Translation and psychometric evaluation of the Spanish version of the Heart Failure-Specific Health Literacy

To translate and adapt the Heart Failure-Specific Health Literacy Scale (HFS-HLS) for Castilian Spanish (i.e., the Spanish spoken in Spain) and to evaluate its psychometric properties in patients with heart failure visited in primary care centres. Forward and back translations were used to translate and adapt the HFS-HLS, and a panel of experts assessed the validity of the adaptation until consensus was achieved. Face validity was explored through cognitive debriefing with 20 patients. Psychometric properties were examined for test-retest reliability (intraclass correlation index) and internal consistency (Cronbach’s α), concurrent and discriminant validity (Pearson correlation coefficient) using the HLS-EU-Q16 and EHFScBS health literacy scales, and construct validity using confirmatory factor analysis and fit indices. Differences in mean results for the adapted instrument and between subgroups were examined with ANOVA tests. The linguistically and culturally adapted Castilian Spanish HFS-HLS (Cast-Span HFS-HLS) was administered to 195 participants. Overall fit parameters for three dimensions of confirmatory factor analysis were adequate. Test-retest reliability showed an intraclass correlation coefficient of 0.89 (95% CI: 0.80 to 0.94) for the total HL scale and 0.87, 0.86, and 0.89 for the functional, communicative, and critical subcales, respectively. The internal consistency for the total HL was good (Cronbach α = 0.80), and for the three sub-scales were α = 0.88 (Functional), α = 0.55 (communicative), and α = 0.79 (critical). Results of the new adapted instrument were associated with both the HLS-EU-Q16 (r=0.37, 95% CI: 0.24 to 0.49; p<0.001) and the EHFScBS (r=-0.14; 95% CI: -0.28 to -0.004). The Cast-Span HFS-HLS showed that overall HL scores were significantly lower in older, female, and individuals with lower educational attainment (p<0.001). The Cast-Span HFS-HLS is valid and reliable instrument that can usefully test health literacy in community-dwelling patients with heart failure. • Heart failure patients' poor health literacy hinders self-care, raising hospitalization • The Spanish Heart Failure-Specific Health Literacy Scale is valid and reliable instrument • This instrument includes semantic and cultural adaptations for the Spanish population • Screening for low Health literacy in clinical practice helps identify patients at risk for poor health outcomes • Older patients, females and those with lower educational attainment have limited Health literacy compared to younger patients, males and those with higher levels of education. • Heart Failure patients can benefit from a Health literacy assessment to tailor interventions for improve self-care