Validity and Reliability of Health Literacy Scale for Turkish Diabetic Patients

Purpose: The aim of the study was to examine the psychometric properties of Health Literacy Scale which measures health literacy in three levels (functional, communicative, critical) for Turkish Diabetic Patients.

Methods: This study was conducted as a methodological study. Health Literacy scale was developed by Ishikawa et al. (2008) to provide a better understanding of diabetic patients perspective in disease management focusing health-promotion activities. Following approval from Ishikawa, ethical committee and institutional approvals were obtained. Turkish adaptation of scale started with language adaptation process. Scale translated from English to Turkish by three experts (one language expert, two nursing expert); and back translation was done by a language expert. After language adaptation for content validity, translated scale were evaluated by 5 experts who were nurses and doctors with research and clinical focus in community health, internal medicine nursing and health promotion and self-management in diabetes. For evaluation of Health Literacy Scale items, experts used a likert-type content validity scale (4: perfectly appropriate, 3: appropriate 2: appropriate, but small modifications are needed, 1: not appropriate). Validation of scale continued with construct validity with 140 diabetic patients (who had diabetes diagnosis at least for one year) enrolled from diabetes outpatient clinic. Kendall W analysis, Pearson correlation, Cronbach alpha coefficient and split-half correlation coefficients used for construct validity and reliability statistical analysis.  

Results: In terms of language adaptation back translation (from Turkish to English) was found equal with original scale. Content validity expert opinions for items ranged from 3.4 to 4. Health Literacy Scale was found valid and reliable for Turkish diabetes patients.

Conclusion: Low levels of health literacy is associated with important healthcare outcomes. For effective management of diabetes, it is important and crucial to engage patients in management of their chronic condition with increasing self-efficacy, autonomy and disease knowledge. The validated and reliable Health Literacy Scale will allow clinicians to be assess health literacy levels of their patients, identify patients with limited health literacy and develop strategies to improve healthcare and personal outcomes.