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HOME > J Korean Acad Community Health Nurs > Volume 26(4); 2015 > Article
Original Article
Development of a Health Literacy Assessment Scale for Asian Immigrant Women in South Korea
Jisook An1,2, Sook Ja Yang2
Journal of Korean Academy of Community Health Nursing 2015;26(4):330-341.
DOI: https://doi.org/10.12799/jkachn.2015.26.4.330
Published online: December 12, 2015

1Department of Nursing, Kyungnam University, Changwon, Korea

2Division of Nursing Science, Ewha Womans University, Seoul, Korea

Corresponding author: Yang, Sook Ja Division of Nursing Science, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea. Tel: +82-2-3277-4652, Fax: +82-2-3277-2850, E-mail: yangsj@ewha.ac.kr
• Received: September 17, 2015   • Revised: October 21, 2015   • Accepted: December 14, 2015

Copyright © 2015 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study developed a self-report measure for easy assessing of the health literacy of Asian immigrant women in South Korea.
  • Methods
    After a literature review, focus group interviews, and content validity evaluation, 14 preliminary items were generated. These were translated into Chinese, Vietnamese, and English. Data were collected from 229 Asian immigrant women. Validity and reliability tests were conducted.
  • Results
    Factor analysis yielded final 10 items in three factors: primary functional and interactive health literacy, secondary functional and interactive health literacy, and critical health literacy, which explained 61.90% of the total variance of health literacy. In known-group comparisons, health literacy was significantly lower in recent immigrants, those with a low education level, and those with low Korean language proficiency. For convergent validity, health literacy was positively associated with health specific self-efficacy and maternal health knowledge. For criterion-related validity, health literacy was positively associated with the REALM-SF. The overall reliability coefficient (Cronbach's ⍺) of the instrument was .773.
  • Conclusion
    The Health Literacy Assessment Scale for Asian Immigrant Women (HLAS) represents a multidimensional construct which encompasses functional, interactive, and critical health literacy. This self-report HLAS can be a useful and convenient method for appraising the health literacy of Asian immigrant women.
  • Key Words: Health literacy; Immigrant; Women
Table 1.
Sociodemographic Characteristics of Participants†
(N=229)
Characteristics Categories n (%) M±SD Range
Residence Metropolitan 34 (14.84)    
Urban 95 (41.48)    
Rural 100 (43.68)    
Time since immigration (year) ＜1 44 (19.21) 3.92±2.49 0.5~9
1~＜3 65 (28.38)    
3~＜5 53 (23.14)    
≥5 67 (29.27)    
Country of origin China 70 (30.56)    
Vietnam 110 (48.03)    
The Philippines 20 (8.73)    
Others‡ 29 (12.68)    
Age (year) ＜30 131 (58.20) 29.2±5.18 20~43
≥30 94 (41.80)    
Number of cohabitants 0~1 31 (13.78) 2.74±1.33 0~10
2 75 (33.33)    
≥3 119 (52.89)    
Education Elementary school 21 (9.17)    
Middle school 81 (35.37)    
High school 83 (36.24)    
≥College 44 (19.22)    
Occupation Yes 71 (31.56)    
No 154 (68.44)    
Subjective income Poor 30 (13.82)    
Moderate 164 (75.58)    
Good 10 (4.61)    
Unknown 13 (5.99)    
Korean proficiency Speaking   2.74±0.79 1~5
Listening   2.82±0.80  
Reading   2.92±0.83  
Writing   2.70±0.86  
Subjective health status Good 18 (8.04) 3.34±0.76 1~5
Moderate 132 (58.93)    
Poor 74 (33.03)    

†Missing data were excluded;

‡Cambodia, Indonesia, India, Uzbekistan.

Table 2.
Items and Factor Loadings and Communality of HLAS
Items Factor loadings
 Communality
Factor 1† Factor 2‡ Factor 3§
7. I am able to describe my symptoms directly to the doctor. .77     .62
2. By looking at the packaging, I can understand how to take my medication. .71     .46
9. If I am curious about my own or my family's health, I am able to ask the doctor. .61     .47
4. When I went to the hospital, I was able to find where I wanted to go by following the signs. .52     .35
6. I need another person's help to book my next appointment.   −.77   .59
3. I need another person's help to fill out various hospital forms (surgery consent forms, examination consent forms, vaccination pretest chart, etc.)   −.74   .51
8. It is difficult to understand the doctor's explanations.   −.65   .50
1. I find medical terminologies that I don't understand in health related information received from the hospital.   −.53   .31
13. I consistently follow healthy lifestyle habits (exercise, diet, not smoking, not consuming alcohol, etc.).     .64 .40
11. When I buy foodstuffs, I check the ingredients on the packaging.     .51 .36
    Eigen value 3.38 1.73 1.08  
    Proportion of variances (%) 33.80 17.30 10.80  
    Total variances (%) 33.80 51.10 61.90  
    KMO=.77; Bartlett test of sphericity=558.90, p＜.001        
    Cronbach's ⍺ .76 .77 .55  
    Total Cronbach's ⍺=.77        

HLAS=Health Literacy Assessment Scale for Asian Immigrant Women;

†Secondary functional and interactive health literacy;

‡Primary functional and interactive health literacy;

§critical health literacy.

Table 3.
Differences in HLAS by Time Since Immigration, Education and Korean Proficiency
Variables Characteristics Categories Total score of HLAS
M±SD F p (post hoc)
Time since immigration (year) ＜1a   18.40±6.57 14.27 ＜.001
  1~＜3b   19.32±5.57   (a, b＜c, d)
  3~＜5c   23.12±5.86    
  ≥5d   24.91±6.00    
Education Elementary schoola   17.21±7.54 3.74 .012
  Middle schoolb   21.74±6.38   (a＜d)
  High schoolc   21.83±5.72    
  ≥Colleged   23.13±7.00    
Korean proficiency Speaking Poora 17.92±6.12 33.91 ＜.001
    Moderateb 22.32±5.18   (a＜b＜c)
    Goodc 28.41±6.68    
  Listening Poora 17.51±6.15 26.59 ＜.001
    Moderateb 22.30±5.29   (a＜b＜c)
    Goodc 26.60±7.11    
  Reading Poora 16.62±5.42 35.12 ＜.001
    Moderateb 22.54±5.32   (a＜b＜c)
    Goodc 26.34±7.00    
  Writing Poora 18.03±5.84 24.74 ＜.001
    Moderateb 22.83±5.57   (a＜b＜c)
    Goodc 26.52±7.11    

HLAS=Health literacy assessment scale for asian immigrant women.

Table 4.
Convergent and Criterion-related Validity Evaluation of HLAS
Variables Total score of HLAS
ɼ p
Health specific self-efficacy .21 .003
Maternal health knowledge .40 ＜.001
REALM-SF .56 ＜.001

HLAS=Health literacy assessment scale for asian immigrant women; REALM-SF=Rapid estimate of adult literacy in medicine-short form.

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    Development of a Health Literacy Assessment Scale for Asian Immigrant Women in South Korea
    Development of a Health Literacy Assessment Scale for Asian Immigrant Women in South Korea
    Characteristics Categories n (%) M±SD Range
    Residence Metropolitan 34 (14.84)    
    Urban 95 (41.48)    
    Rural 100 (43.68)    
    Time since immigration (year) ＜1 44 (19.21) 3.92±2.49 0.5~9
    1~＜3 65 (28.38)    
    3~＜5 53 (23.14)    
    ≥5 67 (29.27)    
    Country of origin China 70 (30.56)    
    Vietnam 110 (48.03)    
    The Philippines 20 (8.73)    
    Others‡ 29 (12.68)    
    Age (year) ＜30 131 (58.20) 29.2±5.18 20~43
    ≥30 94 (41.80)    
    Number of cohabitants 0~1 31 (13.78) 2.74±1.33 0~10
    2 75 (33.33)    
    ≥3 119 (52.89)    
    Education Elementary school 21 (9.17)    
    Middle school 81 (35.37)    
    High school 83 (36.24)    
    ≥College 44 (19.22)    
    Occupation Yes 71 (31.56)    
    No 154 (68.44)    
    Subjective income Poor 30 (13.82)    
    Moderate 164 (75.58)    
    Good 10 (4.61)    
    Unknown 13 (5.99)    
    Korean proficiency Speaking   2.74±0.79 1~5
    Listening   2.82±0.80  
    Reading   2.92±0.83  
    Writing   2.70±0.86  
    Subjective health status Good 18 (8.04) 3.34±0.76 1~5
    Moderate 132 (58.93)    
    Poor 74 (33.03)    
    Items Factor loadings
    		 Communality
    Factor 1† Factor 2‡ Factor 3§
    7. I am able to describe my symptoms directly to the doctor. .77     .62
    2. By looking at the packaging, I can understand how to take my medication. .71     .46
    9. If I am curious about my own or my family's health, I am able to ask the doctor. .61     .47
    4. When I went to the hospital, I was able to find where I wanted to go by following the signs. .52     .35
    6. I need another person's help to book my next appointment.   −.77   .59
    3. I need another person's help to fill out various hospital forms (surgery consent forms, examination consent forms, vaccination pretest chart, etc.)   −.74   .51
    8. It is difficult to understand the doctor's explanations.   −.65   .50
    1. I find medical terminologies that I don't understand in health related information received from the hospital.   −.53   .31
    13. I consistently follow healthy lifestyle habits (exercise, diet, not smoking, not consuming alcohol, etc.).     .64 .40
    11. When I buy foodstuffs, I check the ingredients on the packaging.     .51 .36
        Eigen value 3.38 1.73 1.08  
        Proportion of variances (%) 33.80 17.30 10.80  
        Total variances (%) 33.80 51.10 61.90  
        KMO=.77; Bartlett test of sphericity=558.90, p＜.001        
        Cronbach's ⍺ .76 .77 .55  
        Total Cronbach's ⍺=.77        
    Variables Characteristics Categories Total score of HLAS
    M±SD F p (post hoc)
    Time since immigration (year) ＜1a   18.40±6.57 14.27 ＜.001
      1~＜3b   19.32±5.57   (a, b＜c, d)
      3~＜5c   23.12±5.86    
      ≥5d   24.91±6.00    
    Education Elementary schoola   17.21±7.54 3.74 .012
      Middle schoolb   21.74±6.38   (a＜d)
      High schoolc   21.83±5.72    
      ≥Colleged   23.13±7.00    
    Korean proficiency Speaking Poora 17.92±6.12 33.91 ＜.001
        Moderateb 22.32±5.18   (a＜b＜c)
        Goodc 28.41±6.68    
      Listening Poora 17.51±6.15 26.59 ＜.001
        Moderateb 22.30±5.29   (a＜b＜c)
        Goodc 26.60±7.11    
      Reading Poora 16.62±5.42 35.12 ＜.001
        Moderateb 22.54±5.32   (a＜b＜c)
        Goodc 26.34±7.00    
      Writing Poora 18.03±5.84 24.74 ＜.001
        Moderateb 22.83±5.57   (a＜b＜c)
        Goodc 26.52±7.11    
    Variables Total score of HLAS
    ɼ p
    Health specific self-efficacy .21 .003
    Maternal health knowledge .40 ＜.001
    REALM-SF .56 ＜.001
    Table 1. Sociodemographic Characteristics of Participants† (N=229)

    Missing data were excluded;

    Cambodia, Indonesia, India, Uzbekistan.

    Table 2. Items and Factor Loadings and Communality of HLAS

    HLAS=Health Literacy Assessment Scale for Asian Immigrant Women;

    Secondary functional and interactive health literacy;

    Primary functional and interactive health literacy;

    critical health literacy.

    Table 3. Differences in HLAS by Time Since Immigration, Education and Korean Proficiency

    HLAS=Health literacy assessment scale for asian immigrant women.

    Table 4. Convergent and Criterion-related Validity Evaluation of HLAS

    HLAS=Health literacy assessment scale for asian immigrant women; REALM-SF=Rapid estimate of adult literacy in medicine-short form.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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