Development and validation of the short-form Mandarin Health Literacy Scale

Objectives: A Mandarin Health Literacy Scale (MHLS) has been developed and validated to assess Taiwanese adults' functional health literacy in terms of their ability to read, comprehend, and utilize basic health information in making personal health decisions. The purpose of this study was to develop a shortened version of the MHLS, the short-form Mandarin Health Literacy Scale (s-MHLS), and to examine the psychometric qualities of the shortened instrument. Methods: The study sample consisted of 3491 Taiwanese adults who were randomly selected using the threestage stratified sampling design with a sampling rate proportional-to-size within each stage. The measurement models were examined using AMOS 19.0. Results: Item selection was determined by the correlation between the question sets and the total scores on the MHLS. The MHLS was reduced from 33 text-reading items to 8 and 17 numerical items to 3. Confirmatory factor analysis supported the unidimensionality of s-MHLS. Measurement model analysis revealed that s-MHLS yielded a better fit than MHLS. The Cronbach's correlation between the MHLS and s-MHLS was 0.97, and the s-MHLS had satisfactory internal reliability (Cronbach's alpha=0.94). The s-MHLS was significantly correlated with education, reading ability, need for reading assistance, health knowledge, and perceived health status, suggesting that the shortened instrument had good convergent and known-group validity. Conclusions: The s-MHLS is valid and reliable. It could be employed in clinical and research settings to assess functional health literacy in the Mandarinspeaking population.