title: Validation of the Dutch functional, communicative and critical health literacy scales.
abstract: OBJECTIVE
  While most existing health literacy (HL) measures focus primarily on reading comprehension, the functional, communicative and critical HL scales from Ishikawa et al. [19] aim to measure a broader HL spectrum. The objective of this study was to evaluate the validity of the Dutch translation of this instrument.
  
  
  METHODS
  Two survey studies (n = 79 and n = 209) and one cognitive interview study (n = 18) were performed among samples of breast cancer patients and patients with rheumatic diseases.
  
  
  RESULTS
  Analyses showed the scales measured three distinct factors and convergent validity was satisfactory for communicative and critical HL. Nevertheless, the comprehension of the items and the suitability of the response options raised some problems.
  
  
  CONCLUSIONS
  The HL scales seem promising to measure a broad definition of HL. By revising some of the items and response options as proposed in this article, the scale will become more understandable for people with low HL skills, which might increase the content validity and the distributional properties of the scale.
  
  
  CONCLUSIONS
  The scale should be revised and revalidated. An improved version should be used in practice to gain insight into HL levels of patients. This will help to develop suitable education programs for people with low HL skills.
authors.affiliation: Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands. r.vandervaart@utwente.nl
authors.forename: Rosalie
authors.initials: R
authors.lastname: van der Vaart
authors.forename: Constance H C
authors.initials: CH
authors.lastname: Drossaert
authors.forename: Erik
authors.initials: E
authors.lastname: Taal
authors.forename: Peter M
authors.initials: PM
authors.lastname: ten Klooster
authors.forename: Rianne T E
authors.initials: RT
authors.lastname: Hilderink-Koertshuis
authors.forename: Joost M
authors.initials: JM
authors.lastname: Klaase
authors.forename: Mart A F J
authors.initials: MA
authors.lastname: van de Laar
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology; D003142:Communication; D032882:Comprehension; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006304:Health Status; D006801:Humans; D007802:Language; D008875:Middle Aged; D009426:Netherlands; D036301:Qualitative Research; D015203:Reproducibility of Results; D012216:Rheumatic Diseases / Q000523:psychology; D011795:Surveys and Questionnaires; D014175:Translating