Translation and validation of a brief Health Literacy instrument for children into Danish

Background Evidence for health literacy (HL) as an important determinant of health and health behaviour is increasing. Brief and generic tools for measuring HL in children are few. One such tool is the Health Literacy for School-Aged Children (HLSAC) instrument, which is a 10-item theory-based tool developed in Finland for measuring HL in children aged 13-15. The aim of this study was to translate and validate the HLSAC-instrument among Danish children aged 12-14. Methods The instrument was translated into Danish by a recommended standardized forward-backward translation process, and then pre-tested for face validity with 61 pupils from four schools. Thereafter, the instrument was tested among 805 pupils from 15 schools. Structural validity was analysed with confirmatory factor analysis (CFA), predictive validity with regression analysis, and internal consistency with Cronbach's alpha. Results When HL was modelled as one latent factor with all 10 items loading on this factor, CFA showed standardized factor loadings from 0.52 to 0.75 (p < 0.001) and an excellent model fit (comparative fit index >0.95, Tucker-Lewis Index >0.95, standardized root mean square residual <0.08, and root mean square error of approximation <0.06). The predictive validity regarding food intake was good (p < 0.001, r2=0.027) and the internal consistency was high (Cronbach's alpha=0.86). Conclusions A valid and reliable version of the HLSAC-instrument is now available in Danish for measuring HL among children aged 12-14. This instrument is considered useful for future surveys to inform and guide public health policy, health promotion strategies and health education targeting children. Key messages A validated brief Health Literacy instrument for school-aged children is now available in Danish. The Health Literacy instrument’s ability to predict healthy food intake is promising for the utility.