Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries

Tuyen V. Duong, Altyn Aringazina, Gaukhar Baisunova, Nurjanah, Thuc V. Pham, Khue M. Pham, Tien Q. Truong, Kien T. Nguyen, Win Myint Oo, Emma Mohamad, Tin Tin Su, Hsiao-Ling Huang, Kristine Sorensen, Juergen M. Pelikan, Stephan Van den Broucke, Peter Wushou Chang*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Health literacy has been increasingly recognized as one of the most important social determinants for health. However, an appropriate and comprehensive assessment tool is not available in many Asian countries. This study validates a comprehensive health literacy survey tool European health literacy questionnaire (HLS-EU-Q47) for the general public in several Asian countries.

Methods: A cross-sectional survey based on multistage random sampling in the target countries. A total of 10,024 participants aged >= 15 years were recruited during 2013-2014 in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. The questionnaire was translated into local languages to measure general health literacy and its three domains. To evaluate the validity of the tool in these countries, data were analyzed by confirmatory factor analysis, internal consistency analysis, and regression analysis.

Results: The questionnaire was shown to have good construct validity, satisfactory goodness-of-fit of the data to the hypothetical model in three health literacy domains, high internal consistency (Cronbach's alpha >0.90), satisfactory item-scale convergent validity (item-scale correlation >= 0.40), and no floor/ceiling effects in these countries. General health literacy index score was significantly associated with level of education (P from

Conclusions: The HLS-EU-Q47 was a satisfactory and comprehensive health literacy survey tool for use in Asia. (C) 2016 The Authors. Publishing services by Elsevier B.V. on behalf of The Japan Epidemiological Association.

Original languageEnglish
Pages (from-to)80-86
Number of pages7
JournalJournal of Epidemiology
Issue number2
Publication statusPublished - Feb 2017


  • Validation
  • Health literacy
  • HLS-EU-Q47
  • Asian health literacy surveys
  • Confirmatory factor analysis
  • CARE

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