ArticlePloS one2023
Validation of a culturally adapted Swedish-language version of the Death Literacy Index.
Article in PloS one, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Death literacy: Tensions between theory and practice.Palliative care and social practice · 2026Article
- Mapping death literacy in the East of England: A cross-sectional survey with qualitative insights to inform public health strategy.Palliative care and social practice · 2026Article
- Strengthening death literacy in multicultural communities: Community-led interventions and cross-cultural validation of the Death Literacy Index.Palliative care and social practice · 2026Article
- Investigating effect versus impact in a participatory action research project: Building end-of-life communication competence in residential care facilities for older people.Palliative care and social practice · 2026Article
- Patient characteristics associated with death literacy in advanced non-small-cell lung cancer: A preliminary single-centre cross-sectional study.Palliative care and social practice · 2026Article
- Translation and validation of the revised and short forms of the Death Literacy Index in the Chinese population.Frontiers in public health · 2026Article
- Associations between sociodemographic factors, experience of death and dying, and death literacy: A nationally representative cross-sectional study.Palliative care and social practice · 2026Article
- Development and validation of the Japanese version of the Death Literacy Index (DLI-J) and its short form (DLI-J-9).PCN reports : psychiatry and clinical neurosciences · 2025Article
- Proactive end-of-life conversations in residential care homes: a qualitative interview study exploring residents' and family members' experiences.BMC geriatrics · 2025Article
- Progressing the Death Literacy Index: the development of a revised version (DLI-R) and a short format (DLI-9).Palliative care and social practice · 2024Article
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8 authors.
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Abstract
The death literacy index (DLI) was developed in Australia to measure death literacy, a set of experience-based knowledge needed to understand and act on end-of-life (EOL) care options but has not yet been validated outside its original context. The aim of this study was to develop a culturally adapted Swedish-language version of the DLI, the DLI-S, and assess sources of evidence for its validity in a Swedish context. The study involved a multi-step process of translation and cultural adaptation and two validation phases: examining first content and response process validity through expert review (n = 10) and cognitive interviews (n = 10); and second, internal structure validity of DLI-S data collected from an online cross-sectional survey (n = 503). The psychometric evaluation involved analysis of descriptive statistics on item and scale-level, internal consistency and test-retest reliability, and confirmatory factor analysis. During translation and adaptation, changes were made to adjust items to the Swedish context. Additional adjustments were made following findings from the expert review and cognitive interviews. The content validity index exceeded recommended thresholds (S-CVIAve = 0.926). The psychometric evaluation provided support for DLI-S' validity. The hypothesized six-factor model showed good fit (χ2 = 1107.631 p<0.001, CFI = 0.993, TLI = 0.993, RMSEA = 0.064, SRMR = 0.054). High internal consistency reliability was demonstrated for the overall scale (Cronbach's α = 0.94) and each sub-scale (α 0.81-0.92). Test-retest reliability was acceptable, ICC ranging between 0.66-0.85. Through a comprehensive assessment of several sources of evidence, we show that the DLI-S demonstrates satisfactory validity and acceptability to measure death literacy in the Swedish context. There are, however, indications that the sub-scales measuring community capacity perform worse in comparison to other sca and may function differently in Sweden than in the original context. The DLI-S has potential to contribute to research on community-based EOL interventions.
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