Validity and Reliability of Health Literacy for Iranian Adult (HELIA) Questionnaire in the older Adult in Tabriz

Abstract

Abstract Background: Due to the development of technology and rapid updating of educational materials in the field of health, it is imperative that older adults as a recipient of health services could benefit from health information. With regard to the rate of health literacy is considerably low among aged population, they have difficulty in understanding and reading information related to their health status. Since the promotion of health literacy is one of health system pillar, providing an appropriate instrument to promote the health of older people could be useful. Therefore, the aim of the curent study was to evaluate the validity and reliability of HELIA health literacy questionnaire among older population in Tabriz city.

Methods: This study was a descriptive-analytical and cross-sectional, 495 older adults were recruited through stratified two-stage cluster cluster sampling in Tabriz city, Iran. To assess validity, Face Validity ,Content validity (CVR and CVI) ,and construct t validity were performed. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were applied to determine construct validity . Cronbach alpha and test-retest (intra-class correlation coefficient) were employed to examine the reliability of the instrument. Data analysis was conducted using IBM SPSS-26 and STATE -14 software. Results: In the present study 495 older adults were participated, the mean age of participants was 64.87. The majority of participants were female (53.7%. (Face validity was assessed through the agreement coeffienct (panel of experts), opinions of the older adults, the level of difficulty of the items, and the impact score of the item. The result of content validity showed that six questions ( One question in the field of reading skill, two questions in the field of access to health information, Two questions in the field ofunderstanding health instructions and recommendations, one questions in the field of decision making and application of health information) were removed due to items with a low CVI score (< 0.78) and low CVR score (< 0.33), experts' opinion, and duplication. The concurrent validity of this questionnaire was evaluated using IHLQ questionnaire. Exploratory factor analysis (EFA), showed 35.92% total variance The rsuslt of Confirmatory factor analysis (CFA) revealed that factor loading were greater than 0.3 and no all items wereremoved. . . Cronbach's alpha was reported to be 0.70 to 0.95 for all dimensions of Helia Questionnaire. The test-retest intraclass correlation coefficients (ICC) was 0.90 (95% CI 0.83- 0.94). Discussion: The results of the present study shows/indicates that Helia questionnaire could be an appropriate instrument to assess health literacy in Iranian older adults, which has good validity and reliability properties . Therefore, this instrument should be integrated into comprehensive geriatric assessment program for older adults care in Health Care System (HCS) so that health education issues could be taught based on level of health literacy among older people

keywords: Health literacy, older adults, validity, reliability