Translation, cross-cultural adaptation and psychometric evaluation of Brazilian Portuguese version of the 14-item Health Literacy Scale

Abstract We evaluated the psychometric properties of the Health Literacy Scale - 14 (HLS-14), the Brazilian Portuguese version. In the methodological study with a cross-sectional design, the following were performed: translation, cross-cultural adaptation and evaluation of the psychometric properties. After being subjected to a committee of experts, translated and adapted, the instrument was pre-tested with 52 adults and applied to 143 adults and older people of Piracicaba-SP. Internal consistency was assessed based on the Kendall correlation coefficient and Cronbach’s alpha (>0.70), and the confirmatory factor analysis (CFA) was conducted using the chi-square test, the Standardized Residual Mean Square Root (SRMR), the Root Mean Square Error of Approximation (RMSEA) (<0.05), the Comparative Fit Index (CFI) (>0.95) and the Tucker-Lewis Index (TLI) (>0.95). The analysis of operational equivalence showed agreement between most of the questions, exception questions 6, 8, 9 and 14. Cronbach’s alpha was 0.82. There was reasonable adjustment in the CFA: CFI=0.886, TLI=0.86, RMSEA=0.085 (90%CI: 0.065-0.105), SRMR=0.071, chi-square (74 degrees of freedom) = 149.510, p<0.001. The exclusion of question 5 increased the adjustment level to satisfactory. The Brazilian Portuguese version of HLS-14 can be considered a valid health literacy assessment instrument.

摘要：本研究对巴西葡萄牙语版《健康素养量表-14（Health Literacy Scale-14，HLS-14）》的心理测量学特性进行了评估。本研究为采用横断面设计的方法学研究，依次开展了量表翻译、跨文化调适与心理测量学特性评价三项工作。经专家委员会审定、翻译与调适后，研究首先对52名成年人开展预测试，随后向巴西圣保罗州皮拉西卡巴市的143名成年人及老年人施测了该量表。内部一致性采用肯德尔相关系数（Kendall correlation coefficient）与克朗巴哈α系数（Cronbach’s alpha，阈值>0.70）进行评估；验证性因子分析（Confirmatory Factor Analysis，CFA）则通过卡方检验（chi-square test）、标准化残差均方根（Standardized Residual Mean Square Root，SRMR）、近似均方根误差（Root Mean Square Error of Approximation，RMSEA，阈值<0.05）、比较拟合指数（Comparative Fit Index，CFI，阈值>0.95）以及塔克-刘易斯指数（Tucker-Lewis Index，TLI，阈值>0.95）完成。操作等价性分析结果显示，除第6、8、9、14题外，绝大多数题目一致性良好。本次研究测得克朗巴哈α系数为0.82。验证性因子分析结果显示模型适配度尚可：CFI=0.886，TLI=0.86，RMSEA=0.085（90%置信区间：0.065~0.105），SRMR=0.071，卡方检验自由度为74时，χ²=149.510，p<0.001。剔除第5题后，模型适配度提升至良好水平。综上，巴西葡萄牙语版HLS-14可被视为一款有效的健康素养评估工具。