Background
Original | Developed by: | HLS19 version | Revised by: |
---|---|---|---|
HLS-EU-Q47 | HLS-EU Consortium (2012) [20] | HLS19-Q47 | HLS19 Consortium (2021) [19] |
HLS-EU-Q16 | HLS-EU Consortium (2012) [20] | HLS19-Q16 | HLS19 Consortium (2021) [19] |
Short version | Suggested by: | HLS19 version | Validated by: |
HLS-Q12 | Finbråten et al. (2018) [21] | HLS19-Q12-NO | Le et al. (2021) [22] |
HLS-SF12 | Duong et al. (2019) [23] | HLS19-SF12 | Present study |
HLS19 version | Suggested by: | ||
HLS19-Q12 | HLS19 Consortium (2021) [19] | ||
HLS19-YP12 | Present study |
Methods
Sampling and data collection
Characteristics of the participants
Characteristic | n (%), n = 890a | n (%), n = 419b |
---|---|---|
Age | ||
16-20yo | 436 (49.0) | 230 (54.9) |
21-25yo | 454 (51.0) | 189 (45.1) |
Gender | ||
Male | 459 (51.6) | 209 (49.9) |
Education | ||
Below and equal to upper secondary school | 684 (76.9) | 324 (77.3) |
Above upper secondary school | 201 (22.6) | 93 (22.2) |
Missing | 5 (0.6) | 2 (0.5) |
Economic deprivation | ||
Yes | 90 (10.1) | 43 (10.3) |
No | 704 (79.1) | 334 (79.7) |
Missing | 96 (10.8) | 42 (10.0) |
Social status | ||
1–5 | 245 (27.5) | 117 (27.9) |
6–10 | 591 (66.4) | 273 (65.2) |
Missing | 54 (6.1) | 29 (6.9) |
Long-term illness | ||
Yes | 204 (22.9) | 99 (23.6) |
No | 682 (76.6) | 318 (75.9) |
Missing | 4 (0.4) | 2 (0.5) |
Health status | ||
Mostly healthy | 777 (87.3) | 370 (88.3) |
Increased risk or having chronic health problem | 106 (11.9) | 47 (11.2) |
Missing | 7 (0.8) | 2 (0.5) |
Measures, translation, and cultural adaptations
The HLS19-Q47 and its 12-item short versions
Translation and cultural adaptation of the HLS19-Q47
Pilot testing of the instruments
Model estimation
Rasch modelling
Confirmatory factor modelling
Item no. and in HLS19-Q47 | On a scale from very easy to very difficult, how easy would you say it is to | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1: HL04 | …find out where to get professional help when you are ill? [Instructions: such as doctor, nurse, pharmacist, psychologist] | 1.000 | .353 | .302 | .409 | .260 | .282 | .306 | .294 | .257 | .252 | .253 | .354 |
2: HL07 | …understand information about what to do in a medical emergency? | .353 | 1.000 | .381 | .383 | .377 | .360 | .451 | .359 | .359 | .321 | .303 | .363 |
3: HL10 | …judge the advantages and disadvantages of different treatment options? | .302 | .381 | 1.000 | .474 | .303 | .358 | .417 | .259 | .437 | .377 | .362 | .312 |
4: HL13 | …use information your doctor gives to you to make decisions about your illness? | .409 | .383 | .474 | 1.000 | .313 | .374 | .409 | .342 | .378 | .360 | .333 | .402 |
5: HL18 | …find information on how to handle mental health problems? [Instructions: stress, depression, or anxiety] | .260 | .377 | .303 | .313 | 1.000 | .322 | .334 | .262 | .286 | .292 | .281 | .304 |
6: HL23 | …understand information about recommended health screenings or examinations? [Instructions: e.g., colorectal cancer screening, measuring blood pressure, blood sugar test] | .282 | .360 | .358 | .374 | .322 | 1.000 | .427 | .375 | .327 | .406 | .361 | .325 |
7: HL26 | …judge which vaccinations, you or your family may need? | .306 | .451 | .417 | .409 | .334 | .427 | 1.000 | .436 | .340 | .274 | .326 | .360 |
8: HL30 | …decide how you can protect yourself from illness using advice from family or friends? | .294 | .359 | .259 | .342 | .262 | .375 | .436 | 1.000 | .319 | .286 | .253 | .266 |
9: HL36 | …find information about how to promote health at work, at school or in the neighborhood? | .257 | .359 | .437 | .378 | .286 | .327 | .340 | .319 | 1.000 | .338 | .428 | .446 |
10: HL38 | …understand information on food packaging? | .252 | .321 | .377 | .360 | .292 | .406 | .274 | .286 | .338 | 1.000 | .190 | .316 |
11: HL41 | …judge how your neighborhood may affect your health and well-being? [Instructions: Your community, your neighborhood] | .253 | .303 | .362 | .333 | .281 | .361 | .326 | .253 | .428 | .190 | 1.000 | .334 |
12: HL46 | …influence your living conditions that affect your health and well-being? [Instructions: Drinking and eating habits, exercise etc.] | .354 | .363 | .312 | .402 | .304 | .325 | .360 | .266 | .446 | .316 | .334 | 1.000 |
N | 406 | 399 | 393 | 403 | 407 | 406 | 403 | 409 | 401 | 411 | 398 | 405 | |
Percentage (%) distribution of “very difficult” responses | 2 | 3 | 3 | 1 | 6 | 1 | 2 | 2 | 2 | 2 | 6 | 2 | |
Percentage (%) distribution of “difficult” responses | 12 | 23 | 40 | 19 | 36 | 15 | 31 | 24 | 32 | 20 | 40 | 17 | |
Percentage (%) distribution of “easy” responses | 42 | 53 | 46 | 59 | 43 | 54 | 46 | 54 | 52 | 47 | 42 | 59 | |
Percentage (%) distribution of “very easy” responses | 44 | 21 | 12 | 21 | 15 | 30 | 21 | 20 | 14 | 30 | 11 | 22 |
Developing the HLS19-YP12
Handling missing data
Results
Descriptive statistics and correlations between the items of HLS19-YP12
Overall data-model fit and unidimensionality of 12-item short versions
HLS19-YP12 | HLS19-Q12 | HLS19-SF12 | HLS19-Q12-NO | |
---|---|---|---|---|
Present study | HLS19 Consortium (2021) [19] | Duong et al. (2019) [23] | Finbråten et al. (2018) [21] | |
Unidimensionality t-tests (CI)RUMM | ||||
Number significant tests | 16 | 27 | 34 | 17 |
Out of: | 415 | 413 | 414 | 414 |
Dim(%) | 3.86% | 6.54% | 8.21% | 4.11% |
Proportion lower 95% CI | 1.8% | 4.4% | 6.1% | 2.0% |
Chi-square interactionRUMM | ||||
Total item chi-square | 49.54 | 72.11 | 56.72 | 61.17 |
df | 48 | 48 | 48 | 48 |
Probability | 0.41 | 0.01 a | 0.18 | 0.10 |
Mean (SD) in logitsRUMM | ||||
Item fit residual | 0.12 (1.01) | -0.01 (1.08) | 0.17 (1.07) | 0.04 (1.08) |
Person fit residual | -0.40 (1.46) | -0.41 (1.40) | -0.36 (1.31) | -0.36 (1.34) |
Mean person location in logitsRUMM | 1.035 | 1.155 | 1.141 | 1.084 |
Reliability | ||||
Omega (by Excel-based tool)Mplus | 0.86 | 0.85 | 0.84 | 0.84 |
PSI based on PMLERUMM | 0.82 | 0.81 | 0.81 | 0.79 |
PSR (MMLE/WLE)CQ | 0.829/0.827 | 0.816/0.815 | 0.812/0.809 | 0.809/0.808 |
Log-likelihoodsCQ | ||||
Deviance (ep) | 9,659 (37) | 9,666 (37) | 9,679 (37) | 9,772 (37) |
AIC (ep) | 9,733 (37) | 9,740 (37) | 9,753 (37) | 9,846 (37) |
Exploring dimensionality by using confirmatory factor analysis
Model | Short version | \({{\varvec{\chi}}}_{{\varvec{M}}}^{2}\boldsymbol{ }({\varvec{d}}{\varvec{f}}),\boldsymbol{ }{\varvec{p}}\) | SRMR | \({\varvec{N}}{\varvec{o}}.{{\varvec{r}}}_{{\varvec{r}}{\varvec{e}}{\varvec{s}}}\) \((>.10)\) | RMSEA (CI) | CFI/TLI |
---|---|---|---|---|---|---|
one-factor | HLS19-YP12 | 135.48 (54), .000 | .030 | none | .039 (.024-.053) | .985/.981 |
HLS19-Q12 | 174.13 (54), .000 | .039 | 6 (-.18 – .14) | .057 (.044-.070) | .963/.955 | |
HLS19-SF12 | 211.74 (54), .000 | .052 | 9 (-.17 – .17) | .078 (.066-.090) | .926/.909 | |
HLS19-Q12-NO | 174.42 (54), .000 | .042 | 5 (-.20 – .14) | .061 (.048-.074) | .958/.948 | |
three-factor: HC,DP,HP | HLS19-YP12 | 115.20 (51), .000 | .028 | 1 (-.13) | .034 (.015-.049) | .989/.986 |
HLS19-Q12 | 163.64 (51), .000 | .037 | 3 (-.15 – .12) | .054 (.040-.067) | .969/.959 | |
HLS19-SF12 | 188.16 (51), .000 | .047 | 10 (-.14 – .13) | .072 (.060-.085) | .940/.922 | |
HLS19-Q12-NO | 164.96 (51), .000 | .039 | 5 (-.18 – .12) | .057 (.044-.070) | .965/.955 |
HLS19-YP12 | HLS19-Q12 | HLS19-SF12 | HLS19-Q12-NO | ||||
---|---|---|---|---|---|---|---|
Present study | HLS19 Consortium (2021) [19] | Duong et al. (2019) [23] | Finbråten et al. (2018) [21] | ||||
Item no | F1 | Item no | F1 | Item no | F1 | Item no | F1 |
COREHL4 | .513 | COREHL4 | .572 | COREHL2 | .429 | COREHL2 | .394 |
COREHL7 | .627 | COREHL7 | .594 | COREHL6 | .505 | COREHL7 | .573 |
COREHL10 | .630 | COREHL10 | .536 | COREHL10 | .518 | COREHL10 | .544 |
COREHL13 | .658 | COREHL16 | .645 | COREHL15 | .566 | COREHL14 | .597 |
COREHL18 | .513 | COREHL18 | .532 | COREHL18 | .525 | COREHL18 | .566 |
COREHL23 | .613 | COREHL23 | .617 | COREHL23 | .637 | COREHL23 | .616 |
COREHL26 | .648 | COREHL24 | .569 | COREHL26 | .618 | COREHL28 | .430 |
COREHL30 | .538 | COREHL31 | .425 | COREHL30 | .576 | COREHL30 | .532 |
COREHL36 | .620 | COREHL32 | .562 | COREHL33 | .519 | COREHL32 | .591 |
COREHL38 | .535 | COREHL37 | .622 | COREHL39 | .588 | COREHL38 | .605 |
COREHL41 | .542 | COREHL42 | .550 | COREHL43 | .601 | COREHL43 | .618 |
COREHL46 | .588 | COREHL44 | .602 | COREHL45 | .534 | COREHL44 | .582 |
Rasch analyses at item level for HLS19-YP12, HLS19-Q12, HLS19-SF12, and HLS19-Q12-NO
Individual item fit
HD | CD | Item no | RW in HLS19 | Item:On a scale from very difficult to very easy, how easy would you say it is: | 1-dimensional analysis HLS19- YP12 | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
ConQuest | RUMM | |||||||||||
Infitw MNSQ | CI | T- value | Item estimate | SE | Ordered | DIFa | ||||||
lb | ub | |||||||||||
HC | F | 4 | x | …to find out where to get professional help when you are ill? | 1.07 | 0.86 | 1.14 | 1.0 | -0.525 | 0.077 | yes | none |
U | 7 | x | …to understand information about what to do in a medical emergency? | 0.99 | 0.86 | 1.14 | -0.1 | 0.101 | 0.078 | yes | none | |
J | 10 | …to judge the advantages and disadvantages of different treatment options? | 0.98 | 0.87 | 1.13 | -0.3 | 0.422 | 0.084 | yes | none | ||
A | 13 | x | …to use information your doctor gives to you to make decisions about your illness? | 0.93 | 0.86 | 1.14 | -1.0 | -0.283 | 0.087 | yes | none | |
DP | F | 18 | x | …to find information on how to handle mental health problems? | 1.09 | 0.87 | 1.13 | 1.3 | 0.537 | 0.074 | yes | none |
U | 23 | x | …to understand information about recommended health screenings or examinations? | 0.92 | 0.86 | 1.14 | -1.2 | -0.481 | 0.083 | yes | none | |
J | 26 | x | …to judge which vaccinations, you or your family may need? | 0.97 | 0.87 | 1.13 | -0.5 | -0.058 | 0.079 | yes | none | |
A | 30 | x | …to decide how you can protect yourself from illness using advice from family or friends? | 1.04 | 0.87 | 1.13 | 0.5 | -0.089 | 0.081 | yes | none | |
HP | F | 36 | x | …to find information about how to promote health at work, at school or in the neighborhood? | 0.97 | 0.87 | 1.13 | -0.4 | 0.057 | 0.084 | yes | none |
U | 38 | …to understand information on food packaging? | 1.02 | 0.87 | 1.13 | 0.4 | -0.224 | 0.076 | yes | none | ||
J | 41 | x | …to judge how your neighborhood may affect your health and well-being? | 1.10 | 0.87 | 1.13 | 1.4 | 0.775 | 0.077 | yes | none | |
A | 46 | x | …to influence your living conditions that affect your health and well-being? | 0.99 | 0.86 | 1.14 | -0.1 | -0.233 | 0.085 | yes | none |
HD | CD | Item no | RW in HLS19 | Item:On a scale from very difficult to very easy, how easy would you say it is: | 1-dimensional analysis HLS19- Q12 | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
ConQuest | RUMM | |||||||||||
Infitw MNSQ | CI | T- value | Item estimate | SE | Ordered | DIFa | ||||||
lb | ub | |||||||||||
HC | F | 4 | x | …to find out where to get professional help when you are ill? | 1.00 | 0.86 | 1.14 | 0.1 | -0.410 | 0.077 | yes | LSg,b |
U | 7 | x | …to understand information about what to do in a medical emergency? | 0.99 | 0.86 | 1.14 | -0.1 | 0.239 | 0.078 | yes | none | |
J | 10 | …to judge the advantages and disadvantages of different treatment options? | 1.07 | 0.87 | 1.13 | 1.1 | 0.542 | 0.083 | yes | none | ||
A | 16 | x | …to act on advice from your doctor or pharmacist? | 0.93 | 0.84 | 1.16 | -0.9 | -0.542 | 0.086 | no | none | |
DP | F | 18 | x | …to find information on how to handle mental health problems? | 1.06 | 0.87 | 1.13 | 0.9 | 0.676 | 0.074 | yes | none |
U | 23 | x | …to understand information about recommended health screenings or examinations? | 0.93 | 0.86 | 1.14 | -1.0 | -0.334 | 0.083 | yes | none | |
J | 24 | x | …to judge if information on unhealthy habits, such as smoking, low physical activity or drinking too much alcohol, are reliable? | 0.99 | 0.87 | 1.13 | -0.1 | -0.231 | 0.078 | yes | none | |
A | 31 | x | …to decide how you can protect yourself from illness using information from the mass media? | u1.14 | 0.87 | 1.13 | u2.1 | 0.693 | 0.079 | yes | Full-CInb | |
HP | F | 32 | x | …to find information on healthy lifestyles such as physical exercise, healthy food, or nutrition? | 1.02 | 0.87 | 1.13 | 0.3 | -0.405 | 0.074 | yes | none |
U | 37 | x | …to understand advice concerning your health from family or friends? | 0.95 | 0.85 | 1.15 | -0.7 | -0.347 | 0.089 | yes | none | |
J | 42 | x | …to judge how your housing conditions may affect your health and well-being? | 1.08 | 0.86 | 1.14 | 1.2 | 0.084 | 0.075 | yes | Full-CI | |
A | 44 | x | …to make decisions to improve your health and well-being? | 1.00 | 0.87 | 1.13 | 0.0 | 0.035 | 0.077 | yes | none |
HD | CD | Item no | RW in HLS19 | Item:On a scale from very difficult to very easy, how easy would you say it is: | 1-dimensional analysis HLS19-SF12 | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
ConQuest | RUMM | |||||||||||
Infitw MNSQ | CI | T- value | Item estimate | SE | Ordered | DIFa | ||||||
lb | ub | |||||||||||
HC | F | 2 | …to find information on treatments of illnesses that concern you? | 1.06 | 0.86 | 1.14 | 0.8 | 0.214 | 0.083 | yes | none | |
U | 6 | x | …to understand the instruction leaflets that come with your medicine? | 1.06 | 0.87 | 1.13 | 0.9 | 0.042 | 0.075 | yes | Hg,b | |
J | 10 | …to judge the advantages and disadvantages of different treatment options? | 1.03 | 0.87 | 1.13 | 0.5 | 0.527 | 0.083 | yes | none | ||
A | 15 | x | …to call an ambulance in a medical emergency? | 0.98 | 0.82 | 1.18 | -0.2 | -0.425 | 0.077 | no | none | |
DP | F | 18 | x | …to find information on how to handle mental health problems? | 1.04 | 0.87 | 1.13 | 0.7 | 0.673 | 0.073 | yes | none |
U | 23 | x | …to understand information about recommended health screenings or examinations? | 0.94 | 0.86 | 1.14 | -0.9 | -0.352 | 0.083 | yes | none | |
J | 26 | x | …to judge which vaccinations, you or your family may need? | 0.99 | 0.88 | 1.12 | -0.2 | 0.097 | 0.078 | yes | none | |
A | 30 | x | …to decide how you can protect yourself from illness using advice from family or friends? | 1.00 | 0.87 | 1.13 | 0.0 | 0.065 | 0.081 | yes | none | |
HP | F | 33 | x | …to find information about activities that are good for your mental health and well-being? | 1.08 | 0.88 | 1.12 | 1.3 | -0.587 | 0.077 | yes | none |
U | 39 | x | …to understand information in the mass media on how to improve your health? | 0.98 | 0.87 | 1.13 | -0.2 | 0.212 | 0.081 | yes | none | |
J | 43 | x | …to judge which everyday habits affect your health? | 0.95 | 0.86 | 1.14 | -0.7 | -0.482 | 0.083 | yes | none | |
A | 45 | x | …to join a sports club or exercise group if you want to be physically active? | 1.08 | 0.87 | 1.13 | 1.1 | 0.015 | 0.068 | yes | LTc |
HD | CD | Item no | RW in HLS19 | Item:On a scale from very difficult to very easy, how easy would you say it is: | 1-dimensional analysis HLS19- Q12-NO | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
ConQuest | RUMM | |||||||||||
Infitw MNSQ | CI | T- value | Item estimate | SE | Ordered | DIFa | ||||||
lb | ub | |||||||||||
HC | F | 2 | …to find information on treatments of illnesses that concern you? | 1.10 | 0.86 | 1.14 | 1.3 | 0.173 | 0.082 | yes | none | |
U | 7 | x | …to understand information about what to do in a medical emergency? | 1.00 | 0.86 | 1.14 | 0.0 | 0.187 | 0.077 | yes | none | |
J | 10 | …to judge the advantages and disadvantages of different treatment options? | 1.02 | 0.87 | 1.13 | 0.3 | 0.501 | 0.082 | yes | none | ||
A | 14 | …to follow instructions on medication? | 0.98 | 0.86 | 1.14 | -0.2 | -0.668 | 0.082 | yes | LSb | ||
DP | F | 18 | x | …to find information on how to handle mental health problems? | 1.01 | 0.87 | 1.13 | 0.1 | 0.619 | 0.073 | yes | none |
U | 23 | x | …to understand information about recommended health screenings or examinations? | 0.94 | 0.86 | 1.14 | -0.9 | -0.390 | 0.082 | yes | none | |
J | 28 | x | …to judge if the information on health risks in the mass media is reliable? | 1.13 | 0.87 | 1.13 | 1.9 | 0.660 | 0.075 | yes | none | |
A | 30 | x | …to decide how you can protect yourself from illness using advice from family or friends? | 1.03 | 0.87 | 1.13 | 0.5 | 0.003 | 0.081 | yes | none | |
HP | F | 32 | x | …to find information on healthy lifestyles such as physical exercise, healthy food, or nutrition? | 1.00 | 0.87 | 1.13 | 0.0 | -0.449 | 0.074 | yes | none |
U | 38 | …to understand information on food packaging? | 0.96 | 0.87 | 1.13 | -0.6 | -0.128 | 0.075 | yes | none | ||
J | 43 | x | …to judge which everyday habits affect your health? | 0.94 | 0.86 | 1.14 | -0.9 | -0.500 | 0.082 | yes | none | |
A | 44 | x | …to make decisions to improve your health and well-being? | 1.00 | 0.87 | 1.13 | 0.0 | -0.008 | 0.076 | yes | none |