title: Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries.
abstract: BACKGROUND
  Health literacy has been increasingly recognized as one of the most important social determinants for health. However, an appropriate and comprehensive assessment tool is not available in many Asian countries. This study validates a comprehensive health literacy survey tool European health literacy questionnaire (HLS-EU-Q47) for the general public in several Asian countries.
  
  
  METHODS
  A cross-sectional survey based on multistage random sampling in the target countries. A total of 10,024 participants aged ≥15 years were recruited during 2013-2014 in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. The questionnaire was translated into local languages to measure general health literacy and its three domains. To evaluate the validity of the tool in these countries, data were analyzed by confirmatory factor analysis, internal consistency analysis, and regression analysis.
  
  
  RESULTS
  The questionnaire was shown to have good construct validity, satisfactory goodness-of-fit of the data to the hypothetical model in three health literacy domains, high internal consistency (Cronbach's alpha >0.90), satisfactory item-scale convergent validity (item-scale correlation ≥0.40), and no floor/ceiling effects in these countries. General health literacy index score was significantly associated with level of education (P from <0.001 to 0.011) and perceived social status (P from <0.001 to 0.016), with evidence of known-group validity.
  
  
  CONCLUSIONS
  The HLS-EU-Q47 was a satisfactory and comprehensive health literacy survey tool for use in Asia.
authors.affiliation: School of Public Health, Taipei Medical University, Taipei, Taiwan; National Health Research Institutes, Miaoli County, Taiwan.
authors.forename: Tuyen V
authors.initials: TV
authors.lastname: Duong
authors.affiliation: Kazakhstan School of Public Health, Almaty, Kazakhstan.
authors.forename: Altyn
authors.initials: A
authors.lastname: Aringazina
authors.affiliation: Kazakh National Medical University, Almaty, Kazakhstan.
authors.forename: Gaukhar
authors.initials: G
authors.lastname: Baisunova
authors.affiliation: Dian Nuswantoro University, Semarang, Indonesia.
authors.lastname: Nurjanah
authors.affiliation: Hai Phong University of Medicine and Pharmacy, Haiphong, Viet Nam.
authors.forename: Thuc V
authors.initials: TV
authors.lastname: Pham
authors.affiliation: Hai Phong University of Medicine and Pharmacy, Haiphong, Viet Nam.
authors.forename: Khue M
authors.initials: KM
authors.lastname: Pham
authors.affiliation: Ha Noi University of Public Health, Hanoi, Viet Nam.
authors.forename: Tien Q
authors.initials: TQ
authors.lastname: Truong
authors.affiliation: Ha Noi University of Public Health, Hanoi, Viet Nam.
authors.forename: Kien T
authors.initials: KT
authors.lastname: Nguyen
authors.affiliation: University of Medicine 1, Yangon, Myanmar.
authors.forename: Win Myint
authors.initials: WM
authors.lastname: Oo
authors.affiliation: Universiti Kebangsaan Malaysia, Selangor, Malaysia.
authors.forename: Emma
authors.initials: E
authors.lastname: Mohamad
authors.affiliation: University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Tin Tin
authors.initials: TT
authors.lastname: Su
authors.affiliation: Yuanpei University of Medical Technology, Hsin Chu, Taiwan.
authors.forename: Hsiao-Ling
authors.initials: HL
authors.lastname: Huang
authors.affiliation: Maastricht University, Maastricht, Netherlands.
authors.forename: Kristine
authors.initials: K
authors.lastname: Sørensen
authors.affiliation: Ludwig Boltzmann Institute Health Promotion Research and University of Vienna, Vienna, Austria.
authors.forename: Jürgen M
authors.initials: JM
authors.lastname: Pelikan
authors.affiliation: Université Catholique de Louvain, Louvain-la-Neuve, Belgium.
authors.forename: Stephan
authors.initials: S
authors.lastname: Van den Broucke
authors.affiliation: School of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Family Medicine, National Taipei Hospital, MOHW, Taipei, Taiwan. Electronic address: peter.chang3@gmail.com.
authors.forename: Peter Wushou
authors.initials: PW
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D001208:Asia; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Asian health literacy surveys; Confirmatory factor analysis; HLS-EU-Q47; Health literacy; Validation