title: German translation, cultural adaptation, and validation of the Health Literacy Questionnaire (HLQ).
abstract: The Health Literacy Questionnaire (HLQ), developed in Australia in 2012 using a 'validity-driven' approach, has been rapidly adopted and is being applied in many countries and languages. It is a multidimensional measure comprising nine distinct domains that may be used for surveys, needs assessment, evaluation and outcomes assessment as well as for informing service improvement and the development of interventions. The aim of this paper is to describe the German translation of the HLQ and to present the results of the validation of the culturally adapted version. The HLQ comprises 44 items, which were translated and culturally adapted to the German context. This study uses data collected from a sample of 1,058 persons with chronic conditions. Statistical analyses include descriptive and confirmatory factor analyses. In one-factor congeneric models, all scales demonstrated good fit after few model adjustments. In a single, highly restrictive nine-factor model (no cross-loadings, no correlated errors) replication of the original English-language version was achieved with fit indices and psychometric properties similar to the original HLQ. Reliability for all scales was excellent, with a Cronbach's Alpha of at least 0.77. High to very high correlations between some HLQ factors were observed, suggesting that higher order factors may be present. Our rigorous development and validation protocol, as well as strict adaptation processes, have generated a remarkable reproduction of the HLQ in German. The results of this validation provide evidence that the HLQ is robust and can be recommended for use in German-speaking populations.
  
  
  BACKGROUND
  German Clinical Trial Registration (DRKS): DRKS00000584. Registered 23 March 2011.
authors.affiliation: Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Berlin, Germany.|Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.
authors.forename: Sandra
authors.identifier: http://orcid.org/0000-0001-6185-9423
authors.initials: S
authors.lastname: Nolte
authors.affiliation: Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dwinger
authors.affiliation: Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Elsworth
authors.affiliation: Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Conrad
authors.affiliation: Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Berlin, Germany.|Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
authors.forename: Matthias
authors.initials: M
authors.lastname: Rose
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Härter
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Dirmaier
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jördis M
authors.initials: JM
authors.lastname: Zill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D003469:Culture; D005260:Female; D005858:Germany; D006266:Health Education; D057220:Health Literacy; D006298:Health Services Administration; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000379:methods*; D011795:Surveys and Questionnaires; D014177:Translations