title: Cross-cultural adaptation and validation of the health literacy assessment tool METER in the Portuguese adult population.
abstract: OBJECTIVE
  We aimed to culturally adapt and validate METER in the Portuguese population, and to define cut-off values for adequate health literacy.
  
  
  METHODS
  We used the standard procedure for the adaptation of the words and surveyed health professionals to select the non-words. The instrument was administered to a total sample of 249 participants and retested in a sub-sample of 45 after three months. Cut-offs were defined using the modified Angoff procedure. Construct validity was assessed through association with educational attainment and health-related occupation.
  
  
  RESULTS
  Exploratory factor analysis revealed two dimensions of the instrument, one for words and another for non-words. METER showed a high degree of internal consistency, and acceptable test-retest reliability. Adequate health literacy was defined as scoring at least 35/40 in words and 18/30 in non-words. Physicians scored higher than any other group, followed by health researchers, researchers from other areas and by people with progressively lower levels of education (p<0.001).
  
  
  CONCLUSIONS
  We culturally adapted a brief and simple instrument for health literacy assessment, and showed it was valid and reliable.
  
  
  CONCLUSIONS
  The Portuguese version of METER can be used to assess health literacy in Portuguese adults and to explore associations with health outcomes.
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal; Monte Murado Health Family Unit, Vila Nova de Gaia, Portugal.
authors.forename: Dagmara
authors.initials: D
authors.lastname: Paiva
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Silva
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.
authors.forename: Milton
authors.initials: M
authors.lastname: Severo
authors.affiliation: Institute of Social Sciences, University of Lisbon, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Ferreira
authors.affiliation: Institute of Preventive Medicine, Faculty of Medicine of Lisbon, Lisbon, Portugal.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Santos
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal. Electronic address: anazev@med.up.pt.
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
mesh_terms: D000328:Adult; D003431:Cross-Cultural Comparison; D005163:Factor Analysis, Statistical; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000592:standards*; D006306:Health Surveys; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards*; D011174:Portugal; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D009626:Terminology as Topic; D014175:Translating; D055815:Young Adult
keywords: Health literacy; METER; Validation studies