Translation and validation of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) into the Slovenian language

Abstract Background: The European Health Literacy Questionnaire (HLS-EU-Q47) is a self-assessment tool for standardised measurement of health literacy. Aim: To translate HLS-EU-Q47 into the Slovenian language and to investigate its reliability and validity in Slovenia. Method: HLS-EU-Q47 was translated into Slovenian, back-translated, and subjected to a pilot test. The accepted Slovenian version of the questionnaire was mailed to 2,500 randomly selected adult residents of the Republic of Slovenia. Reliability was examined using Cronbach’s alpha for the 1-, 3-, 4-, and 12-factor models addressing health literacy, three main health contexts, four health information processing competencies, and 12 combinations, respectively. Validity was explored with confirmatory factor analysis, univariate analysis, and multiple linear regression. Results: A total of 517 responses were collected (21% response rate). The highest Cronbach’s alpha was obtained for the 1-factor model (0.950), followed by the 3-, 4-, and 12-factor models. In the confirmatory factor analysis, the 12-factor model provided the most valid results (CFI 0.812; RMSEA 0.067, CI 0.065 to 0.070), followed by the 3-, 4-, and 1-factor models. In the multiple regression model, only the association between self-assessment of health and the health literacy index was statistically significant (p < 0.001). Conclusion: The Slovenian version of HLS-EU-Q47 is a reliable instrument for measuring health literacy. All models of the questionnaire showed reasonable model fit, but none fully satisfied all validity criteria. Respondents differentiated better between the three main health contexts (health care, disease prevention, and health promotion) than the four health information processing competencies (access, understand, appraise, and apply).