title: Structural properties and psychometric improvements of the Health Literacy Questionnaire in a Slovak population.
abstract: OBJECTIVE
  Health literacy is an important determinant of health and health equity and therefore requires robust measurement. The aim was to examine the psychometric properties of the Slovak version of the Health Literacy Questionnaire (HLQ) including revised wording of response categories.
  
  
  METHODS
  A cross-sectional survey of the general Slovak adult population (N = 360, mean age 39) was conducted with the HLQ following its translation and cultural adaptation. Psychometric tests (confirmatory factor analysis, Cronbach's alpha, composite reliability) and association (linear regression, ANOVA) with sociodemographic variables were undertaken. The performance of alternative version of response options were explored with the Mann-Whittney U test and item response theory.
  
  
  RESULTS
  A highly restrictive nine-factor confirmatory factor analysis showed acceptable fit [χ2WLSMV = 1684 (df  = 866), p < 0.0001; CFI = 0.943, TLI = 0.938, RMSEA = 0.051, WRMR = 1.297] and reliability was acceptable (range 0.73-0.84). The revised response categories had a better distribution with lower average scores in three domains, compared with the original, and improved item information curves.
  
  
  CONCLUSIONS
  The nine HLQ scales are robust, providing a fine-grained assessment of health literacy. The revised response options improve psychometric properties and are recommended for future studies.
authors.affiliation: Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia. peter.kolarcik@upjs.sk.|Department of Health Psychology, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 01, Kosice, Slovakia. peter.kolarcik@upjs.sk.|Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic. peter.kolarcik@upjs.sk.
authors.forename: Peter
authors.initials: P
authors.lastname: Kolarcik
authors.affiliation: Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia.|Department of Health Psychology, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 01, Kosice, Slovakia.
authors.forename: Eva
authors.initials: E
authors.lastname: Cepova
authors.affiliation: Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia.|Department of Health Psychology, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 01, Kosice, Slovakia.|Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic.
authors.forename: Andrea
authors.initials: A
authors.lastname: Madarasova Geckova
authors.affiliation: Health Systems Improvement Unit, School of Health and Social Development, Deakin University, Geelong, VIC, Australia.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Elsworth
authors.affiliation: Health Systems Improvement Unit, School of Health and Social Development, Deakin University, Geelong, VIC, Australia.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Batterham
authors.affiliation: Health Systems Improvement Unit, School of Health and Social Development, Deakin University, Geelong, VIC, Australia.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D057220:Health Literacy / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D018154:Slovakia; D011795:Surveys and Questionnaires
keywords: Cultural adaptation; Health Literacy Questionnaire (HLQ); Health literacy; Item response theory; Measurement; Psychometrics