Abstract:
Background: Patients’ competencies and resources to manage their own health, which is termed health literacy, is
a necessity for better health outcomes. Thus, it is relevant to have a comprehensive health literacy measurement
tool suitable for populations of interest. The Health Literacy Questionnaire (HLQ) is a tool useful for health literacy
assessment covering nine dimensions/scales of health literacy. The HLQ has been translated and validated in
diverse contexts but has so far not been assessed in any country in sub-Saharan Africa. We sought to translate this
tool into the most common language used in Ghana and assess its validity.
Methods: We carried out a cross-sectional study using the HLQ concurrently with an assessment of a malaria
programme for caregivers with children under 5 years. The HLQ was translated using a systematic translation
procedure. We analysed the psychometric properties of the HLQ based on data collected by face-to-face interview
of 1234 caregivers. The analysis covered tests on difficulty level of scales, composite reliability, Cronbach’s alpha and
confirmatory factor analysis (CFA).
Results: Cognitive testing showed that some words were ambiguous, which led to minor rewording of the
questionnaire. A nine-factor CFA model was fitted to the 44 question items with no cross-loadings or correlated
residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ2 DWLS (866 df) =
17,177.58, p < 0.000, CFI = 0.971, TLI = 0.969, RMSEA = 0.126 and SRMR = 0.107. Composite reliability and Cronbach’s
alpha were > 0.65 for all scales except Cronbach’s alpha for scale 9, ‘Understanding health information well enough
to know what to do’ (0.57). The mean differences between most demographic groups among health literacy scales
were statistically significant.
Conclusion: The Akan-Twi version of HLQ proved relevant in our description of the health literacy levels among
the caregivers in our study. This validated tool will be useful to conduct health literacy needs assessments to guide
policies addressing such needs. Further work is needed to validate this tool for use in Ghana and similar contexts.
