Health literacy in Peru: Transcultural adaptation and validation of a brief instrument adapted from HLS-EU-Q47

OBJECTIVE: To analyze the psychometric properties of the abbreviated version of HLS-EU-Q47 in the Peruvian population. DESIGN: Cross-sectional analytical design. SETTING: Two capital cities in the northern region of Peru. PARTICIPANTS: 1196 male and female residents aged 18-59. INTERVENTIONS: The translation and back-translation processes into the local language of the instrument under study were carried out. It was subsequently tested with a focus group, after which the final version was finalized. MAIN OUTCOME: Both exploratory and confirmatory construct validation of an abbreviated version of the HLS-EU-Q47 were conducted. RESULTS: The abbreviated version showed adequate internal consistency (McDonald's Omega) and a well-defined three-factor structure. Exploratory factor analysis yielded 12 items grouped into functional literacy, critical literacy, and health promotion/action, explaining 68% of the total variance, with strong factor loadings (0.58-0.95) and adequate communalities (0.58-0.82). Confirmatory factor analysis supported the three-factor correlated model showing adequate goodness-of-fit indices and confirming the structural validity of the instrument (Comparative Fit Index, CFI=0.970; Tucker-Lewis Index, TLI=0.961; Standardized Root Mean Square Residual, SRMR=0.056); although Root Mean Square Error of Approximation, RMSEA was elevated (0.096), consistent with parsimonious models. Additionally, factorial invariance across sex and age groups was confirmed (ΔCFI≤0.001; ΔRMSEA≤0.006), supporting the stability and comparability of the instrument. CONCLUSION: The short version of 12 items of the HLS-EU is a valid and reliable tool for the Peruvian population and is theoretically more powerful for integrating the functional and critical levels of health literacy.