Adaptation of the All Aspects of Health Literacy Scale (AAHLS) for Karen refugees: factor analysis

ABSTRACT

Health literacy has been identified as a significant predictor of healthcare utilization among refugee and immigrant communities. Considering its potential impact on their health outcomes, accurately measuring levels of health literacy among limited English proficiency (LEP) populations is an important area of investigation. This study examined the psychometric properties of a modified version of the All Aspects of Health Literacy Scale (AAHLS), based on Nutbeam’s model of health literacy, using an exploratory factor (EFA) and confirmatory factor (CFA) analysis among a sample of Karen refugees, an ethnic minority group from Burma. Results of the EFA confirmed a 3-factor model in our sample. CFA results indicated good model fits, demonstrating a promising use of the AAHLS in assessing health literacy among Karen refugees. The findings of this study support the validity of using this measure among this population and suggest some necessary adjustments to incorporate factors unique to the refugee experience that may affect the interpretation and application of items in the AAHLS. Further replication using other LEP samples is necessary to confirm the psychometric properties of the AAHLS and its ability to assess health literacy using Nutbeam’s theoretical model of health literacy.

KEYWORDS:

• Health literacy
• Karen refugees
• factor analysis

Acknowledgements

The authors would like to express our thanks to the members of the research team: Aye Bay Na Sa, Lahmay Paw, Hsa Tha Blay Wah, and LaeYudra Greely for conducting interviews, Biplab Sudhin Bhattacharya, Omeed Fathi, Mary Keovisai, and Qian Zhang for their help in the interview process, Carmen Zhang for data entry, and ThinThin Conlon, Daniel Leong, and Faustina Palmatier for their role as community advisors. We also want to acknowledge Dr. Li Lin, a retired Professor of Industrial and Systems Engineering at UB, who was instrumental in getting the project off the ground. Most importantly, we want to thank the Karen Society of Buffalo for their support and all the Karen community members who participated in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was partially funded by the Buffalo Center for Social Research Les Brun Research Endowment Fund, Community for Global Health Equity Seed Grant, and HomeBASE funding from the University at Buffalo.