The intent of the study was to develop and validate a comparable health literacy test for Spanish‐speaking and English‐speaking populations.
The design of the instrument, named the (), combined a word recognition test, as appearing in the (), and a comprehension test using multiple‐choice questions designed by an expert panel. We used the item response theory (IRT) in developing and validating the instrument.
Validation of involved testing and comparing the instrument with other health literacy instruments in a sample of 201 Spanish‐speaking and 202 English‐speaking subjects recruited from the Ambulatory Care Center at the University of North Carolina Healthcare System.
Based on IRT analysis, 18 items were retained in the comparable test. The Spanish version of the test, , was highly correlated with other Spanish health literacy instruments, (=0.88, <.05) and the Spanish () (=0.62, <.05). The English version, , had high correlations with (=0.94, <.05) and the English (=0.68, <.05). Significant correlations were found between and years of schooling in both Spanish‐ and English‐speaking samples (=0.15 and 0.39, respectively). displayed satisfactory reliability of 0.80 and 0.89 in the Spanish‐ and English‐speaking samples, respectively. IRT analysis indicated that the score was highly reliable for individuals with a low level of health literacy.
The new instrument, , has good reliability and validity. It is particularly useful for identifying individuals with low health literacy and could be used to screen for low health literacy among Spanish and English speakers.