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Cited by 329Health Literacy and Information AccessibilityHealth Education and ValidationSurvey Methodology and Nonresponse

Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries

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Duong, Tuyen V., Aringazina, Altyn, Baisunova, Gaukhar, Nurjanah, Pham, Thuc V., Pham, Khue M., Truong, Tien Q., Nguyen, Kien T. +8 more·2017·Journal of Epidemiology
DOI 10.1016/j.je.2016.09.005PMC PMC5328731
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Abstract

BACKGROUND: Health literacy has been increasingly recognized as one of the most important social determinants for health. However, an appropriate and comprehensive assessment tool is not available in many Asian countries. This study validates a comprehensive health literacy survey tool European health literacy questionnaire (HLS-EU-Q47) for the general public in several Asian countries. METHODS: A cross-sectional survey based on multistage random sampling in the target countries. A total of 10,024 participants aged ≥15 years were recruited during 2013-2014 in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. The questionnaire was translated into local languages to measure general health literacy and its three domains. To evaluate the validity of the tool in these countries, data were analyzed by confirmatory factor analysis, internal consistency analysis, and regression analysis. RESULTS: The questionnaire was shown to have good construct validity, satisfactory goodness-of-fit of the data to the hypothetical model in three health literacy domains, high internal consistency (Cronbach's alpha >0.90), satisfactory item-scale convergent validity (item-scale correlation ≥0.40), and no floor/ceiling effects in these countries. General health literacy index score was significantly associated with level of education (P from <0.001 to 0.011) and perceived social status (P from <0.001 to 0.016), with evidence of known-group validity. CONCLUSIONS: The HLS-EU-Q47 was a satisfactory and comprehensive health literacy survey tool for use in Asia.

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  • Previous international collaborative research indicated that the proportion of the population with inadequate level of health literacy varied by country.

    “Previous international collaborative research explored the differences and similarities in general health literacy of adults in European countries (Sorensen et al., 2015) and in Asian countries (Duong et al., 2017), indicating that the proportion of the population with inadequate level of health literacy varied by country.”

    From Digital health literacy and trust in health information sources: A comparative study of university students in Japan, the United States, and India (2025) · cites this paper as Duong et al., 2017

    The Results (Table 1) report different mean general health-literacy scores across the six Asian country samples, supporting the claim of cross-country variation. The paper does not report the proportion classified as having inadequate health literacy, and the Discussion (Limitations) cautions that most samples should not be treated as nationally representative. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Previous research has demonstrated associations between general health literacy and socioeconomic status.

    “Subjective social status was positively associated with DHLI scores, which was consistent with previous research that has demonstrated associations between general health literacy and socioeconomic status (Duong et al., 2017; Ishikawa et al., 2023; Sorensen et al., 2015), as well as between socioeconomic status and digital health literacy (Estrela et al., 2023; Jiang et al., 2025).”

    From Digital health literacy and trust in health information sources: A comparative study of university students in Japan, the United States, and India (2025) · cites this paper as Duong et al., 2017

  • Health literacy in Asian countries is generally lower than that of European countries.

    “Health literacy in Asian countries is generally lower than that of European countries (Duong et al., 2017).”

    From Digital health literacy and trust in health information sources: A comparative study of university students in Japan, the United States, and India (2025) · cites this paper as Duong et al., 2017

    The Results report health-literacy scores for six Asian countries, but no European scores or comparison with European countries. The Discussion compares the questionnaire’s reliability in Asia and Europe, not their health-literacy levels. A reference title mentions lower health literacy in Japan than in Europe, but that does not establish the broader claim about Asian countries generally. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

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Authors
Duong, T. V., Aringazina, A., Baisunova, G., Nurjanah, Pham, T. V., Pham, K. M., Truong, T. Q., Nguyen, K. T., Oo, W. M., Mohamad, E., Su, T. T., Huang, H.-L., Sørensen, K., Pelikan, J. M., Van den Broucke, S., & Chang, P. W.
Affiliations
  • National Health Research Institutes (TW)
  • Kazakh National Medical University (KZ)
  • Hai phong University Of Medicine and Pharmacy (VN)
  • University Of Medicine 1 Yangon (MM)
  • National University of Malaysia (MY)
  • University of Malaya (MY)
  • Yuanpei University (TW)
  • Maastricht University (NL)
  • University of Vienna (AT)
  • Ministry of Health and Welfare (TW)
Corresponding author
Chang, Peter Wushou
ORCID
Venue
Journal of Epidemiology
Publisher
Japan Epidemiological Association
Published
2017-02
Volume
27
Issue
2
Pages
80-86
ISSN
0917-5040 (ISSN-L)
DOI
10.1016/j.je.2016.09.005
PMC
PMC5328731
OpenAlex
W2575874589
Cited by
329
References
4
Citations by year
2026: 38 · 2025: 34 · 2024: 40 · 2023: 33 · 2022: 45 · 2021: 49 · 2020: 41 · 2019: 31 · 2018: 14 · 2017: 4
FWCI
38.03
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Epidemiology (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • The University of Malaya Research Repository (University of Malaya) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, cc-by-nc-nd)
  • DIAL (Catholic University of Leuven) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • Journal of Epidemiology (cc-by)
Funders
Health Promotion Administration, Ministry of Health and Welfare
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
  • Social Sciences › Education › Health Education and Validation
  • Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
Keywords
health literacy, HLS-EU-Q47, questionnaire validation, cross-cultural adaptation, Asian populations, social determinants of health, educational attainment, perceived social status, Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, Vietnam
MeSH terms
Adolescent, Adult, Asia, Cross-Sectional Studies, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Reproducibility of Results, Young Adult, Health Literacy

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