title: Validation of the European Health Literacy Survey Questionnaire in Women With Breast Cancer.
abstract: Health literacy enables effective communication, participation, and cooperation with clinicians of patients with breast cancer in healthcare processes. The European Health Literacy Survey Questionnaire (HLS-EU-Q) comprehensively assesses multiple conceptual domains of health literacy in a diverse range of health contexts. However, the HLS-EU-Q has not been validated in women with breast cancer.
  
  
  
  We examined the psychometric properties, particularly the factorial validity, of the HLS-EU-Q in women with breast cancer.
  
  
  
  We performed a first-order confirmatory factor analysis (CFA) to verify the 12-subdomain model of the 47-item HLS-EU-Q. A second-order CFA was conducted to investigate whether the 12 subdomains reflected the 3 domains of healthcare, disease prevention, and health promotion correspondingly.
  
  
  
  A total of 475 women with breast cancer participated in this study. The first-order CFA fitted with the HLS-EU-Q containing 47 items. However, item 29, with a low factor loading (-0.05), was deleted. The modified first-order CFA adequately fitted the data of the HLS-EU-Q with 46 items. The second-order CFA model acceptably fitted with the data, but the 3 domains with high correlations (0.92-1.00) were merged into a single domain, health literacy.
  
  
  
  Our results supported the factorial validity of the 12-subdomain HLS-EU-Q with 46 items in women with breast cancer. It is recommended that the 12 subdomain scores be summed up to represent overall health literacy.
  
  
  
  The HLS-EU-Q with 46 items is recommended for use in capturing the diverse health literacy competencies of women with breast cancer in different health contexts.
authors.affiliation: Author Affiliations: School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei City (Ms Huang, Mr Lin, and Dr Hsieh); School of Occupational Therapy, Chung Shan Medical University; and Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung City (Dr Lu); Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City; and Department of Surgery, School of Medicine, Taipei Medical University (Dr Tam); Division of Plastic Surgery, Department of Surgery, Taipei Medical University-Wan Fang Hospital; and Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University (Dr Chen); and Master Program in Long-Term Care and School of Gerontology and Health Management, College of Nursing, Taipei Medical University; and Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital (Dr Hou); and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City (Dr Hsieh).
authors.forename: Yi-Jing
authors.initials: YJ
authors.lastname: Huang
authors.forename: Gong-Hong
authors.initials: GH
authors.lastname: Lin
authors.forename: Wen-Shian
authors.initials: WS
authors.lastname: Lu
authors.forename: Ka-Wai
authors.initials: KW
authors.lastname: Tam
authors.forename: Chiehfeng
authors.initials: C
authors.lastname: Chen
authors.forename: Wen-Hsuan
authors.initials: WH
authors.lastname: Hou
authors.forename: Ching-Lin
authors.initials: CL
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000503:physiopathology* / Q000523:psychology*; D005060:Europe; D005163:Factor Analysis, Statistical; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data*; D006293:Health Promotion / Q000706:statistics & numerical data*; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires