title: Internal consistency of the Spanish health literacy test (TOFHLA-SPR) for Puerto Rico.
abstract: BACKGROUND
  Low functional health literacy has been related to poor viral control, and lower levels of ART adherence in people living with HIV/AIDS. Research in functional health literacy among people living with HIV/AIDS in Puerto Rico (PR) is an unexplored area. The purpose of this paper is to describe how the full-length Spanish Version of the Test of Functional Health Literacy in Adults (TOFHLA-S) scale was adapted to PR.
  
  
  METHODS
  Thirty participants (women = 16, men = 14) completed a basic demographic questionnaire, the TOFHLA-S and participated in an interview. Analyses were performed to examine the information provided by participants and the internal consistency of the TOFHLA-S.
  
  
  RESULTS
  The mean age was 47.7 years (range 34-77). Thirty-seven percent had less than 12 years of formal schooling and 43% reported having education above high school. Changes suggested by participants included: increasing font size from 14 to 16 points for better readability and changes/simplification of several words in order to make them colloquial and comprehensible for the PR context. The reliability coefficient obtained for this scale was strong (estimated alpha = 0.95) however, differences were observed by subtype: numeracy (estimated alpha(num) = .819 vs. comprehension (estimated alpha =. 953).
  
  
  CONCLUSIONS
  Based on this process, we have adapted the original version of the TOFHLA-S and the new version of the full-length TOFHLA-S, PR is now valid for further research and testing levels of functional health literacy in a larger sample in PR.
authors.affiliation: University of Puerto Rico Medical Sciences Campus, School of Nursing, PO. Box 365067, San Juan, PR. marta.rivero1@upr.edu
authors.forename: Marta
authors.initials: M
authors.lastname: Rivero-Méndez
authors.forename: Erick
authors.initials: E
authors.lastname: Suárez
authors.forename: Solymar S
authors.initials: SS
authors.lastname: Solís-Báez
authors.forename: Gloryvee
authors.initials: G
authors.lastname: Hernández
authors.forename: Wanda
authors.initials: W
authors.lastname: Cordero
authors.forename: Irma
authors.initials: I
authors.lastname: Vázquez
authors.forename: Zullettevy
authors.initials: Z
authors.lastname: Medina
authors.forename: Raisa
authors.initials: R
authors.lastname: Padilla
authors.forename: Aida
authors.initials: A
authors.lastname: Flores
authors.forename: José Luis
authors.initials: JL
authors.lastname: Bonilla
authors.forename: William L
authors.initials: WL
authors.lastname: Holzemer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections; D057220:Health Literacy; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D011647:Puerto Rico; D011795:Surveys and Questionnaires