Table 1.
Main instrument characteristics of tools assessing health literacy among the general population in this literature review.
| Author, Year | Scale Names | Nation | Theoretical Basis | Methods | Sample | Domains, Items (#) | Feasibility; Reliability; Validity | Domains |
|---|---|---|---|---|---|---|---|---|
| Measurement modes based on health-related fields | ||||||||
| Pleasant, A., 2008 [32] | The public health literacy knowledge scale | The United States | Thirteen essential Facts for Life messages | Expert consultation; participant feedback; Flesch–Kinkaid readability assessment | 829 public (Mexico = 200, China = 220, Ghana = 204, India = 205) | 13, 17 | 75% response rate; Cronbach’s alpha = 0.797; the public health knowledge scale and the science literacy scale = 0.391 | Timing of births; safe motherhood; child development and early learning; breastfeeding, nutrition and growth; immunization; diarrhea; coughs, colds and more serious illnesses; hygiene; malaria; HIV/AIDS; injury prevention; disasters and emergencies |
| O’Connor, M., 2015 [33] | The mental health literacy scale | Australia | Mental health literacy consists of seven attributes; Diagnostic and Statistical Manual of Mental Disorders IV TR criteria | Developed using an iterative process; a consensus by the clinical panel; feedback | 372 participants | 7, 35 | /; Cronbach’s alpha = 0.797; / | Ability to recognize disorders; knowledge of where to seek information; knowledge of risk factors and causes; knowledge of self-treatment; knowledge of professional help available; attitudes that promote recognition or appropriate help-seeking behavior |
| Measurement modes based on health-related abilities | ||||||||
| Schrauben, S.J., 2017 [34] | Zambia’s health literacy scale | Zambia | The Institute of Medicine’s (IOM) definition of health literacy | Cross-sectional questionnaire; factor analysis methods | 13,646 participants between the ages of 15 and 49 | 4, 15 | /; Cronbach’s alpha = 0.68; good content validity | Capacity to interpret; capacity to obtain; capacity to understand; make appropriate health decisions |
| Jordan, J.E., 2013 [35] | The health literacy management scale | Australia | / | Develop conceptual framework of health literacy (in-depth interviews, concept mapping workshops); cognitive interviews; scale score and test–retest reliability calculation | 542 participants | 8, 29 | 61% response rate; Cronbach’s alpha > 0.82; / | Patient attitudes towards their health; understanding health information; social support; socioeconomic considerations; accessing general medical practitioner (GP) healthcare services; communication with health professionals; being proactive; using health information |
| McCormack, L, 2010 [36] | Health Literacy Skills Instrument | The United States | / | Real-world health-related stimuli (print (prose, document, or quantitative), Internet-based information seeking), cognitive interviews | 1559 Knowledge Network panelists aged 18 or over | 5, 25 | Completion rate = 71%, took 45 min; Cronbach’s alpha = 0.86; item-total correlations of 0.40 or higher item response theory (IRT) discrimination parameters of 1.00 or higher | Identifying and understanding health-related text; interpreting information and/or data in the form of tables, charts, pictures, symbols, maps, and videos; completing computations; making inferences based on the information presented or applying information to a specific scenario; utilizing the Internet/computer to obtain health information |
| Haghdoost, A.A., 2015 [37] | The Iranian Health Literacy Questionnaire | Iran | Priorities in accordance with Iranian health policies and culture sensitivity | Comprehensive review of the literature; expert consultation (health educator, an epidemiologist, and two specialists in oral health and community medicine) | 1080 participants aged 18 to 60 years | 10, 36 | 91% response rate; Cronbach’s alpha = 0.71–0.96; Kaiser–Meyer–Olkin (KMO) = 0.95, Bartlett’s test = 3.017 | Reading/comprehension skills; individual empowerment (first aid skills); communication/decision making skills; assessment skills of health information in virtual media; accurate assessment/judgment skills; social empowerment; individual empowerment (household medical equipment use); health information access; health information use; health knowledge |
| Chinn, D., 2013 [38] | All Aspects of Health Literacy Scale | The UK | Nutbeam’s health literacy theory (functional, communicative, and critical health literacy) | Undertook a review of published research on health literacy definitions and concepts, and on its measurement; drew up a list of potential items; the course of a local consultation exercise | 146 participants | 3, 14 | Took approximately 7 min on average; Cronbach’s alpha = 0.75; functional health literacy and communicative health literacy = 0.393, functional health literacy and critical health literacy = 0.59, communicative health literacy and critical health literacy = 0.186 | Functional health literacy; communicative health literacy; critical health literacy |
| Suka, M., 2013 [39] | The 14-item health literacy scale | Japan | Ishikawa and colleagues’ health literacy scale specific to diabetes patients | Questionnaire | 1507 eligible respondents aged 30–69 years | 3, 14 | 96.4%–99.5% response rate; Cronbach’s alpha = 0.83; Acceptable fit of the three-factor model (comparative fit index = 0.912, normed fit index = 0.905, root mean square error of approximation = 0.082) | Functional health literacy; communicative health literacy; critical health literacy |
| The combination of both measurement modes | ||||||||
| Tsai, T.I., 2011 [40] | The Mandarin Health Literacy Scale | China (Taiwan) | The Institute of Medicine’s definition of health literacy (four kinds of abilities); an individual often encounters six main types of health information and health services in a health care system; three domains of literacy skills | Semi-structured in-depth interviews of health care consumers; consultation with health care, education, and psychometrics experts; generation of an item pool; selection of items for inclusion in the Mandarin Health Literacy Scale; evaluation of readability | 323 Taiwanese adults | 5, 50 | 72.1% response rate; Cronbach’s alpha = 0.97; an item-total correlation equal to or greater than 0.40 | Years of schooling; reading habit; health status; health knowledge; reading assistance |
| Sørensen, K., 2013 [41] | The European Health Literacy Survey Questionnaire | Netherlands | A conceptual model and definition | Item development, pre-testing, field-testing, external consultation, plain language check, and translation from English to Bulgarian, Dutch, German, Greek, Polish, and Spanish | 19 focus group sample, 99 pre-test sample | 12, 47 | Less than 95% response rate took 20–30 min; Cronbach’s alpha = 0.51–0.91; / | The three domains: healthcare; disease prevention; health promotion four-component structure: accessing; understanding; appraising and applying health related information |
| Intarakamhang, U., 2016 [42] | ABCDE (alcohol, baccy, coping, diet, and exercise)-health literacy scale | Thailand | The concepts of ABCDE behavior; the principles of promoting diet, managed exercise, reducing alcohol consumption, and ceasing smoking | Qualitative research methods focused on theoretical publications; expert consultation; focus groups; the causal models for measuring health literacy | 4401 participants aged >15 years | 8, 64 | 97.8% response rate; Cronbach’s alpha = 0.611–0.912; / | Needed health knowledge and understanding; accessing information and services; communicating with professionals; managing their health condition; getting media and information literacy; making appropriate health decisions to good practice; participating in social health literacy; maintaining healthy behavior |
Note: # number of Dimensions and Items. / not always available.