Concurrent validation of two key health literacy instruments in a South Eastern European population

E. Toçi*, G. Burazeri, K. Sorensen, H. Kamberi, H. Brand

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Public health practice has come to increasing recognition of health promotion and the central role of knowledge, attitude, beliefs and practices in achieving health promotion. Health literacy (HL) is an under-explored topic in South Eastern European countries. There are no HL reports from Albania to date. The aim of this study was to assess the concurrent validity of the European Health Literacy Survey Questionnaire (HLS-EU-Q) and the Test of Functional Health Literacy in Adults (TOFHLA) in a population-based sample of adults in Albania. Methods: A cross-sectional study was conducted in 2013 in Tirana, Albania, including 239 individuals aged >= 18 years (61% women; 87% response). A structured interviewer-administered questionnaire was applied twice (test and retest procedure after 2 weeks) including HLS-EU-Q and TOFHLA instruments. Results: The internal consistency was high for both instruments (Cronbach's alpha for the test procedure was 0.92 for TOFHLA and 0.98 for HLS-EU-Q). Both tools exhibited a high stability over time (Spearman's rho: 0.88 for TOFHLA and 0.87 for HLS-EU). Mean values of both instruments were similar in men and women (mean score for TOFHLA: 76.0 vs. 76.5, P = 0.83; mean score for HLS-EU-Q: 32.2 vs. 32.6, P = 0.63). For both instruments, higher HL scores were significantly associated with younger age, higher educational and economic level and lower body mass index. Conclusions: Our study provides valuable novel evidence on concurrent validation of two major HL instruments in a South Eastern European population-based sample. Future studies should be conducted in order to confirm and expand our findings.

Original languageEnglish
Pages (from-to)482-486
Number of pages5
JournalEuropean Journal of Public Health
Issue number3
Early online date12 Nov 2014
Publication statusPublished - Jun 2015


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