Development and Validation of the HL6: a Brief, Technology-Based Remote Measure of Health Literacy

• Type of Material: Article
• Authors: Stacy Cooper Bailey, Northwestern University; James W Griffith, Northwestern University; Chandana Vuyyuru, Northwestern University; Stephanie Batio, Northwestern University; Evelyn Velazquez, Northwestern University; Delesha M Carpenter, University of North Carolina; Terry C Davis, Louisiana State Univ Hlth Shreveport; Ruth Parker, Emory University; Michelle Taddeo, Northwestern University; Michael S Wolf, Northwestern University
• Language: English
• Date: 2022-07-25
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s), under exclusive licence to Society of General Internal Medicine 2022
• Final Published Version (URL): http://dx.doi.org/10.1007/s11606-022-07739-3
• Title of Journal or Parent Work: JOURNAL OF GENERAL INTERNAL MEDICINE
• Volume: 38
• Issue: 2
• Start Page: 421
• End Page: 427
• Grant/Funding Information: Supported in part by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp.; Research reported in this publication was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number UL1TR001422, and National Institute on Aging, Grant Number P30AG059988. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: technology; General & Internal Medicine; Life Sciences & Biomedicine; ADHERENCE; Medicine, General & Internal; health literacy; PRIMARY-CARE; OUTCOMES; Health Care Sciences & Services; Science & Technology; measurement
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: Most health literacy measures require in-person administration or rely upon self-report. Objective: We sought to develop and test the feasibility of a brief, objective health literacy measure that could be deployed via text messaging or online survey. Design: Participants were recruited from ongoing NIH studies to complete a phone interview and online survey to test candidate items. Psychometric analyses included parallel analysis for dimensionality and item response theory. After 9 months, participants were randomized to receive the final instrument via text messaging or online survey. Participants: Three hundred six English and Spanish-speaking adults with ≥ 1 chronic condition Main Measures: Thirty-three candidate items for the new measure and patient-reported physical function, anxiety, depression, and medication adherence. All participants previously completed the Newest Vital Sign (NVS) in parent NIH studies. Key Results: Participants were older (average 67 years), 69.6% were female, 44.3% were low income, and 22.0% had a high school level of education or less. Candidate items loaded onto a single factor (RMSEA: 0.04, CFI: 0.99, TLI: 0.98, all loadings >.59). Six items were chosen for the final measure, named the HL6. Items demonstrated acceptable internal consistency (α=0.73) and did not display differential item functioning by language. Higher HL6 scores were significantly associated with greater educational attainment (r=0.41), higher NVS scores (r=0.55), greater physical functioning (r=0.26), fewer depressive symptoms (r=−0.20), fewer anxiety symptoms (r=−0.15), and fewer barriers to medication adherence (r=−0.30; all p<.01). In feasibility testing, 75.2% of participants in the text messaging arm completed the HL6 versus 66.2% in the online survey arm (p=0.09). Socioeconomic disparities in completion were more common in the online survey arm. Conclusions: The HL6 demonstrates adequate reliability and validity in both English and Spanish. This performance-based assessment can be administered remotely using commonly available technologies with fewer logistical challenges than assessments requiring in-person administration.