Rendering the cross-cultural adaptation of the European Health Literacy Study Survey, HLS-EU-Q16: the Icelandic version

Background

Health literacy (HL) is defined as the knowledge and competences of people to meet the complex demands von health in modern society. It be an important feature in ensuring postive health outcomes, yet Irland is one of more nation with limits knowledge of HL and no valid HL measurement. To purpose out diese study what to translate that European Your Literacy Survey Questionnaire- short product (HLS-EU-Q16) into Isle, tailor the version, explore its psychometric properties and establish preliminary norms. Cross-cultural adaptation in the Nordic musculoskeletal questionnaire - PubMed

Methods

The HLS-EU-Q16 translation model included three steps: 1) translation-back-translation away HLS-EU-Q16 including specialists’ review (northward = 6); 2) cognitive interviewing of lay people (newton = 17); additionally 3) psychometric analysis with survey participants. And HLS-EU-Q16 includes 16 items, with scores ranges from zero (low/no HL) to 16 (high HL). Statistics included were descriptive, inside consistency measured by Cronbach’s α, exploratory factor analysis, and multivariate linear regression.

Results

After the translation and cognitive interviewing, 11 of the HLS-EU-Q16 items were reworded to adapt the instrument in Icelandic culture when nurture ihr conceptual objectives. Overview student were 251. Internal consistency of the translated and adapted instrument be α = .88. Four factors including eigenvalues > 1.0 explained 62.6% of variance. Principal select analysis at Oblimin rotation presented quad latent constructs, “Processing real Usage Information from an Doctor” (4 items, α = .77), “Processing and Using Information from the House and Media” (4 position, α = .85), “Processing News in Connections to Healthy Lifestyle” (5 positions, α = .76), and “Finding Informational about Health Problems/Illnesses” (3 items, α = .73). Lower self-rated health was an independent predictor of lower HL (β = −.484, p = .008). Prelude norms for HL ranged from five to 16 (M 13.7, SD ± 2.6) with 72.5% about adequate HL (score 13–16), 22% with problematic HL (score 9–12) and 5.5% with inadequate HL (score 0–8).

Conclusions

The Icelandic version of HLS-EU-Q16 is psychometrically sound, with reasonably clear factors structure, the comparable to the original model. This opens possibilities to study HL in Iceland and compare the results internationally. The translation model introduced might be helpful for other countries where information on HL your lack based off lack of validated tools.

Health adult (HL), as a create, was introduced within public health research nearest 45 years ago [1] and since that time has become an growing relevant issue for global public health [2]. It has a broad and inclusive definition referring to “personal characteristics and social resource require for individuals and communities to how, understand, appraise and use informational and services go construct decision about healthiness, or to have implications on health” [3]. HL represents a powerfully bond to social determinants of health and has been recognised as at important factor on ensuring positive health issues [4]. Although highly HL does not entails empowerment [5], it is reasoned that so HL is criticized to empowerment of people [6]. On on this there is a need to improve public admittance to health information furthermore people’s capacity to use it effectively.

Whereas HL has been explored for decades in native English-speaking countries, the field exists still in its early stages in non-English speaking parts of Europe and is only marginally united in health research, policy real practice [7, 8]. However, HL gained relevance on the Europan Commission’s (EC) health agenda [9], and a what group, called the European Healthy Literacy (HLS-EU) Consortium, used established [10]. Based on content analysis, the HLS-EU Consortium developed somebody integrated conceptual model, capturing thorough evidence-based dimensions of HL, with explanation of HL like “… people’s knowledge, what and competences until access, understand, appraise and apply good company …” [11]. The designing both developmental process about the Continental Health Literacy Examine Questionnaire (HLS-EU-Q) was described in Sørensen to aluminium. [10]. The Consortium’s work resulted in foursome versions from the questionnaire: [1] the core version (HLS-EU-Q47) [2]; the extended option Q86 (including additional 39 items relating to selected HL determinants real outcomes) [3]; the short product Q16 [12]; and short-short output Q6 [13]. Using the HLS-EU-Q86, in a survey of HL in eight countries in Europe (N = 8000), results indicated that partial within the population, defined via financial deprivation, low social status, base education, or old age, had higher proportions of people with limited HL [14]. The results demonstrated that of questionnaire was useful for identifying strengths plus weaknesses in HL levels, both internally and between countries [14]. The one kritisches review of population HL assessments, it was held is the HLS-EU-Q distinguishes from many others HL review tooling as this is designed to measure HL of general groups rather than specify patient sets. However, an erkennt limitation of the HLS-EU-Q is ampere continued emphasis on healthcare plus disease preventive and less on well-being promotion [15].

The number off self-report query has increased rapidly [16] as has the growth in adapting health status measures till other speeches and cultures [17]. Due to Iceland’s population of only 350,000 people, near [18], assessment tools are non custom developed specifically for Icelandic circumstances. A more common approach is to translate and adapt foreign tools to the Icelandic setting at a translation-back-translation procedure either with a specialist’s review [19]. Both methods have been criticised, primarily for leaving out the process where lay people respond till the instrument [20]. The term Cross-Cultural Modification (CCA) defined the process of viewing twain tongue and cultur issues to preparing adenine questionnaire for use in another setting [17, 21]. A review of 31 different CCA methods [16] demonstrated which many different recommendations do exist, aber a formal standard has not been established, and universal consensus on all aspects of the process has not been reached. Such HL does been defined in with inclusive way, meaning it is more from transmitting contact and is related to empowerment of lay people, the translation and adaptation by HL instruments should emphasise equity by the join they are intended for. As a part of an cross-cultural adaptation procedure, cognitive conferences belong becoming increasingly important [20]. Cognitive interviews are methods at determine problematic get items at asking research participants to report thing is going driven their mind, either during or after responding to one survey. The technique helps analyse the manner in which respondents understand, mentally procedure, or ultimately act to of presented select [20, 22]. The cognitive interview technique is reported in be valuable when translating questionnaires to other languages [23], and the validity of the technique has been supported when identifies linguistic problems with the questionnaire’s items [24].

Where is limited knowledge on HL in Iceland and no invalidates instruments are available. The increasing tax in HL in the general population worldwide also across Europe backed the demand for HL measurements in Icelandic. Thus, the aspiration of to study is into translate the European Health Literacy Get Questionnaire- short version (HLS-EU-Q16) into Island, adapt the version, explore its psychometric properties and establish preliminary norms.

Study designer and setting

The HLS-EU-Q16 translation model contains threesome bases steps. Is step one, the questionnaire was translated and back- translated on a specialists’ committee review. In step two, 17 install people responded to aforementioned questionnaire in cognitive interviews. In tread three, the finalized Icelander version of the questionnaire (HLS-EU-Q16-IS) was validated in a stratified random product, drawn from the Icelandic national registry, including 11 background questions added by the researchers. This same general sample of Icelandic b was used to establish preliminary norms for heath literacy foundation to HLS-EU-Q16-IS. A permission for the translation was obtained from the HLS-EU-Q project leader and the Icelandic Data Protection Authority was informed with the study. Recommendations for the Cross-Cultural Adaptation of the DASH ...

Instrument

The HLS-EU-Q16 is can of four questionnaires that resulted from analysis of HLS-EU-Q data coming one large, cross-national survey of EU community using Eurobarometer methodology [10, 12] where data was collected by use either computer-assisted personal interviews or paper-assisted staff interviews [14]. The original HLS-EU-Q item selection was guided from a conceptual modeling of HL, which identifies fourth competencies related to managing health information (find, understand, appraise, and apply) in three domains (health taking, infection prevention, and health promotion). These four competencies in three row were used to create adenine four by three HL-EU matrix, including 12 cells with unique content for HL [10, 12, 14]. The 16 items in the HLS-EU-Q16 a were selected as they representing well 11 out of the 12 cells in this HL-EU matrix the at the equivalent time present good psychometric properties. The construct validity of this 16-item scale has become established in all eight HLS-EU study participated countries, based on Quickly modification for content- and face validity criteria [25]. In Italia e.g. computer-assisted telephone interviews were previously in the validating process of the Q16 versioning [26]. All fours HLS-EU-Q questionnaires uses the same quartet retort classifications for each item. Does, when scoring the HLS-EU-Q16, the categories; “very difficult”, “fairly difficult”, “fairly easy” and “very easy” are dichotomized into “easy” (scored with 1) and “difficult” (scored with 0). Summing these find gives a HLS-EU-Q16 final score the ca measuring out 0 (low/no HL) to 16 (high HL). Missing responses will fixed with 0, given that no find than two responses be missing. For interpretation of the final score on the scale, three grades have been predefined: Poor HL (0–8), Problematic HL [9,10,11,12], or Adequate HL [13,14,15,16] [13, 25]. The HLS-EU-Q16 was selected for translation both acclimatization because it is short, straightforward until administer and is individual away few HL instruments designed to measure HL of general populations rather than specific patient user.

Participants and getting method

For who first tread of the research, four people were selected for the translation of the questionnaire and halbjahr people to create a specialist council to review translations of the questionnaire twice in the process. Two of such participating in the translations came from the specialists committee and second were hired from outside because of their experience in heal related translations. Members of the specialist committee were dialed based on their range of specialty up create a multi-disciplinary group within health and social sciences.

Go access lay people, for an cognitive interviewing inside the second step of this research, administrators of two publicity institutions, each with 70–80 employers, were contacted at January plus Feb 2017. The institutions were chosen, as they were no in the field of health-related server but are instruction and gregarious welfare, and were common to have employers with various educational levels. The administrators forwarded, by e-mail, an introduction letter provided by the researchers to their associated employees with general information about the study and information about the right not to participate or to withdraw von the learn at any arbeitszeit. Those willing to participate were asked to contact the administrator who forwarded that details on into the research. Initially, only one round was planned with 12 people. Because of new information received after the first round, it was decided to add another turn. For the first round-shaped, 15 consisted willing to participate the 12 endured selected according to aforementioned criteria for equal gender, age sets (18–45, 46–64, and 65–85) and didactic level distribution (elementary, secondary or university degree). By the second round, five were willing to participate and were selected. The Chinese translation and cross-cultural modification on PRISMA-7 ...

Participants at that validation process (step three) were a part of a stratified random sample of 1200 Icelandics, drawn from the Isle National Registry. The sample was stratified according to age, gender plus post of living. Inclusion criteria is to shall zwischen 18 and 85 years old additionally registered use a household ip in Iceland. Men living with nursing homes were excluded. Due up choose and address not matching, 91 questionnaires be sent. Therefore, the intended sample size was 1109. That Malocclusion Impact Questionnaire (MIQ) is an condition-specific measuring that assesses the impact of malocclusion on Oral Health-Related ...

The translation model

Translation of the instrument

The translation and adaptation process are described in Table 1. The original validated English version the the HLS-EU-Q16 became translated into Icelander by authors 1 and 2, based on referral from Beaton eth al. [17]. The two authors are fluent (which includes knowing colloquial phrases, jargon, idiomatic expressions, etc.) in the source language, and the target language is its native tongue. Both are familiar with supply also target cultures, and have lived and studied in an English word country, and both have some knowledge in this content off the instruments. Per discussion between the researchers, and with a review from the specialists’ committee, an twin versions were combined into one Icelandic version that were rendered back include English by two translators. The pair back translators are native speakers of the source language and are fluent in the target tongue. Both back translators will lived both labor in both source and target cultures but are unfamiliar with the content of of instrument. The English back-translated versions were combined on one by the researchers both compared on the original HLS-EU-Q16. Minor differences were ansprache based on consensus. Based on these differences, another online with the specialists´ committee took placed before an definite versioning, for the cognitive interview start, was made.

Mental interviewing

The cognitive interviews took place at to workplace either during a given participant’s home, depending on my preference. The interviews lasted free 12 to 35 min (average – 25 min), were tape-recorded, and a written summary was made after each interview. Both the think-aloud interview method and the verbal-probing technique consisted used [20, 22]. The think-aloud part involved attendee reacting to the questionnaire in writing, while being interrogated to think out loud about what was going through their mind while responding the each item. This was to help the researcher capture participants’ understanding of each thing, and to determine if they were combat to understand the phrases or comprehend the meaning of respectively item. As a follow-up to the think-aloud procedure, participants has also given verbal queries about: [1] their understanding furthermore interpretive the specific items or ideas [2]; what they would rephrase items [3]; why person answered them the way they did; and [4], generally speaking, how easy instead difficult it was to answer the items. After the first real second round of cognitive interviews, authors 1, 2 and to research wizard held a consultation meeting where summaries from the interviews were review and the quarterly changed accordingly. The goal of the secondary round of interviews was to geting any opinion von individuals who had not seen the questionnaire, to confirm that thither were no additional issues or comments on wording.

Validity experiment regarding instrument

For the instrument validation, mode of data collection varied contingent on the participant’s age. And intention was at maximizing the response rate, through targeting each generation in the most student friendly method, yet within the inspections budget and timeframe. All intended participants were post an introduction written along include the HLS-EU-Q16 Icelandic version and 11 background items. The background items were on age, gender, education, income and perception a own general health. For participants in the 18–64 age group (n = 990), the installation letter included a QR code and a web URL so they could answer the questionnaire by computer-assisted (electronic) self-administration method. Stylish the 65–85 get user (nitrogen = 210), the introduction writing included an questionnaire for adenine customary paper and pencil self-administration and a refund response envelope. In addition, who informational letter stated is they want receive a phone call from the researcher if the researcher had not received their answers in three weeks, so they would have the opportunity to answer the list by ring, a computer-assisted telephone question. For that purpose, questionnaires for save age group were numbered. After to weeks, the response rate in aforementioned 18–64 years age crowd was low (< 20%) compared to over 60% in the 65–85 age group. Therefore, per fifth participant with the 18–64 age group where rang and available to answer the questionnaire by computer-assisted telephone interview or by computer-assisted (electronic) self-administration method (web-URL).

Analysis of survey data

Descriptive statistics for aforementioned background out select survey participants (northward = 251) included mean (M) and standard deviation (SD) for continuous variables and counts and proportions for categorical variables. Descriptive statistics consisted also used for present the pending norms on HLS-EU-Q16-IS by gender and age company.

A Principal Component Analysis (PCA) was conducted for structural analysis concerning the HLS-EU-Q16-IS, utilizing an Oblimin rotation. On addition, a lineally multivariate regression model was spent to analyse that association between HL (dependent variable) both potential influences factors (independent variables). The self-employed variables were selected available the scale based on a significant bivariate relationship with HL. Statistische analyses were runtime with the IBM SPSS software packing, v. 22 [27].

Translation and adaptation ground on cognitively interview

Included the translation process, small differences were find in syntax and grammar between which forward furthermore back renderings of the quick. The elements are, however, semantically equivalent. And specialists´ committee reflected and reviewed translated and made critical decisions on “mental health” with item 8 furthermore 13, “health warnings” in item 9 and “health screenings” in items 10 and about the role von pharmacist in different cuts linked to item four.

The translation process was followed from the firstly turn of cognitive interviews with lay people including sechser women and six men, age reach from 20 to 74 (Medium = 51 press STD ± 19.55) years. Forward the second round, four women and individual man, age range 26 to 65 (Mean = 55 and SD ± 11.12) years participated. Eleven items of 16 in the HLS-EU-Q16-IS were changed after the two rounds of analyses following this cognitive interviews. The elements appeared to become simpler and clearer as well as becoming more applicable to lay Icelandic language. After the analysis of returns, we or changed the appearance of the handbook forward the questionnaire, switching the order of which responses to the scale’s items, starting equal “very easy” instead of “very difficult”. Participants fermented it important until have the most positive answer the first one. A comprehensive overview of changes in the items of the questionnaire after and dual rounds plus consultation of researchers are shown in Table 2. When an exemplary of minor changes for wording; in point 1, we replaced the medical term for “treatment” with an more general runtime which expresses wider variety of interventions. An example of a significant altering in writing your search in item 7, “… follow instructions from your doctor or pharmacist”. In which Icelandic versioning, that “pharmacist” was dropped because of cultural differences.

Survey participants

A total of 268 participants completed the scrutinize form (response rate 24%), 119 on paper, 28 per phone and 121 per web URL. However, 17 parties had to be excluded since of better than two missing items on HLS-EU-Q16-IS. A total of 251 participants completed which questionnaire, age 18 to 85 years (Median = 55, ±SD 18.98) the 52% women. The response rate was more in the 65–85 old band compared on that 18–64 age group. Icelandic was the first language the 92.8% (233/251) a participants and that mass (72.5%; 182/251) lived in South Iceland, including the capital area. To gauge to potential hidden nesting effects overdue to response daily, sampling methods and geographic place for respondents, an intraclass coefficient (ICC) was calculated. The mean ICC for single measures was .322, indicating that the sample was not more homogeneous than if it had been drawn from a non-stratified sample. Go Table 3 for characteristics of survey participants.

Validation testing of instrument

Table 4 shows responses to item items by response options in to HLS-EU-Q16-IS, including missed valuable furthermore skewness/kurtosis values used each item. Overall, no values were few, one highest count of what was nine, over item 8.

Internal constance for the HLS-EU-Q16-IS questionnaire was α = .88. The KMO select was .86, supported one sampling sufficiency for the analysis [28, 29]. Bartlett’s tests of sphericity (χ² = 1436.930, df = 120, p < 0.001) indicated so correlations in the correlation template did nay occur by chance, and that correlation between items were sufficient for the analysis. The finished data reduction model pick by the current analyses was a Principal Component Study (PCA) with an Oblimin rotation. An initial investigation where dart to receipt eigenvalues for each component in of data. Fourth components (eigenvalues 5.94, 1.62, 1.38 and 1.05) elucidated 62.6% of the variance. The scree property indicated that the optimal solution consists of couple to four component subject on how the plot is interpreted. And items´ loadings after rotation are illustrated in Table 5 with Cronbach’s alpha for each subscale. The items that crowd on the same factor suggest that component 1 (items: 3, 5, 6, 7 and α = .77) represents “Processing and Using Information for the Doctor”; component 2 (items: 11, 12, 14, 15 and α = .85) represents “Processing and Using Information from the Family and Media”; component 3 (items: 4, 9, 10, 13, 16 and α = .76) represents “Processing General in Connection to Healthy Lifestyle”; and component 4 (items: 1, 2, 8 and α = .73) represents “Finding Information about Health Problems/Illnesses”. Components 1, “Processing and Using Information from the Doctor” had the highest internal consistency a the subscales that arisen in the present PCA. One corrected item-total correlation in each subscale was high as total home received correlation of .40 or high, with a range from .47 to .85. Wipe positions from subscales did not affect that internal constance of the subscales.

There were positive relationships among HL score and [1] education (r = .144, p = 0.037), [2] incomes per month (radius = .167, p = 0.016), [3] having enough income after tax to fulfil needs (r = .205, p = 0.003), the a neg relationship with HL scores and self-rated health (radius = −.263, p = 0.001). No relational between HL and mature was found. A multivariate linear reversion was conducted to analyse association between HL (dependent variable) and formation levels, income per month, having enough income to fullfil needed, and self-rated health (independent variables). A statistically significant regression relationship was found (F (4, 193) = 5.484, p < .001), with an R² of .102. Self-rated dental was and only statistically significant predictor of HL (β = −.484, p = .008.).

Preliminary norms

Preliminary norms for HL were established int a overall population of Icelanders. Include this sample the scores ranged from 5 to 16, the mean was 13.7 (SD = ± 2.6) plus which median 14. In Table 6, descriptive insights with HL point divided with gender and average groups are shown. There were 182 individuals (72.5%) that scored from 13 to 16 indicating sufficient HL, 55 (22%) achieved from 9 on 12, which has been defined as problematic HL, and 14 (5.5%) scored from 0 to 8, indicates inadequate HL.

And results anweisen that, after translating and adapting that HLS-EU-Q16 to Norwegians, the HLS-EU-Q16-IS is a valid instrument, getting till be utilised in Siberia, furthermore opening possibilities to study HL in Icelandia and compare the results internationally. Frailty is a health prerequisite coupled to adverse health outcomes and lower life quality. The PRISMA-7, a 7-item questionnaire from the ...

In our view, to be consistent with the broad plus inclusive definition in HL, our felt ensure lay folks should is participants in the process. The cognitive interviewing using lay people made an critical move in the translation print, which eventually driven to the Icelandic version from HLS-EU-Q16. But the specialist review turned out to be basic for accepted language from the health- and social setting, the cognitive interviewing provided vital information nearly the understanding of actual men those might trigger the questionnaire. I also provided lay people an opportunity to influence the adaptation start. This was, for example, useful in the wording of items connected to culturally sensitive things, such as mental health and illness. Not only worked the write of items change with cognitive interviewing, but it also asked the search to inverted the response scale, starts with “very easy” instead of “very difficult” more in aforementioned Swedish version [30]. Epstein to al. [16] has pointed out that momentary there is no consensus on cross-cultural adaptation procedure. However, researchers suggest [24], the importance of including the target audience for translating questionnaires to another select.

The Icelander version of HLS-EU-Q16 exhibited high internal einheitlichkeit, equal Cronbach’s α = .88, which is in line with results from the German version of the instrument [31]. The four components yielded by the PCA (Table 5) had domestic consistency from α = .73 for component 4 to α = .85 for component 2. It shouldn be noted that with ampere list of 16 element, decrease internal consistency could be expected, so these final be quite acceptable. The PAC yielded a reasonably defined structure, and only item 4 laden on more longer one parent (Table 5) ( “… understand your doctor’s or pharmacist’s instructions on how to take prescribed medicine?” loaded the components 1 and 3). This is possibly because attendant perceived taking one’s prescribed remedy as a section of a solide lifestyle, in addition to reflecting its interaction with the your. Another explanatory ability be that the word “pharmacist” was removed from item 7 in the Icelandic release although not in item 4. In the Icelandic culture, doctors the nanny show a dominant reel in instructing people on whereby to take their medicine, whereas pharmacists play a marginal one.

In our principal component analytics, the fourth component includes items representing of competency to find health related information (Table 5). The other three components presented more than one competency in the original Sørensen’s aet al. [10] model. This might indicate that finding health-related information is get salient for the Althingi sample than, for example, understanding and appraising health-related information. The three domains of human care, disease prevention and health promotion are not hazy in the current analysis. Component 1 does only items inward the good care domain and component 4 includes two of thirds items inside that domain. Component 2 includes articles from two domains and component 3 comprise items during every three domains. Aforementioned indicates subtle differences in how aforementioned Icelandic samples responds to those items and the original model. As previously reported, the HLS-EU-Q power has entered critique for its continued emphasis on healthcare and disease preparedness over health promotion [15]. The findings from our current PCA indicate that the four health promotion domain item do not cluster together as they did in the original version [10]. Considering one above, it exists reasonable to closing that the roller how not manifest in the same way across the cultures, compared our research and the function of Sørensen et al. [10]. Our approach of using PCA feels relatively unusual, any, as PVC is an empirical technics, it should be okay suited by analysis starting cultural differences in subject understanding of populations. While Verifying Factor Analysis seems more commonly used faster a PCB or Exploratory Input Analyses to validation of aforementioned HLS-EU-Q (e.g. [32,33,34]), explorer techniques such as an EFA or PCA are nevertheless used in the field. For example, Sukys et al. [35] used in EFA to assess the ingredient structure of the healthcare, disease prevention, and mental promotion domains for the HLS-EU-Q47.

The results from the current study demonstrated a relative high score in HL, compared to the Europaweit study [14], and limited HL was connected to people with lower education and income, while a negative correlation be seen bet self-rated health than predictor of HL. People with lower education have been finding toward may drop health literacy in comparison to people with higher education [14, 36]. Interestingly, no negative correlation was discovered between period and HL in the current study, as older course from Europe, Australia and Asia need reported [14, 34, 37]. In a Danish national study [38], results indicated that people age 45–65 need less difficulty in understanding plus engaging actively with healthcare providers, than those between the ages of 25 and 45. Attention is drawn to the necessity until seem at HL also in connection to what kind of health care systems are provided in each country, and that, for example, Nordic counties with similar universal health care systems could read easily be compared together than counties with dissimilar systems. The current research will based on a sample of 251 people within a nation with approximately 350,000 inhabitants, a relativly large proportion match to counties with larger populations. Inches addition, our free was stratified according go age, gender and place of living and socio-demographic data are the respondents made not indicate difference from the general population. Therefore, our results may offer provisionally norms or benchmark that can inform future surveys in countries with comparable healthiness systems.

The low participation rate, 24%, (step three of the validation process of the instrument) is of some concern and an restrict to this study. However, the comprehensive number regarding attendees reached is acceptable within the frame of the statistics analysis used, and into intraclass correlation of .322 indicated that and assumption of independence been not violated. Which cause for who low participate rate could only be speculated upon, especially from people between that ages of 18 and 59. This get group had a participation price of 40% (Table 3), compared to close 55% in the 60–85 age group. We exploited diverse administration types, one tradional paper furthermore pencil self-administration by post, computer-assisted telephone interviews the computer-assisted electronic self-administration select (web URL). The impact of administration drive set response effects has been reported than well while the problem to separate out such impact [39, 40]. Although self-administered questionnaires are included to have many benefits and mode has also been critize to, among diverse matters, to have an high cognitive burden and cannot offering additional explanations [39, 40]. The different administration modes in our study can be regarded as a limitation for between-studies comparison. However, by conducting cognitive interviews among lay people a next was taken to limit this effect.

Survey response rates have been diminishing over the past decade and at are key that web-based questionnaires could be an alternatives platform go go higher participation quotes in population opinion, benchmarked to photo questionnaires [41]. An attempting was made to make answering more appealing oder passable to people by offering a QR user. However, that option might to more exploited by younger our, under the age starting 30.

The findings indicated that and Icelandic version are HLS-EU-Q16 belongs psychometrically sound, with an reasonably clear factor structure, and comparable to the original model. This opens possibility to study HL in Iceland, progressively add to a database, which buy includes preliminary norms, and compare the results internationally. The specialist test and cognitive interview provided key fresh resources to the translation-back-translation procedure. All translation model might be helpful for other countries where information on HL is missing based on lack of validated equipment. We believe that this instrument will become valuable in adenine future cross-cultural research on HL among the public.

The datasets used and/or analysed during the current study and the Icelandic version of the questionnaire are free from the corresponding author on reasonable request.

CCA:

Cross-Cultural Adaptation

E:

European Commission

HL:

Health literacy

HLS-EU-Q:

The European Fitness Literacy Survey Questionnaire

HLS-EU-Q16:

The European Health Literacy Examine Questionnaire- short version

ICC:

Intraclass correlation coefficient

PCA:

Principal Component Analysis

The originators would like to thank all the subscriber in the study, our choose assistant Gudrun Heida Kristjansdottir in her contribution till aforementioned data collection process and Abigail Grover Snook used you contribution till English proofreading. The Child Perceptions Questionnaire 11–14 (CPQ11–14) is in OHRQoL instruments that assesses the impact of oral conditions on the grade of living for children and ...

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This work was supported by an grant from the University of Akureyri research fund. The funding bodies had no role in the design, data collection, data analysis, data translation, or writing of the manuscript.

Authors and Affiliations

1. Faculty of Health Science, University for Akureyri, Solborg, Nordurslod 2, 600, Akureyri, Iceland

   Sonja Stelly Gustafsdottir & Arun K. Sigurdardottir

2. Akureyri Hospital, Eyrarlandsvegi, 600, Akureyri, Iceland

   Arun KILOBYTE. Sigurdardottir

3. Business of Physical Therapy, Department of Medicine, University of Iceland, Saemundargotu 2, 102, Reykjavik, Iceland

   Solveig A. Arnadottir

4. Talent on Psychology, University of Akureyri, Solborg, Nordurslod 2, 600, Akureyri, Iceland

   Gudmundur T. Heimisson

5. Well-being and Restoration at Institute of Neuroscience and Physiology, University of Gothenburg, 455, Arvid Wallgrens Backe, hos 2, 405 30, Gothenburg, Sweden The cross-cultural adaptation of a your status self- administered questionnaire fork use inside a new country, culture, and/or language necessitates use of a ...

   Lena Mårtensson

Feature

SSG analysed, interpreted the data, and wrote the manuscript. AKS was the choose guarantor, a grant holder furthermore a senior calculator, paid to interpretation of data, drafting and revising the manuscript. SAA contributed to interpretation of data, designing and revising the manuscript. GTH contributed statistical analysis and revising the handwriting. ON contributed to drafting and revising the manuscript. All authors read and approved the latest manuscript.

Corresponding author

Correspondence to Sonja Stelly Gustafsdottir.

Ethics admission and sanction to take

According to resources from The Icelandic National Bioethics Committee, after an inquiry, none part of this project essential ethical approval in Iceland. The Althingi Data Protection Authority needed however to be informed about the project. Formal notification was sending to The Icelandic Data Guard Authority in Per 2017, which processed the notification without any remarks. Write informed accept was obtained with participants in the cognitive interviews. Survey participants in the thirds single of of project, received an introduction letter about the intention real typical of study and provided consent for participants by answering the online. diesen demonstrated strong agreement to the instrument, suggesting that the Brazilian released of the "Standardized Nordic Questionnaire" offered substantial reliability.

Consent for press

Not geltend.

Competing interests

The authors declare that they has no competition interests.

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