Trial reportPloS one2025
Study of the psychometric properties of the HLS-EU-12 questionnaire in rural Bangladesh.
Trial report in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04505150 (Lowering Blood Pressure by Changing Lifestyle Through a Motivational Education Program), which is not on this map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Lowering Blood Pressure by Changing Lifestyle Through a Motivational Education Program: a Cluster RCT Study Protocol
Who cites it
1 citing paper in PubMed.
- Structural Validation and Measurement Invariance of the HLS-Q12 Health Literacy Instrument in Finnish Adults: Comparing Traditional and Alignment Methods.International journal of public health · 2026Article
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesPoorer health literacy leads to limited knowledge of diseases and lower adherence to medication. Several tools are available for measuring health literacy, including the HLS-EU-Q12 questionnaire. This study aimed to examine the psychometric properties of the HLS-EU-Q12 questionnaire using Rasch measurement theory to assess general health literacy among adults in rural Bangladesh. MATERIALS AND
methodsBaseline data was collected through a cluster randomized control trial (RCT) in the Narail district of Bangladesh from 1 December 2020 to 31 January 2021, involving 307 adults aged 30-75 with hypertension. The HLS-EU-Q12 questionnaire, which has 12 items, was validated using the Rasch measurement model and analyzed using RUMM2030. The analysis was focused on differential item functioning (DIF) across gender and age, targeting, multidimensionality, response dependency, and item categorization.
resultsThe sample consisted of almost equal proportions of females (50.2%) and males (49.8%), and control (50.8%) and intervention participants (49.2%). Initial examination indicated that the tool had a poor overall fit with the Rasch model, shown by a significant item-trait interaction (χ2 = 100.5 df = 48, p < 0.001). The reliability, measured by person separation index (PSI), was 0.746, which was considered satisfactory. The overall item fit residual (IFR) (M = 0.236, SD = 1.318) and the person fit residuals (PFR) (M = -0.186, SD = 1.03) were within the acceptable range of SD ± 1.4. All items were found to have ordered thresholds, suggesting that respondents had no difficulty differentiating between response options on the 4-point Likert-type scale. Only item 12 ("Join a sports club or exercise class if you want to") had a fit residual value outside the acceptable range. Removing item 12 resulted in a good overall fit (χ2 = 60.35 df = 44, p = 0.05) and a slight improvement to the PSI (0.746 for 12 items vs.0.756 for 11 items). None of the items showed significant DIF for age and gender. Only two items showed residual correlation coefficient 0.20, indicating possible redundancy. The analysis demonstrated the scale's unidimensionality, as shown by the lower bound of a binomial 95% confidence interval (CI) for the observed proportion (5.2%) being within the 95% confidence limit.
conclusionThe study demonstrated the potential effectiveness of the HLS-EU-Q12 as a tool for assessing health literacy among adults in Bangladesh. However, further study is needed to evaluate the tool across different populations, including an in-depth investigation of item 12 to determine its inclusion or removal.
trial registrationClinicalTrials.gov NCT04505150. Registered on 7 August 2020.
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