Development of a Health Literacy Assessment Scale for Asian Immigrant Women in South Korea

Article information

Res Community Public Health Nurs. 2015;26(4):330-341

Publication date (electronic) : 2015 December 12

doi : https://doi.org/10.12799/jkachn.2015.26.4.330

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 2015 September 17; Revised 2015 October 21; Accepted 2015 December 14.

Abstract

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.

Keywords: Health literacy; Immigrant; Women

Table 1.

Sociodemographic Characteristics of Participants^†

(N=229)

Table 2.

Items and Factor Loadings and Communality of HLAS

Table 3.

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

Table 4.

Convergent and Criterion-related Validity Evaluation of HLAS

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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
Age (year)	≥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)
Occupation	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
Items	Factor 1^†	Factor 2^‡	Factor 3^§	Communality
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
Variables	Characteristics	Categories	M±SD	F	p (post hoc)
Time since immigration (year)	＜1^a		18.40±6.57	14.27	＜.001
	1~＜3^b		19.32±5.57		(a, b＜c, d)
	3~＜5^c		23.12±5.86
	≥5^d		24.91±6.00
Education	Elementary school^a		17.21±7.54	3.74	.012
	Middle school^b		21.74±6.38		(a＜d)
	High school^c		21.83±5.72
	≥College^d		23.13±7.00
Korean proficiency	Speaking	Poor^a	17.92±6.12	33.91	＜.001
		Moderate^b	22.32±5.18		(a＜b＜c)
		Good^c	28.41±6.68
	Listening	Poor^a	17.51±6.15	26.59	＜.001
		Moderate^b	22.30±5.29		(a＜b＜c)
		Good^c	26.60±7.11
	Reading	Poor^a	16.62±5.42	35.12	＜.001
		Moderate^b	22.54±5.32		(a＜b＜c)
		Good^c	26.34±7.00
	Writing	Poor^a	18.03±5.84	24.74	＜.001
		Moderate^b	22.83±5.57		(a＜b＜c)
		Good^c	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
Variables	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.