Measurement Invariance and Differential Item Functioning of the Health Literacy Instrument for Adults (HELIA): A Large-Scale Cross-Sectional Study in Iran
Health literacy is important for health behavior engagement. Therefore, it is important to have a good instrument assessing health literacy with a theoretical framework. The present study aimed to examine the measurement invariance and differential item functioning (DIF) of a newly developed health...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Healthcare |
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| Online Access: | https://www.mdpi.com/2227-9032/10/10/2064 |
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| author | Mehran Alijanzadeh Chung-Ying Lin Rafat Yahaghi Jalal Rahmani Nahid Yazdi Elahe Jafari Hashem Alijani Narges Zamani Razie Fotuhi Elham Taherkhani Zeinab Buchali Robabe Jafari Narges Mahmoudi Leila Poorzolfaghar Safie Ahmadizade Azam Shahbazkhania Zainab Alimoradi Amir H. Pakpour |
| author_facet | Mehran Alijanzadeh Chung-Ying Lin Rafat Yahaghi Jalal Rahmani Nahid Yazdi Elahe Jafari Hashem Alijani Narges Zamani Razie Fotuhi Elham Taherkhani Zeinab Buchali Robabe Jafari Narges Mahmoudi Leila Poorzolfaghar Safie Ahmadizade Azam Shahbazkhania Zainab Alimoradi Amir H. Pakpour |
| author_sort | Mehran Alijanzadeh |
| collection | DOAJ |
| description | Health literacy is important for health behavior engagement. Therefore, it is important to have a good instrument assessing health literacy with a theoretical framework. The present study aimed to examine the measurement invariance and differential item functioning (DIF) of a newly developed health literacy instrument; that is, the Health Literacy Instrument for Adults (HELIA). Confirmatory factor analysis (CFA) and Rasch models were used to examine the data collected from a large Iranian sample (<i>N</i> = 9775; 67.3% females; mean age = 36.44 years). All the participants completed the HELIA. CFA was used to examine if the HELIA had a five-factor structure (including reading, access to information, understanding, appraisal, and decision making/behavioral intention factors) and multigroup CFA to examine if the five-factor structure of HELIA was invariant across gender, educational level, accommodation, and age subgroups. Rasch models were used to examine whether each factor of HELIA was unidimensional and DIF contrast in Rasch to examine if the HELIA items were interpreted similarly across the aforementioned subgroups. The CFA results supported the five-factor structure of HELIA, and the Rasch models verified that each HELIA factor is unidimensional. Additionally, multigroup CFA supported the measurement invariance of HELIA across the following subgroups: male vs. female; highly educated vs. poorly educated; city residents vs. suburban residents; and younger age vs. older age. The DIF contrasts in the Rasch models additionally showed that there are no substantial DIF items in the HELIA across aforementioned subgroups. Therefore, the HELIA is a feasible and comprehensive instrument assessing health literacy across different populations in Iran. |
| first_indexed | 2024-03-09T20:10:00Z |
| format | Article |
| id | doaj.art-aeec00b5f4e54e4bba7a35fc5d8b7694 |
| institution | Directory Open Access Journal |
| issn | 2227-9032 |
| language | English |
| last_indexed | 2024-03-09T20:10:00Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Healthcare |
| spelling | doaj.art-aeec00b5f4e54e4bba7a35fc5d8b76942023-11-24T00:21:35ZengMDPI AGHealthcare2227-90322022-10-011010206410.3390/healthcare10102064Measurement Invariance and Differential Item Functioning of the Health Literacy Instrument for Adults (HELIA): A Large-Scale Cross-Sectional Study in IranMehran Alijanzadeh0Chung-Ying Lin1Rafat Yahaghi2Jalal Rahmani3Nahid Yazdi4Elahe Jafari5Hashem Alijani6Narges Zamani7Razie Fotuhi8Elham Taherkhani9Zeinab Buchali10Robabe Jafari11Narges Mahmoudi12Leila Poorzolfaghar13Safie Ahmadizade14Azam Shahbazkhania15Zainab Alimoradi16Amir H. Pakpour17Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranInstitute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, TaiwanSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, IranHealth literacy is important for health behavior engagement. Therefore, it is important to have a good instrument assessing health literacy with a theoretical framework. The present study aimed to examine the measurement invariance and differential item functioning (DIF) of a newly developed health literacy instrument; that is, the Health Literacy Instrument for Adults (HELIA). Confirmatory factor analysis (CFA) and Rasch models were used to examine the data collected from a large Iranian sample (<i>N</i> = 9775; 67.3% females; mean age = 36.44 years). All the participants completed the HELIA. CFA was used to examine if the HELIA had a five-factor structure (including reading, access to information, understanding, appraisal, and decision making/behavioral intention factors) and multigroup CFA to examine if the five-factor structure of HELIA was invariant across gender, educational level, accommodation, and age subgroups. Rasch models were used to examine whether each factor of HELIA was unidimensional and DIF contrast in Rasch to examine if the HELIA items were interpreted similarly across the aforementioned subgroups. The CFA results supported the five-factor structure of HELIA, and the Rasch models verified that each HELIA factor is unidimensional. Additionally, multigroup CFA supported the measurement invariance of HELIA across the following subgroups: male vs. female; highly educated vs. poorly educated; city residents vs. suburban residents; and younger age vs. older age. The DIF contrasts in the Rasch models additionally showed that there are no substantial DIF items in the HELIA across aforementioned subgroups. Therefore, the HELIA is a feasible and comprehensive instrument assessing health literacy across different populations in Iran.https://www.mdpi.com/2227-9032/10/10/2064confirmatory factor analysisfactor structurehealth literacypsychometricsRaschvalidity |
| spellingShingle | Mehran Alijanzadeh Chung-Ying Lin Rafat Yahaghi Jalal Rahmani Nahid Yazdi Elahe Jafari Hashem Alijani Narges Zamani Razie Fotuhi Elham Taherkhani Zeinab Buchali Robabe Jafari Narges Mahmoudi Leila Poorzolfaghar Safie Ahmadizade Azam Shahbazkhania Zainab Alimoradi Amir H. Pakpour Measurement Invariance and Differential Item Functioning of the Health Literacy Instrument for Adults (HELIA): A Large-Scale Cross-Sectional Study in Iran Healthcare confirmatory factor analysis factor structure health literacy psychometrics Rasch validity |
| title | Measurement Invariance and Differential Item Functioning of the Health Literacy Instrument for Adults (HELIA): A Large-Scale Cross-Sectional Study in Iran |
| title_full | Measurement Invariance and Differential Item Functioning of the Health Literacy Instrument for Adults (HELIA): A Large-Scale Cross-Sectional Study in Iran |
| title_fullStr | Measurement Invariance and Differential Item Functioning of the Health Literacy Instrument for Adults (HELIA): A Large-Scale Cross-Sectional Study in Iran |
| title_full_unstemmed | Measurement Invariance and Differential Item Functioning of the Health Literacy Instrument for Adults (HELIA): A Large-Scale Cross-Sectional Study in Iran |
| title_short | Measurement Invariance and Differential Item Functioning of the Health Literacy Instrument for Adults (HELIA): A Large-Scale Cross-Sectional Study in Iran |
| title_sort | measurement invariance and differential item functioning of the health literacy instrument for adults helia a large scale cross sectional study in iran |
| topic | confirmatory factor analysis factor structure health literacy psychometrics Rasch validity |
| url | https://www.mdpi.com/2227-9032/10/10/2064 |
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