The Functional, Communicative, and Critical Health Literacy (FCCHL) Scales: Cross-Cultural Adaptation and the Psychometric Properties of the Iranian Version

Abstract

Background: Patients today are required to understand more and more complex health information, and to navigate increasingly complex health systems. As a result, they need to develop skills such as finding, processing, understanding, and applying information about health issues, which has been conceptualized as health literacy (HL). Assessing HL is critical to providing meaningful health information to patients. Objectives: This study aimed to examine the cultural adaptation and the psychometric properties of the Iranian version of the functional, communicative and critical health literacy (FCCHL) scales measuring three aspects of HL among type 2 diabetic patients. Patients and Methods: We conducted a methodological survey of 187 patients with type 2 diabetes using a cross-sectional design. The study was carried out in two phases: the first phase was designed to obtain a cross-cultural equivalent of the FCCHL scales, based on Beaton's guidelines. In the second phase, a cross-sectional study was conducted to evaluate the psychometric properties of the questionnaire. Results: Exploratory factor analysis (EFA) identified three main factors with 27.07, 22.46, and 16.23 of extracted variance, respectively. Confirmatory factor analysis (CFA) completely supported the three-factor model of the HL scales. Internal consistency was approved for the total scale (alpha = 0.82) and for the functional, communicative, and critical subscales (alpha = 0.91, 0.80, and 0.76, respectively). Convergent validity analysis indicated a significant positive correlation (r = 0.45; P < 0.01) between the scores on the functional HL scales and the Iranian version of the Short Test of Health Literacy in Adults (S-TOFHLA), which was to be expected. Conclusions: We concluded that the FCCHL scales are valid and reliable, and can be used to measure health literacy among Iranian diabetic patients. However, further research is needed to establish stronger psychometric properties for the use of this questionnaire in Iran.