Objective: The benefit of health literacy (HL) on adopting a healthy lifestyle is well established and enhancing HL as part of regular health checkups contributes to the prevention of lifestyle-related diseases. Tuned health advices requires preliminary assessment of HL. To balance evaluation precision and cumbersomeness, we aimed to find the most parsimonious questionnaire for our checkups.

 Methods: Participants (n = 714 with 55% female, 51.2 ± 10.9 years old) were recruited among the examinees who visited our checkups, and a cross-sectional survey was conducted by using the Japanese version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47). Three short versions of HLS-EU-Q47 (HLS-Q12, HL-SF12, and HLS-EU-Q16), were explored using confirmatory factor analysis (CFA) to assess dimensionality and factorial validity together with Rasch analysis (RA) to provide detailed information at the item level.

 Results: Using likelihood-ratio tests, we found that all three short versions were better fit under a three-dimensional Rasch model (health care, disease prevention and health promotion) than one-dimensional one. All of them were above threshold for person separation reliability (PSR > 0.65), with only moderate loss of separation compared to HLS-EU-Q47. CFA supported the factor structure of the three domains, and HLS-Q12 has the best goodness-of-fit indices.

 Conclusions: Among the parsimonious questionnaire that we compared, HLS-Q12 is the best candidate, meeting the assumptions and the requirements of objective measurement while offering clinically feasible screening during regular checkups. In the next phase, we will evaluate the benefit of using individual's HL to tune life-style improvement advice.