Health Literacy
The Health Literacy Management Scale (HeLMS): A measure of an individual's capacity to seek, understand and use health information within the healthcare setting

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Abstract

Objective

Health literacy refers to an individual's ability to seek, understand, and use health information. This paper describes the development and psychometric testing of the Health Literacy Management Scale (HeLMS).

Methods

Content areas were identified from a conceptual framework derived from interviews and concept mapping. Items were generated from statements from concept mapping participants. Construction (N = 333) and replication (N = 350) samples were participants in chronic disease self-management programs and emergency department attendees. Factor analysis was used to refine constructs and define psychometric properties.

Results

Consultations generated 8 scales each with 4–5 items: Understanding health information, Accessing GP healthcare services, Communication with health professionals, Being proactive and Using health information, Patient attitudes towards their health, Social support, and Socioeconomic considerations. Confirmatory factor analyses indicated good fit of the data with the model (RMSEA = 0.07, SRMR = 0.05, CFI = 0.97) and all domains had high internal consistency (Cronbach alpha > 0.82).

Conclusion

The HeLMS has acceptable psychometric properties and assesses a range of health literacy constructs important to patients when seeking, understanding and using health information within the healthcare system.

Practice implications

The HeLMS presents a new approach to assessing health literacy in healthcare settings.

Introduction

Health literacy refers to an individual's ability to seek, understand, and use health information to make appropriate decisions regarding their health [1]. Because of its relevance and importance to patient-centred healthcare and health reform, health literacy is receiving increasing attention from governments, researchers, clinicians and patients [2], [3], [4], [5]. Providing individuals with information, and actively involving them in decisions about their health, are key components of patient-centred healthcare [6], [7]. Active involvement is, however, unlikely to be achieved if patients have suboptimal health literacy.

The majority of available health literacy measures [8], [9], [10], [11], [12], [13], [14] focus on assessing reading, comprehension and numeracy skills, and do not capture many underlying concepts of health literacy [15]. There is a growing consensus that health literacy encompasses a broader range of attributes other than just literacy skills such as abilities to interact within broader social and environmental contexts [16], [17], [18], [19], [20]. Results from available health literacy measures have shown that people with suboptimal health literacy have: difficulty understanding health information [21], [22]; poorer knowledge of their condition [23], [24], [25]; and lower utilization of preventive health services [26], [27], [28]. These tools measure a limited subset of the health literacy abilities that clinicians and health service planners need to understand to improve outcomes.

A clear conceptual framework is essential to the development of a questionnaire that has validity and clinical utility. Without a conceptual grounding, the content of a measure may not accurately reflect the phenomenon under study, and it may be unclear if the most relevant elements have been identified [29]. Conceptualizations of health literacy have been developed from the perspective of researchers, health professionals and literacy experts, with minimal consultation with patients. Modern approaches to questionnaire development consider that the inclusion of patients’ views is a crucial foundation to ensure content validity [30]. We now build on our previous work covering the conceptualizing of health literacy from the patient perspective [31], and detail the development of the Health Literacy Management Scale (HeLMS).

Section snippets

Methods

The development of the HeLMS is outlined in Fig. 1. This included two main components, the development of the conceptual framework (Section 2.1) and the development and testing of the measure (Sections 2.2 Specification of hypothesized dimensions for measurement, 2.3 Item and response scale generation, 2.4 Comparing the grounded factor structure with other common structuring methods, 2.5 Confirmatory factor analysis, 2.6 Cognitive interviews, 2.7 Model replication and examination of item

Conceptual framework

The previously analyzed 48 interviews revealed seven key abilities [31]: knowing when to seek health information; knowing where to seek health information; verbal communication skills; assertiveness; literacy skills; capacity to process and retain information; and application skills.

Concept mapping workshops were undertaken with 8 people with a chronic condition (Workshop 1) and 7 without a chronic condition (Workshop 2), see Table 1. Participants in Workshop 1 produced 45 statements across 9

Discussion

The Health Literacy Management Scale assesses individuals’ abilities, and their broader social and environmental contexts, to determine overall capacity to seek, understand and use health information within the healthcare setting. The HeLMS is based upon a clear conceptual framework of health literacy, which was derived from in-depth consultations with diverse patient groups. Through careful attention to item content, and factor analyses, the HeLMS was designed to have strong content, face and

Acknowledgements

The authors thank Dr Sandra Nolte and those who participated in this research. RB was supported in part by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship, AB was supported in part by an NHMRC Postdoctoral Fellowship, and RHO was supported in part by a NHMRC Population Health Fellowship.

All patient/personal identifiers have been removed or disguised so people described are not identifiable and cannot be identified through the details of the story.

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