Measurement properties of the Health Literacy Questionnaire (HLQ) among older adults who present to the emergency department after a fall: a Rasch analysis

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Abstract

Background

Health literacy is an important concept associated with participation in preventive health initiatives, such as falls prevention programs. A comprehensive health literacy measurement tool, appropriate for this population, is required. The aim of this study was to evaluate the measurement properties of the Health Literacy Questionnaire (HLQ) in a cohort of older adults who presented to a hospital emergency department (ED) after a fall.

Methods

Older adults who presented to an ED after a fall had their health literacy assessed using the HLQ ( n = 433). Data were collected as part of a multi-centre randomised controlled trial of a falls prevention program. Measurement properties of the HLQ were assessed using Rasch analysis.

Results

All nine scales of the HLQ were unidimensional, with good internal consistency reliability. No item bias was found for most items (43 of 44). A degree of overall misfit to the Rasch model was evident for six of the nine HLQ scales. The majority of misfit indicated content overlap between some items and does not compromise measurement. A measurement gap was identified for this cohort at mid to high HLQ score.

Conclusions

The HLQ demonstrated good measurement properties in a cohort of older adults who presented to an ED after a fall. The summation of the HLQ items within each scale, providing unbiased information on nine separate areas of health literacy, is supported. Clinicians, researchers and policy makers may have confidence using the HLQ scale scores to gain information about health literacy in older people presenting to the ED after a fall.

Trial registration

This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).

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Most cited references 15

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Older patients in the emergency department: a review.

Nikolaos Samaras, Thierry Chevalley, Dimitrios Samaras … (2010)

Older patients account for up to a quarter of all emergency department (ED) visits. Atypical clinical presentation of illness, a high prevalence of cognitive disorders, and the presence of multiple comorbidities complicate their evaluation and management. Increased frailty, delayed diagnosis, and greater illness severity contribute to a higher risk of adverse outcomes. This article will review the most common conditions encountered in older patients, including delirium, dementia, falls, and polypharmacy, and suggest simple and efficient strategies for their evaluation and management. It will discuss age-related changes in the signs and symptoms of acute coronary events, abdominal pain, and infection, examine the yield of different diagnostic approaches in this population, and list the underlying medical problems present in half of all "social" admission cases. Complete geriatric assessments are time consuming and beyond the scope of most EDs. We propose a strategy based on the targeting of high-risk patients and provide examples of simple and efficient tools that are appropriate for ED use. Copyright (c) 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

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Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ)

Alison Beauchamp, Rachelle Buchbinder, Sarity Dodson … (2015)

Background Recent advances in the measurement of health literacy allow description of a broad range of personal and social dimensions of the concept. Identifying differences in patterns of health literacy between population sub-groups will increase understanding of how health literacy contributes to health inequities and inform intervention development. The aim of this study was to use a multi-dimensional measurement tool to describe the health literacy of adults in urban and rural Victoria, Australia. Methods Data were collected from clients (n = 813) of 8 health and community care organisations, using the Health Literacy Questionnaire (HLQ). Demographic and health service data were also collected. Data were analysed using descriptive statistics. Effect sizes (ES) for standardised differences in means were used to describe the magnitude of difference between demographic sub-groups. Results Mean age of respondents was 72.1 (range 19–99) years. Females comprised 63 % of the sample, 48 % had not completed secondary education, and 96 % reported at least one existing health condition. Small to large ES were seen for mean differences in HLQ scales between most demographic groups. Compared with participants who spoke English at home, those not speaking English at home had much lower scores for most HLQ scales including the scales ‘Understanding health information well enough to know what to do’ (ES −1.09 [95 % confidence interval (CI) -1.33 to −0.84]), ‘Ability to actively engage with healthcare providers’ (ES −1.00 [95 % CI −1.24, −0.75]), and ‘Navigating the healthcare system’ (ES −0.72 [95 % CI −0.97, −0.48]). Similar patterns and ES were seen for participants born overseas compared with those born in Australia. Smaller ES were seen for sex, age group, private health insurance status, number of chronic conditions, and living alone. Conclusions This study has revealed some large health literacy differences across nine domains of health literacy in adults using health services in Victoria. These findings provide insights into the relationship between health literacy and socioeconomic position in vulnerable groups and, given the focus of the HLQ, provide guidance for the development of equitable interventions.

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Using the Rasch model in nursing research: an introduction and illustrative example.

Curt Hagquist, Malin Bruce, J. Petter Gustavsson (2009)

The purpose was to introduce the Rasch model by showing an application in nursing research. The Rasch model was used to examine the psychometric properties of the nursing self-efficacy (NSE) scale. Data were collected among nursing students in Sweden. Two sets of items were analysed more thoroughly: an original set of nine items with eleven response categories and a revised set of seven items with seven response categories. Invariance of the item functioning and the categorisation of the items were analysed. Targeting was examined by comparisons of the items and persons locations. Differential Item Functioning across sample groups such as gender was examined using analysis of variance. The final set of seven items was also analysed more closely with respect to possible multidimensionality and response dependence. The Rasch analysis of the original set of nine items showed high reliability measured by a person separation index, but it also indicated severe problems with the targeting, the categorisation of the items as well as lack of invariance. Although the revised set comprising seven items with seven categories performed better than the original item set some items showed misfit according to formal test statistics. Graphical examination showed, however, that the items operated in the right direction. The formal test of local independence of the items indicated minor signs of multidimensionality, alternatively response dependence. The Rasch model is useful for rigorous examination and development of measurement instruments in nursing research. The Rasch model facilitates disclosure of lack of invariance and other measurement problems that may not be easily detected by traditional analyses. Hence, the NSE-scale would probably have performed much better if the developmental work had been guided by Rasch analyses. In future work on the scale, priority should be given to improving the targeting and the categorisation of the items.

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Author and article information

Contributors

Rebecca L. Morris: +61 3 9903 0620 , rebecca.morris@monash.edu

Sze-Ee Soh: sze-ee.soh@monash.edu

Keith D. Hill: keith.hill@curtin.edu.au

Rachelle Buchbinder: rachelle.buchbinder@monash.edu

Judy A. Lowthian: judy.lowthian@monash.edu

Julie Redfern: jredfern@georgeinstitute.org.au

Christopher D. Etherton-Beer: christopher.etherton-beer@uwa.edu.au

Anne-Marie Hill: anne-marie.hill@curtin.edu.au

Richard H. Osborne: richard.osborne@deakin.edu.au

Glenn Arendts: glenn.arendts@uwa.edu.au

Anna L. Barker: anna.barker@monash.edu

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 29 August 2017

Publication date PMC-release: 29 August 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 605

Affiliations

[1 ]ISNI 0000 0004 1936 7857, GRID grid.1002.3, Department of Epidemiology and Preventive Medicine, , Monash University, ; Melbourne, VIC 3004 Australia

[2 ]ISNI 0000 0004 1936 7857, GRID grid.1002.3, Department of Physiotherapy, , Monash University, ; Melbourne, Australia

[3 ]ISNI 0000 0004 0375 4078, GRID grid.1032.0, School of Physiotherapy and Exercise Science, , Curtin University, ; Perth, Australia

[4 ]Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia

[5 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, The George Institute for Global Health, , University of Sydney, ; Sydney, Australia

[6 ]ISNI 0000 0004 1936 7910, GRID grid.1012.2, Western Australian Centre for Health & Ageing, , University of Western Australia and Royal Perth Hospital, ; Perth, Australia

[7 ]ISNI 0000 0001 0526 7079, GRID grid.1021.2, Health Systems Improvement Unit, , Deakin University Centre for Population Health Research, ; Geelong, Australia

[8 ]ISNI 0000 0004 1936 7910, GRID grid.1012.2, School of Primary, Aboriginal and Rural Health Care, , University of Western Australia, ; Perth, Australia

[9 ]GRID grid.431595.f, , Harry Perkins Institute of Medical Research, ; Perth, Australia

Article

Publisher ID: 2520

DOI: 10.1186/s12913-017-2520-9

PMC ID: 5575841

PubMed ID: 28851344

SO-VID: 9c33c49a-96db-4a37-99a6-1fd562a4f809

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 29 January 2017

Date accepted : 8 August 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;

Award ID: APP1056802

Award ID: 1067236

Award ID: APP1061793

Award ID: 1052442

Award ID: APP1059122

Award ID: APP1082138

Award Recipient : Rachelle Buchbinder Judy A. Lowthian Julie Redfern Richard H. Osborne Anna L. Barker

Funded by: Australian Postgraduate Award

Funded by: FundRef http://dx.doi.org/10.13039/501100001030, National Heart Foundation of Australia;

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: older adults,falls prevention,health literacy,measurement properties,rasch analysis

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ScienceOpen disciplines: Health & Social care

Keywords: older adults, falls prevention, health literacy, measurement properties, rasch analysis

Measurement properties of the Health Literacy Questionnaire (HLQ) among older adults who present to the emergency department after a fall: a Rasch analysis

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Abstract

Background

Methods

Results

Conclusions

Trial registration

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Tobacco Prevention & Cessation

Most cited references 15

Older patients in the emergency department: a review.

Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ)

Using the Rasch model in nursing research: an introduction and illustrative example.

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