Health literacy test for limited literacy populations (HELT-LL): Validation in South Africa

Abstract

The majority of health literacy measures emanate from high-income countries and are inappropriate for use in limited literacy individuals who are usually excluded from participation in health literacy studies. There is currently no appropriate health literacy measure for the educationally diverse South African population. This study, which reports the validation of the Health Literacy Test for Limited Literacy individuals (HELT-LL), was conducted in primary health-care clinics with 210 isiXhosa-speaking patients with a maximum of 12 years of schooling. The HELT-LL has varied cognitive demands, assesses functional literacy skills as well as local burden of disease knowledge, and also includes self-reported questions. The Multidimensional Screener of Functional Health Literacy (MSFHL) was used as the comparator. Almost a third of the study population (32.4%) had inadequate health literacy, with only a low 17.6% achieving an adequate health literacy rating. The majority of patients (65.9%) with inadequate health literacy had minimal formal schooling of between 0 and 4 years. The HELT-LL score was significantly associated with education (p < 0.001), age (p < 0.001) and English proficiency (p < 0.001). Significant concurrent validity with the MSFHL was established. The HELT-LL is the first general health literacy measure to be developed in South Africa with the aim of enabling the evaluation of health literacy in limited literacy individuals. It was shown to be a valid and reliable measure of health literacy, with good discriminatory ability amongst participants with varying degrees of schooling. It has afforded preliminary insight into the health literacy of the more vulnerable public sector patient population in South Africa.

Keywords

• health literacy
• health literacy measure
• validation
• limited literacy
• primary health-care clinics