title: Assessing health literacy in the eastern and middle-eastern cultures.
abstract: Health literacy is a term employed to assess the ability of people to meet the increasing demands related to health in a rapidly evolving society. Low health literacy can affect the social determinants of health, health outcomes and the use of healthcare services. The purpose of the study was to develop a survey construct to assess health literacy within the context of regional culture. Different socioeconomic status among the Eastern and Middle Eastern countries may restrict, health information access and utilization for those with low literacy.
  
  
  
  By employing expert panel, Delphi technique, focus group methodologies, and pre-testing using participants (N = 900) from the UAE and India, a survey construct to the Eastern-Middle Eastern cultures was developed. Reliability was assessed using Cronbach's α and validity using Factor analysis. Kiaser-Meyer-Olkin (KMO) sampling adequacy and Bartlett's tests were used to assess the strength of the relationship among the variables.
  
  
  
  Inclusion of non-health related items were found to be critical in the authentic assessment of health literacy in the Eastern and Middle Eastern population given the influence of social desirability. Thirty-two percentage of the original 19-item construct was eliminated by the focus group for reasons of relevance and impact for the local culture. Field pretesting participants from two countries, indicated overall construct reliability (Cronbach's α =0.85), validity and consistency (KMO value of 0.92 and Bartlett's test of sphericity was significant).
  
  
  
  The Eastern-Middle Eastern Adult Health Literacy (EMAHL13), screening instrument is brief, simple, a useful indicator of whether or not a patient can read. It assessespatients' ability to comprehend by distinguishing between health and non-health related items. The EMAHL13 will be a useful too for the reliable assessment of health literacy in countries, where culture plays a significant impact. This will be the first steptowards providing equitable access to healthcare for countries that have large populations with low socioeconomic status.
authors.affiliation: Academic Affairs Medical Affairs Department, Tawam Hospital- Johns Hopkins Medicine International Affiliate, Post Box 15258, Al Ain, UAE. schandra@tawamhospital.ae.
authors.forename: Satish Chandrasekhar
authors.initials: SC
authors.lastname: Nair
authors.affiliation: Al Daar Al Ain International School, Al Ain, UAE.
authors.forename: Karthyayani Priya
authors.initials: KP
authors.lastname: Satish
authors.affiliation: Department of Statistics, Gulf Medical University, Ajman, UAE.
authors.forename: Jayadevan
authors.initials: J
authors.lastname: Sreedharan
authors.affiliation: Johns Hopkins Graduate School of Education, Baltimore, MD, USA.
authors.forename: Halah
authors.initials: H
authors.lastname: Ibrahim
mesh_terms: D000293:Adolescent; D000328:Adult; D003469:Culture; D005163:Factor Analysis, Statistical; D005260:Female; D000069576:Health Equity; D057220:Health Literacy; D006801:Humans; D007194:India; D000067010:Literacy; D008297:Male; D008875:Middle Aged; D011932:Reading; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D014479:United Arab Emirates; D055815:Young Adult
keywords: Culture; Health literacy; Health outcomes; Middle Eastern; Survey instrument