Cultural adaptation and validity testing of the Portuguese version of the Health Literacy Questionnaire (HLQ)

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BACKGROUND: Health literacy is considered a determinant of self-management behaviors and health outcomes among people with diabetes. The assessment of health literacy is central to understanding the health needs of a population. This study aimed to adapt the Health Literacy Questionnaire (HLQ) to the Portuguese context and to examine the psychometric properties of a population of people with diabetes.

METHODS: Data were collected using a self-administrated questionnaire from 453 people with diabetes in a specialized diabetes care unit. Analysis included item difficulty level, composite scale reliability, and confirmatory factor analysis (CFA).

RESULTS: The HLQ showed that the items were easily understood by participants. Composite reliability ranged from 0.74 to 0.83. A nine-factor CFA model was fitted to the 44 items. Given the very restricted model, the fit was quite satisfactory [χ2wlsmv = 2147.3 (df = 866), p = 0.001; CFI = 0.931, TLI = 0.925, RMSEA = 0.057 (90% C.I. 0.054-0.060), and WRMR = 1.528].

CONCLUSION: The Portuguese version of the HLQ has shown satisfactory psychometric properties across its nine separate scales in people with diabetes. Given the strong observed properties of the HLQ across cultures, languages, and diseases, the HLQ is likely to be a useful tool in a range of Portuguese settings.

Original languageEnglish
Article number6465
JournalInternational Journal of Environmental Research and Public Health
Issue number11
Publication statusPublished - 26 May 2022


  • Health Literacy
  • Humans
  • Language
  • Portugal
  • Psychometrics
  • Reproducibility of Results
  • Surveys and Questionnaires


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