier?	0.97	0.90	1.10	−0.7			0.97	0.90	1.10	−0.7			0.96	0.90	1.10	−0.8
“	B	40) understand information on how to keep your mind healthy?	0.91	0.91	1.09	−2.0^b			0.89	0.91	1.09	−2.3^b			0.93	0.91	1.09	−1.4	Age, y < o
“	C	41) judge how where you live affects your health and well-being?	1.01	0.90	1.10	0.3		Age, y < o	0.97	0.90	1.10	−0.5		Age, y < o	1.02	0.9	1.10	0.4
“	C	42) judge how your housing conditions help you to stay healthy?	0.99	0.90	1.10	−0.2		Age, y < o	0.96	0.90	1.10	−0.9		Age, y < o	0.99	0.9	1.10	−0.3	Edu, h < l
“	C	43) judge which everyday behaviour is related to health?	0.92	0.89	1.11	−1.5			0.90	0.89	1.11	−1.8			1.15	0.89	1.11	2.5^a	Age, y > o Edu, h > l
“	D	44) make decisions to improve your health?	1.06	0.91	1.09	1.3			1.00	0.91	1.09	0.0			0.99	0.91	1.09	−0.1
“	D	45) join a sports club or exercise class if you want to?	1.12	0.90	1.10	2.3^a			1.06	0.90	1.10	1.3			1.01	0.90	1.10	0.2
“	D	46) influence your living conditions that affect your health and well-being?	1.05	0.91	1.09	1.0			0.98	0.91	1.09	−0.3			1.01	0.91	1.09	0.2	Age, y > o
“	D	47) take part in activities that improve health and well-being in your community?	1.10	0.91	1.09	2.0^a			1.04	0.91	1.09	0.8			1.04	0.90	1.10	0.9

Note. This table reports the item-fit indexes after applying the one-dimensional (subscale correlation fixed to 1), three-dimensional and 12-dimensional approaches (treating the subscales as correlated). The analyses of the ordering of response categories (ordered) and differential item functioning (DIF) are based on the one-dimensional and consecutive approaches (treating the subscales as orthogonal or uncorrelated) for the three health domains and the 12 subscales. Ordered: “No” refers to an item with unordered response categories
^aA t–value > 1.96 and an infit-value > 1 indicate a poor fit with the Rasch model due to there being more variation in the data than was expected by the model (item is under-discriminating)
^bA t–value <−1.96 and an infit-value < 1 indicate a poor fit with the Rasch model due to there being less variation in the data than was expected by the model (item is over-discriminating)
For items displaying uniform DIF, the relevant dichotomized person factor levels are indicated. For example, “Age, y > o” refers to a uniform DIF for the person factor age in favour of the y = younger respondents (47 years or younger) factor level compared to the o = older respondents (48 years or older) factor level. The “Highest completed education level” (Edu) factor has l = low (primary and secondary school) and h = high (university or university college) levels, and the “Gender” factor (Gen) has the f = females and m = males levels
^cnon-uniform DIF (item 22). All other DIFs were uniform
A: access, B: understand, C: appraise, CD: cognitive domain, CI: confidence interval, D: apply, DP: disease prevention, HC: healthcare, HD: health domain, HP: health promotion
RUMM2030 was used for the analyses of the ordering of response categories and DIF. ConQuest 4 was used for all other analyses

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