Development of an item bank of health literacy questions appropriate for limited literacy public sector patients in South Africa

ABSTRACT

The majority of current health literacy measures emanate from high-income countries. In South Africa, there is no appropriate measure available for use by the diverse public sector population, many of whom have some literacy limitations. The objective was to develop a bank of questions for this population informed by a broader definition of health literacy, which acknowledges both traditional cognitive skills and explores the influence of the collective social environment on health literacy. Thirty questions for the Item Bank were developed to ensure cultural, contextual and educational appropriateness, and were continuously subjected to critical review by an expert consultant panel. Patients (n = 120) were recruited from a local primary care clinic and individually interviewed with the assistance of an interpreter to collect data on the Item Bank, Multidimensional Screener of Functional Health Literacy (MSFHL) and sociodemographics. The mean Item Bank score was 55% ± 11.3%. A high 82.5% was categorized as having either inadequate or marginal health literacy. Skills-based questions, particularly numeracy questions, were poorly answered. A significant education effect was established with 8/30 questions. The Procedural knowledge domain had the lowest score, but was not significantly different to the Access and Factual domain scores. The questions afforded preliminary insight into health literacy in a previously unstudied population and clearly demonstrated the need to include questions that did not rely solely on cognitive skills. Study findings provided an ideal base for further question refinement to generate a health literacy measure suitable for this population.

KEYWORDS:

• Health literacy
• South Africa
• public sector
• validity
• instrument development

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics approval

The study was approved by Rhodes University Faculty of Pharmacy Ethics Committee and the Eastern Cape Department of Health.

Notes on contributors

Chipiwa Marimwe, BPharm, is an MPharm graduate student in the Faculty of Pharmacy at Rhodes University in Grahamstown, South Africa. Her research focuses on measures to assess health literacy in limited literacy multilingual public sector patients in South Africa.

Ros Dowse, BPharm, PhD, is an academic pharmacist in the Faculty of Pharmacy at Rhodes University in Grahamstown, South Africa. Her research is grounded in health communication, with a focus on developing written health and medicine-related information and pictograms to facilitate provider–patient communication, where limited literacy, language, and culture constitute communication barriers. She has worked in health literacy, modifying and testing health literacy measures, and is involved in the development of a health literacy test appropriate for use in South Africa.

ORCID

Ros Dowse http://orcid.org/0000-0001-9065-6668

Additional information

Funding

Financial support for the study was received from Rhodes University.