To Örebro University

Background Health literacy is an important social determinant of health and affects the ability to make decisionsand take action to manage one’s health. The purpose of this study was to psychometrically examine the Arabicversions of HLS-EU-Q16 and HLS-EU-Q6 and their response patterns among Arabic-speaking persons in Sweden.

Methods By convenience sampling from a variety of settings, a total of 335 participants were invited to participate.The participants completed a self-assessment of comprehensive health literacy by answering the Ar-HLS-EU-Q16questionnaire, also including the six items for Ar-HLS-EU-Q6. Statistical analysis was guided by The COnsensus-based Standards for the selection of health Measurement Instruments. Floor/ceiling effects, construct, structural andcriterion validity, test-retest reliability and internal consistency reliability were analysed.

Results In total, 320 participants were included in the psychometric evaluation. Mean age was 42.1 (SD 12.5), 63%(n = 199) were females and 53% (n = 169) had at least 10 years of education. No floor or ceiling effect were foundfor the Ar-HLS-EU-Q16 or Ar-HLS-EU-Q6. For both instruments, construct validity was confirmed in four out of fiveexpected correlations (weak positive correlation to educational level, self-perceived health, and years in Sweden;moderate positive correlation with higher sum score on the Arabic electronic health literacy scale, and strong positivecorrelation to higher Ar-HLS-EU-Q16/Ar-HLS-EU-Q6). For Ar-HLS-EU-Q16, the principal component analysis resultedin a three-factor model with all items significantly correlating to only one factor. For Ar-HLS-EU-Q6, the principalcomponent analysis supported a one-factor solution. Criterion validity showed poor agreement between the twoquestionnaires with a Cohen κ 0.58 (p < 0.001). Test-retest reliability showed a substantial agreement, Cohen’s κfor Ar-HLS-EU-Q16 and Ar-HLS-EU-Q6 were both 0.89. The internal consistency of both versions was acceptable,Cronbach alpha for Arabic-HLS-EU-Q16 was 0.91 and for Arabic-HLS-EU-Q6, 0.79. Split-half reliability was 0.95 and 0.78,respectively.

Conclusion The Arabic version of HLS-EU-Q16 shows good psychometric properties, validated in a Swedish setting.The findings can further inform and guide future validation studies in other settings worldwide. Furthermore, theresults of the present study did not support criterion validity of Ar-HLS-EU-Q6.