Health Literacy Questionnaire (HLQ)

The Health Literacy Questionnaire (HLQ) is now one of the most widely used health literacy measures in the world. Over 800 studies are using the HLQ across diseases, settings and countries.
Health literacy is multidimensional therefore we developed a series of independent measures to measure it. It is used for surveys, trials, PREM/PROM assessments, and evaluation over time. Each scale efficiently measures one of nine aspects of health literacy (each scale with 4 to 6 items). You can use one of the scales to measure Functional Health Literacy (with a total of 5 items, akin to a screener). It also measures eight other elements to ensure you measure the full construct of health literacy. Consequently, a short version is not encouraged, many groups use 2 or more health literacy scales (aspects of health literacy), measuring there concepts on interest well and specifically.

The HLQ was developed and tested over many years using the contemporary theoretical validity testing approach. It was designed for and is used in national surveys, clinical trials, general surveys, for quality improvement, evaluation studies, and, importantly, to uncover mechanisms behind health inequalities to inform intervention development. It has been found to be useful at the patient-clinician level. Each scale is reliable and generates key information about an individual's perceived health literacy abilities, and their experiences. It was designed to be sensitive to change, identifying small differences between populations, and changes over time. These characteristics have been repeatedly demonstrated. As each scale is independent, only one or some of the 9 scales need to be used to answer your specific research questions or evaluate specific outcomes. To measure the full multidimensional concept of health literacy, all nine scales are required.

The HLQ is a generic scale. This is deliberate because these days the majority of people have more than one disease - and it is not really possible for respondents to just focus on one part of their life. We recommend the use of disease-specific scales with the HLQ. The HLQ also assists teams to take a strengths-based approach, that is identifying individuals' and groups' mix of strengths, challenges, and preferences. This means that HLQ users not only get rich information on what is really going on for respondents but also what can be done to help them in the areas of health, access, and equity.

Each year, independent validity testing studies are undertaken in a range of cultures and languages. These studies are generally highly robust and consistently demonstrate that the original 9-scale structure holds and is reproducible. This level of reproducibility is rare in the patient-reported outcomes field. See this paper for a critique of if the field: https://gh.bmj.com/content/7/9/e009623

Year Measure first Published: 2013