SUITABILITY OF SHORT VERSIONS OF HLS-EU IN MALAYSIAN POPULATION: A COMPARISON BETWEEN HLS-EU 16 AND HLS-EU 12 Karuthan Chinna Centre for Education and Population Health University Malaya Malaysia

HEALTH LITERACY DEFINITION Health literacy is linked to literacy and entails people’s knowledge motivation and competences to… Access Understand Appraise Apply health information in order to make judgments and take decisions in everyday life Concerning… Healthcare Disease prevention Health promotion to maintain or improve quality of life during the life course (Sorensen, K et al.. 2012)

THE CONCEPTUAL MODEL

Understand Information THE MATRIX Obtain/ Access Information Understand Information Process/ Appraise Information Apply/ Use Health Care (HC) Disease Prevention (DP) Health Promotion (HP)

HLS-EU 16

Understand Information HLS-EU 16 Obtain/ Access Information Understand Information Process/ Appraise Information Apply/ Use Health Care (HC) 2 items 1 item Disease Prevention (DP) Health Promotion (HP) -

Understand Information HEALTH CARE (HC) Obtain/ Access Information Q1 Find information on treatments of illnesses that concern you Q2 Find out where to get professional help when you are ill Understand Information Q3 Understand what your doctor says to you Q4 Understand your doctor’s or pharmacist’s instruction on how to take a prescribed medicine Process/ Appraise Information Q5 Judge when you may need to get a second opinion from another doctor Apply/ Use Q6 Use information the doctor gives you to make decisions about your illness Q7 Follow instructions from your doctor or pharmacist

DISEASE PREVENTION (DP) Obtain/ Access Information Q8 Find information on how to manage mental health problems like stress or depression Understand Information Q9 Understand health warnings about behavior such as smoking, low physical activity and drinking Q10 Understand why you need health screenings Process/ Appraise Information Q11 Judge if the information on health risks in the media is reliable Apply/ Use Q12 Decide how you can protect yourself from illness based on information in the media

Understand Information HEALTH PROMOTION (HP) Obtain/ Access Information Q13 Find out about activities that are good for your mental well-being Understand Information Q14 Understand advice on health from family members or friends Q15 Understand information in the media on how to get healthier Process/ Appraise Information Q16 Judge which everyday behavior is related to your health Apply/ Use _

HLS-EU 12

Understand Information HLS-EU 12 Obtain/ Access Information Understand Information Process/ Appraise Information Apply/ Use Health Care (HC) 1 item Disease Prevention (DP) Health Promotion (HP)

Understand Information HEALTH CARE (HC) Obtain/ Access Information Q1 Find information on treatments of illnesses that concern you Understand Information Q2 Understand the leaflets that come with your medicine Process/ Appraise Information Q3 Judge the advantages and disadvantages of different treatment options? Apply/ Use Q4 Call an ambulance in an emergency

DISEASE PREVENTION (DP) Obtain/ Access Information Q5 Find information on how to manage mental health problems like stress or depression Understand Information Q6 Understand why you need health screenings Process/ Appraise Information Q7 Judge which vaccinations you may need Apply/ Use Q8 Decide how you can protect yourself from illness based on information in the media

Understand Information HEALTH PROMOTION (HP) Obtain/ Access Information Q9 Find out about activities that are good for your mental well-being Understand Information Q10 Understand information in the media on how to get healthier Process/ Appraise Information Q11 Judge which everyday behavior is related to your health Apply/ Use Q12 Join a sports club or exercise class if you want to

METHODOLOGY POPULATION: MALAYSIANS WHO MAKE DECISIONS ON OWN / FAMILY HEALTH SAMPLE DESIGN QUOTA SAMPLING SAMPLE n= 600: 200 MALAYs, 200 CHINESE, 200 INDIANS ADMINISTRATION: SELF-ADMINISTERED SHORT VERSIONS HLS-16 AND HLS-12

SOME RESULTS

INTERNAL CONSISTENCIES Cronbach’s a values from reliability analyses DOMAIN HSL-16 HLS-12 HEALTHCARE (HC) 0.779 0.454 DISEASE PREVENSION (DP) 0.775 0.700 HEALTH PROMOTION (HP) 0.795 0.737

HLS-EU 16 Fit indices Chi-square = 266.8 df = 101 p=.000 GFI = .946 AGFI = .923 CFI = .950 TLI= .941 RMSEA = .052 r=0.92

CONVERGENT & DISCRIMINANT VALIDITIES OF HLS-16 Convergent Validity Discriminant validity CR AVE DP HC HP 0.775 0.408   0.801 0.367 0.696 0.797 0.496 0.837 0.646 CR > 0.7 & > AVE BUT FOR HC, AVE IS LOW DIAGONALS ARE AVEs OFF DIAGONALS ARE R-SQUARES IDEALLY FOR DISCRIMINANT VALIDITY, R-SQUARES MUST BE < AVEs

HLS-EU 12 Fit indices Chi-square = 91.558 df = 51 p=.000 GFI = .976 AGFI = .34 CFI = .977 TLI= .970 RMSEA = .036 r=0.97 r=0.93

CONVERGENT & DISCRIMINANT VALIDITIES OF HLS-12 Convergent Validity Discriminant validity CR AVE DP HC HP 0.743 0.422   0.539 0.238 0.608 0.699 0.368 0.857 0.942 CR > 0.7 & > AVE BUT FOR HC, AVE IS LOW DIAGONALS ARE AVEs OFF DIAGONALS ARE R-SQUARES IDEALLY FOR DISCRIMINANT VALIDITY, R-SQUARES MUST BE < AVEs

COMPARISON OF CONVERGENT VALIDITIES HLS-16 HLS-12 CR AVE DP 0.775 0.408 0.743 0.422 HC 0.801 0.367 0.539 0.238 HP 0.797 0.496 0.699 0.368 Convergence of the items in the domains of HLS-16 is better compared to those in HLS-12

COMPARISON OF DISCRIMINANT VALIDITIES HLS-16 DP HC HP 0.408   0.696 0.367 0.837 0.646 0.496 HLS-12 DP HC HP 0.422   0.608 0.238 0.857 0.942 0.368 Discriminance between domains in HLS-16 is better compared to HLS-12

CONCLUSION HLS-EU 16 seems to fit better in Malaysian context compared to the HLS-T 12