Validation of the Short-Form Health Literacy Questionnaire (HLS-SF12) and Its Determinants among People Living in Rural Areas in Vietnam

Health literacy (HL) is an important factor in improving health inequalities in poor and marginalized groups. Assessing comprehensive HL is critical. In this study, we validated the use of a comprehensive short-form HL survey tool (HLS-SF12) and examined the determinants of HL among people in rural areas. A cross-sectional study was conducted in July 2019 on 440 people residing in mountainous areas in Vietnam. Health literacy was measured using the HLS-SF12. Personal characteristics were also collected. We analyzed data using confirmatory factor analysis, internal consistency analysis, and regression analysis. The questionnaire demonstrated a good construct validity with satisfactory goodness-of-fit indices and item-scale convergent validity. The tool was reliable and homogeneous with Cronbach's alpha = 0.79, with no floor/ceiling effects. People who were married had lower HL (regression coefficient B = -3.12; 95% confidence interval (CI) = -5.69, -0.56; = 0.017) compared with those who never married. Higher education attainment (B = 3.41 to 10.44; < 0.001), a better ability to pay for medication (B = 4.17 to 9.89; < 0.001), and a tendency to view health-related TV/radio more often (B = 5.23 to 6.15; < 0.001) were associated with higher HL. The HLS-SF12 is a valid survey tool for the evaluation of HL in rural populations. A number of personal characteristics were strongly associated with HL.