Background
Methods
Data sources
Data analysis
Composite scale reliability and homogeneity
Discriminant validity
Bayesian structural equation modelling
Fit indices used in Bayesian structural equation modelling
Population heterogeneity and measurement invariance
Results
Reliability and homogeneity of the HLQ scales
Scale | Model | PPP Value | 95 % Cis for the difference between observed and replicated chi-square values | Standardised factor loadings from ‘Wiggle Room’ analysis | Range of residual correlations in ‘Wiggle Room’ analysis | Composite reliability (α in parentheses) |
---|---|---|---|---|---|---|
1. Feeling understood and supported by healthcare providers | No residual correlations | 0.35 | −12.45–18.83 | P1Q2 = 0.80; P1Q8 = 0.90; P1Q17 = 0.76; P1Q22 = 0.90. | −0.12 to 0.01 | 0.86 (0.86) |
Residual correlations estimated | 0.51 | −14.98–14.02 | ||||
2. Having sufficient information to manage my health | No residual correlations | 0.33 | −11.95–21.30 | P1Q1 = 0.67; P1Q10 = 0.82; P1Q14 = 0.89; P1Q23 = 0.91. | −0.09 to 0.15 | 0.85 (0.84) |
Residual correlations estimated | 0.52 | −15.12–16.15 | ||||
3. Actively managing my health | No residual correlations | 0.34 | −16.17–24.69 | P1Q3 = 0.69; P1Q5 = 0.79; P1Q11 = 0.84; P1Q18 = 0.81; P1Q86 = 0.86. | −0.13 to 0.17 | 0.85 (0.85) |
Residual correlations estimated | 0.52 | −17.79–14.79 | ||||
4. Social support for health | No residual correlations | 0.00 | 13.41–64.96 | P1Q3 = 0.68; P1Q5 = 0.66; P1Q11 = 0.94; P1Q15 = 0.55; P1Q19 = 0.81. | −0.17 to 0.32 (0.32 = P1Q15/P1Q19) | 0.80 (0.80) |
Residual correlations estimated | 0.51 | −17.18–16.38 | ||||
5. Appraisal of health information | No residual correlations | 0.18 | −11.55–30.15 | P1Q4 = 0.72; P1Q7 = 0.74; P1Q12 = 0.82; P1Q16 = 0.67; P1Q20 = 0.62. | −0.13 to 0.17 | 0.81 (0.81) |
Residual correlations estimated | 0.49 | −16.92–18.23 | ||||
6. Ability to actively engage with healthcare providers | No residual correlations | 0.04 | −2.12–42.10 | P2Q2 = 0.81; P2Q4 = 0.85; P2Q7 = 0.83; P2Q15 = 0.85; P2Q20 = 0.87. | −0.23 to 0.19 | 0.89 (0.89) |
Residual correlations estimated | 0.52 | −18.00–17.28 | ||||
7. Navigating the healthcare system | No residual correlations | 0.02 | 1.79–49.19 | P2Q1 = 0.76; P2Q8 = 0.77; P2Q11 = 0.82; P2Q13 = 0.91; P2Q16 = 0.73; P2Q19 = 0.66 | −0.09 to 0.24 | 0.87 (0.87) |
Residual correlations estimated | 0.51 | −20.40─20.45 | ||||
8. Ability to find good health information | No residual correlations | 0.01 | −3.89–47.04 | P2Q3 = 0.80; P2Q6 = 0.79; P2Q10 = 0.84; P2Q14 = 0.66; P2Q18 = 0.72 | −0.19 to 0.14 | 0.84 (0.84) |
Residual correlations estimated | 0.50 | −17.82–17.67 | ||||
9. Understanding health information well enough to know what to do | No residual correlations | 0.00 | 18.17–68.47 | P2Q5 = 0.82; P2Q9 = 0.60; P2Q12 = 0.89; P2Q17 = 0.81; P2Q21 = 0.74. | −0.16 to 0.35 (0.35 = P2Q9/P2Q21) | 0.85 (0.83) |
Residual correlations estimated | 0.50 | −17.98–18.52 |
Replicating the nine-factor structure of the HLQ
Item | 1. Understood | 2. Sufficient information | 3. Active management | 4. Social support | 5. Appraisal | 6. Active engagement | 7. Navigate | 8. Good information | 9. Understand information |
---|---|---|---|---|---|---|---|---|---|
P1Q2 | 0.83 | ||||||||
P1Q8 | 0.93 | ||||||||
P1Q17 | 0.53 | 0.17 | −0.10 | ||||||
P1Q22 | 0.86 | ||||||||
P1Q1 | 0.39 | ||||||||
P1Q10 | 0.65 | ||||||||
P1Q14 | 0.92 | ||||||||
P1Q23 | 0.88 | ||||||||
P1Q6 | 0.72 | ||||||||
P1Q9 | 0.78 | ||||||||
P1Q13 | 0.92 | ||||||||
P1Q18 | 0.81 | ||||||||
P1Q21 | 0.96 | ||||||||
P1Q3 | 0.18 | 0.55 | |||||||
P1Q5 | 0.68 | ||||||||
P1Q11 | 0.93 | ||||||||
P1Q15 | 0.70 | ||||||||
P1Q19 | 1.02 | ||||||||
P1Q4 | 0.76 | ||||||||
P1Q7 | 0.78 | ||||||||
P1Q12 | 0.86 | ||||||||
P1Q16 | 0.19 | 0.47 | 0.09 | 0.09 | 0.09 | ||||
P1Q20 | 0.15 | 0.48 | |||||||
P2Q2 | 0.71 | ||||||||
P2Q4 | 0.78 | ||||||||
P2Q7 | 0.75 | ||||||||
P2Q15 | 0.77 | ||||||||
P2Q20 | 0.83 | ||||||||
P2Q1 | 0.68 | ||||||||
P2Q8 | 0.88 | −0.13 | |||||||
P2Q11 | 0.89 | ||||||||
P2Q13 | 0.78 | ||||||||
P2Q16 | 0.57 | ||||||||
P2Q19 | −0.16 | 0.62 | |||||||
P2Q3 | 0.86 | ||||||||
P2Q6 | 0.14 | 0.84 | |||||||
P2Q10 | 0.92 | ||||||||
P2Q14 | 0.22 | 0.40 | 0.29 | ||||||
P2Q18 | −0.16 | 0.22 | 0.41 | 0.20 | |||||
P2Q5 | 0.14 | 0.14 | 0.63 | ||||||
P2Q9 | 0.15 | 0.17 | 0.15 | 0.22 | |||||
P2Q12 | 0.08 | 0.83 | |||||||
P2Q17 | 0.76 | ||||||||
P2Q21 | 0.25 | 0.25 | 0.36 |
1. Understood | 2. Sufficient information | 3. Active management | 4. Social support | 5. Appraisal | 6. Active engagement | 7. Navigate | 8. Good information | 9. Understand information | |
---|---|---|---|---|---|---|---|---|---|
1. Feeling understood and supported by healthcare providers |
0.63
| 0.45 | 0.27 | 0.51 | 0.12 | 0.41 | 0.30 | 0.16 | 0.02 |
2. Having sufficient information to manage my health | 0.67* |
0.55
| 0.38 | 0.51 | 0.19 | 0.42 | 0.39 | 0.35 | 0.03 |
3. Actively managing my health | 0.52* | 0.62* |
0.71
| 0.38 | 0.43 | 0.20 | 0.19 | 0.25 | 0.11 |
4. Social support for health | 0.71* | 0.72* | 0.62* |
0.63
| 0.18 | 0.44 | 0.41 | 0.30 | 0.05 |
5. Appraisal of health information | 0.34* | 0.44* | 0.66* | 0.42* |
0.47
| 0.08 | 0.09 | 0.26 | 0.08 |
6. Ability of actively engage with healthcare providers | 0.64* | 0.65* | 0.45* | 0.66* | 0.27 |
0.59
|
0.79
|
0.65
| 0.19 |
7. Navigating the health system | 0.55* | 0.62* | 0.44* | 0.64* | 0.30 | 0.89* |
0.56
|
0.71
| 0.27 |
8. Ability to find good health information | 0.40* | 0.59* | 0.50* | 0.55* | 0.51* | 0.80* | 0.85* |
0.53
| 0.30 |
9. Understanding health information well enough to know what to do | 0.15 | 0.16 | 0.34* | 0.21 | 0.28 | 0.43* | 0.52* | 0.54* |
0.37
|
Convergent and discriminant validity
Measurement invariance of the HLQ scales
Scale | Grouping Variable | PPP Value | 95 % CIs for the Difference between Observed and Replicated Chi-square values | Range of PPP Values Across Individual Groups |
---|---|---|---|---|
1. Feeling understood and supported by healthcare providers | Gender | 0.54 | −20.37–19.54 | 0.51–0.52 |
Age | 0.29 | −23.83–43.37 | 0.31–0.49 | |
Education | 0.26 | −21.77–46.97 | 0.19–0.49 | |
Home Language | 0.26 | −16.47–28.74 | 0.02–0.49 | |
Organisation | 0.14 | −14.24─74.27 | 0.20─0.43 | |
Comment: Strict invariance models were a satisfactory fit across all classifications and across all specific groups within these classifications. | ||||
2. Having sufficient information to manage my health | Gender | 0.37 | −18.41–22.12 | 0.40–0.41 |
Age | 0.38 | −28.33–38.36 | 0.35–0.50 | |
Education | 0.30 | −24.53─43.38 | 0.17–0.57 | |
Home Language | 0.53 | −22.80–18.07 | 0.49–0.56 | |
Organisation | 0.12 | −16.82–68.33 | 0.07–0.60 | |
Comment: Strict invariance models were a satisfactory fit across all classifications and across all specific groups within these classifications | ||||
3. Actively managing my health | Gender | 0.23 | −15.20–34.12 | 0.03–0.32 |
Age | 0.09 | −7.73–70.08 | 0.14–0.36 | |
Education | 0.22 | −26.39–58.54 | 0.24–0.54 | |
Home Language | 0.46 | −23.82–26.67 | 0.45–0.50 | |
Organisation | 0.34 | −30.59–66.52 | 0.26–0.55 | |
Comment: Strict invariance models were a satisfactory fit across all classifications and across all specific groups within these classifications. | ||||
4. Social support for health | Gender | 0.28 | −17.35–32.76 | 0.39–0.35 |
Age | 0.14 | −18.41–60.05 | 0.22–0.45 | |
Education | 0.42 | −33.56–44.89 | 0.34–0.65 | |
Home Language | 0.36 | −21.46–25.62 | 0.47–0.35 | |
Organisation | 0.12 | −20.47–79.84 | 0.10–0.58 | |
Comment: Strict invariance models were a satisfactory fit across all classifications and across all specific groups within these classifications. | ||||
5. Appraisal of health information | Gender | 0.50 | −24.74–23.86 | 0.47–0.54 |
Age | 0.61 | −41.51–29.24 | 0.41–0.65 | |
Education | 0.48 | −36.51–39.77 | 0.32–0.61 | |
Home Language | 0.11 | −10.01–43.82 | 0.08–0.47 | |
Organisation | 0.12 | −25.04–85.85 | 0.15–0.42 | |
Comment: Strict invariance models were a satisfactory fit across all classifications and across all specific groups within these classifications. | ||||
6. Ability to actively engage with healthcare providers | Gender | 0.15 | −11.89–40.68 | 0.20–0.31 |
Age | 0.11 | −14.81–70.04 | 0.12–0.48 | |
Education | 0.09 | −12.96–67.97 | 0.10–0.41 | |
Home Language | 0.18 | −13.98–38.54 | 0.12–0.47 | |
Organisation | 0.02 | 2.52–107.55 | 0.07–0.52 | |
Comment: Overall test of invariance across organisations marginally significant (indicating unsatisfactory fit) but fit was satisfactory in all groups separately. Satisfactory fit across all other classifications. Follow-up alignment analysis indicated that the loading of one item (‘Ask healthcare providers questions …’) was non-invariant in Organisation 1, being consistently higher in Organisation 1 than in other organisations. | ||||
7. Navigating the healthcare system | Gender | 0.12 | −11.90–49.41 | 0.16–0.28 - |
Age | 0.01 | 15.64–111.02 | 0.02–0.41 | |
Education | 0.02 | 4.90–99.30 | 0.12–0.26 | |
Home Language | 0.13 | −12.53–48.144 | 0.10–0.398 | |
Organisation | 0.01 | 24.17–144.22 | 0.02–0.33 | |
Comment: Fit not satisfactory across organisation, education and age groups. Follow-up alignment analyses showed: (a) that the loading of one item (‘Work out what the best care is …’) was non-invariant in Organisation 6, being consistently higher in this organisation compared with the other organisations. Alignment analysis suggested full metric and scalar invariance across education and age groups. | ||||
8. Ability to find good health information | Gender | 0.34 | −21.52–27.64 | 0.39–0.45 |
Age | 0.12 | −15.77–62.40 | 0.14–0.52 | |
Education | 0.00 | 21.38 - 104.91 | 0.00–0.35 | |
Home Language | 0.04 | −3.82–52.07 | 0.03–0.30 | |
Organisation | 0.00 | 21.78–125.37 | 0.01–0.57 | |
Comment: Fit not satisfactory across organisation, education and, marginally, home language groups. Follow-up alignment analyses showed that: (a) the loading of one item (‘Find information about health …’) was non-invariant in Organisation 4, being consistently lower in this organisation compared with all other organisations; and (b) the loading of one item (‘Get health information … you understand’) was non-invariant across the groups classified according to the language spoken at home, being higher in the group who spoke a language other than English at home. Alignment analysis suggested full metric and scalar invariance across the education groups. | ||||
9. Understanding health information well enough to know what to do | Gender | 0.31 | −19.56–31.24 | 0.31–0.44 |
Age | 0.24 | −27.09–50.95 | 0.25–0.64 | |
Education | 0.022 | 2.15 - 79.32 | 0.10–0.38 | |
Home Language | 0.16 | −13.47–42.17 | 0.36–0.16 | |
Organisation | 0.00 | 26.61–132.36 | 0.01–0.72 | |
Comment: Fit not satisfactory across organisation and education level. Follow-up analysis showed that: (a) the loadings of two items, both of which referred to understanding information from healthcare providers, were non-invariant in Organisation 8 being consistently lower in Organisation 8 that in all other organisations; and (b) the loading of one item (‘Read and understand … medication labels’ was non-invariant in Education Group 2, being higher than in Groups 3, 4 and 5, but lower than in Group 1, suggesting that this item is most salient in the ‘Understanding health information well enough to know what to do’ factor in the groups with less formal education. |