Cultural adaptation and preliminary assessment of a Health Literacy Instrument in a small island developing state: a pilot study to adapt HLS-EU-Q16 for Samoa

Introduction: Samoa faces a high burden of noncommunicable diseases (NCDs). Understanding health literacy can support more effective interventions. This pilot study aimed to culturally adapt the European Health Literacy Survey Questionnaire (HLS-EU-Q16) to the Samoan context (HLS-Samoa-Q24) and conduct a preliminary assessment of its psychometric properties and user feasibility.Methods: A non-probability purposive cluster sampling approach was used to recruit 73 adult respondents. The HLS-EU-Q16 was adapted by adding eight culturally relevant items, resulting in the 24-item HLS-Samoa-Q24. Items were scored on a 4-point Likert scale. Participants completed the instrument and provided feedback through six group interviews.Results: The health literacy level was defined as inadequate for 63 (84%), problematic for seven (12%) and adequate for three individuals (4%). The mean score was 3.90 (SD = 3.87; 95% CI 3.00-4.81), indicating inadequate health literacy. Internal consistency was high (Cronbach's alpha = 0.92; Omega = 0.91). Due to the small, gender-imbalanced sample, confirmatory factor analysis was not feasible, and construct validity remains to be tested. User feasibility of HLS-Samoa-Q24 detailed comprehensibility, relevance of the added items, and an average completion time of 25 minutes.Conclusion: The HLS-Samoa-Q24 shows promise as a culturally adapted instrument for assessing health literacy in Samoa. However, the findings are preliminary and not generalizable. Further validation with a larger, representative sample is needed to confirm its psychometric robustness.