Development and initial validation of the falls health literacy scale. (May 2022)

• Record Type: Journal Article
• Authors: Lim, Mei Ling; van Schooten, Kimberley S.; Radford, Kylie A; Delbaere, Kim
• Is Part Of: Maturitas. Volume 159(2022)
• Page Start: 40
• Page End: 45
• Publication Date: 2022-05
• Subjects: Health behavior -- Health promotion -- Psychometrics -- Accidental falls -- Aged; Climacteric -- Periodicals; Menopause -- Periodicals; Climacteric -- Periodicals; Geriatrics -- Periodicals; Menopause -- Periodicals; Middle Aged -- Periodicals; Climatère -- Périodiques; Ménopause -- Périodiques; Climacterium; Climacteric; Menopause; Electronic journals; Periodicals; 612.66
• DOI: 10.1016/j.maturitas.2021.12.002
• Languages: English
• ISSNs: 0378-5122

Abstract

Highlights: The Falls Health Literacy Scale (FHLS) is a novel instrument that measures health literacy in the context of fall prevention. The FHLS contains a 25-item subjective scale and a 14-item objective scale. The FHLS-subjective assesses self-reported fall-related health literacy and has six subscales relevant to fall prevention. The FHLS-objective provides a performance-based measure of a person's health literacy in the context of fall prevention. The FHLS is sensitive to levels of fall-related health literacy, and has good acceptability and validity in an older population. Abstract: Objectives: (i) To develop the Falls Health Literacy Scale (FHLS), a health literacy tool specific to falls, (ii) to evaluate the FHLS's construct validity towards differentiating individuals with different fall-related health literacy, and (iii) to determine its reliability, construct validity and structure in an older population. Methods: The initial FHLS, developed based on Sørensen et al.'s health literacy model, was first administered to 144 participants aged ≥18 years for feedback and scale improvement and preliminary analysis to determine the FHLS's construct validity in identifying individuals with different fall-related health literacy. After scale refinement, the FHLS was validated in 227 community-living people aged ≥65 years. Results: Adult participants with more fall prevention knowledge scored higher on the initial FHLS than those with less fall prevention knowledge (p≤0.001). The final FHLS includes a 25-item subjective and a 14-item objective scale. Older people with ≥1 fall in the past year reported lower FHLS-subjective scores than those who had no falls (Cohen's [ d ]=0.29, confidence interval [CI]:0.03-0.56, p=0.03). Older people with lower levels of education had lower FHLS-objective scores than their more educated counterparts ( d =0.51, CI:0.38-1.43, p≤0.001). Factor analysis of the FHLS-subjective generated six subscales, with CFA showing adequate model fit (RMSEA=0.077, CFI=0.883 and χ2/df =2.35). FHLS-subjective (25-item) showed good reliability, with Cronbach's alpha=0.93, mean inter-item correlation=0.34 (range -0.03-0.81) and intra-class coefficient =0.86 (95% CI:0.69-0.93). Conclusion: The novel, context-specific FHLS displayed good construct validity and reliability. The FHLS holds promise as a screening tool to differentiate individuals with different degrees of fall-related health literacy, which may help guide fall prevention interventions.