Cultural Adaptation and Validation of the Parental Health Literacy Activities Test-8 with Portuguese Parents

Background. Parents' health literacy has a great impact on child's care and health. Knowing parent's health literacy levels is crucial to avoid the consequences of limited literacy and for the creation of better health policies and educational interventions. To assess those levels, we must have tools tailored to this population. However, there is a lack of specific instruments to evaluate this capacity in Portuguese parents of children aged less than 12 months. Aim. To perform the cultural adaptation and psychometric validation of the Parental Health Literacy Assessment Test-8 for use in Portugal. Methods. Methodological study is divided into two phases: cultural adaptation and psychometric validation. The first phase followed the Beaton guidelines. The second, carried out with 176 parents, took place at a public hospital in Portugal, between October 2020 and June 2021. Data were analyzed for internal reliability using the Kuder-Richardson reliability coefficient (KR-20). Confirmatory factor analysis was used to estimate factor validity, applying polychoric correlation measures using the lavaan package for the R statistical package. Results. In the cultural adaptation, the expert committee adjusted the translated version, validating the content for Portuguese parents. At validation, the calculated value of KR-20 was approximately 0.50. The empirical indices of the goodness-of-fit of the factor model showed a good overall fit, although two of the items had low weights (0.24 and 0.32). The results of the factors show an acceptable value for the factor (FC = 0.756) and a lower value for the average variance extracted. Conclusion. The version of the instrument adapted for Portugal presented adequate semantic and content equivalence. The psychometrics suggested that the PHLAT-8-PT is a reliable and valid instrument that can be used systematically by the health team to measure the health literacy levels and improve health education.

Automated summary

The study aimed to culturally adapt and psychometrically validate a test instrument for assessing the health literacy levels of Portuguese parents with children under 12 months. The findings revealed that the adapted instrument demonstrated adequate semantic and content equivalence for Portuguese parents. Psychometric validation confirmed that the PHLAT-8-PT is a reliable and valid tool that can be utilized by healthcare teams to measure health literacy levels and enhance health education.