# Health literacy: psychometric properties of the HLS-EU-Q16 questionnaire in a Peruvian adult population

## TL;DR

This study validates a health literacy questionnaire in Peru and finds significant inequalities linked to education, income, and access to health services.

## Contribution

The study confirms the validity and reliability of the HLS-EU-Q16 questionnaire in a Peruvian population and identifies sociodemographic disparities in health literacy.

## Key findings

- The HLS-EU-Q16 questionnaire has a three-dimensional structure with excellent psychometric properties in Peruvian adults.
- Health literacy is significantly higher in regions with better access to health services and among those with higher education and income.
- Health literacy decreases with age and is not significantly influenced by sex or ethnicity.

## Abstract

Health literacy is a key component of public health because it is related to quality of life, chronic disease management, and trust in health services, yet it must be measured with reliable instruments.

To evaluate the validity and reliability of the Health Literacy Survey European Questionnaire’s short version (HLS-EU-Q16) in Peruvian adults and to analyze health literacy according to sociodemographic variables.

A cross-sectional psychometric validation study was conducted with 438 participants aged 18 to 80 years using convenience sampling. The culturally adapted HLS-EU-Q16 was administered online; its psychometric properties were analyzed using confirmatory factor analysis and reliability coefficients. Differences in literacy according to sociodemographic characteristics were evaluated using ANOVA and Pearson’s correlations.

Confirmatory factor analysis confirmed the three-dimensional structure (health care, disease prevention, and health promotion) with excellent fit indices (CFI = 0.99, TLI = 0.99, RMSEA = 0.02, SRMR = 0.04). Internal consistency was high (α = 0.95; ω = 0.96). Significant differences in health literacy were found according to region (coast > highlands, p < 0.001), educational level (higher education > primary education, p < 0.001), income (higher income > lower income, p < 0.001), and access to health services (shorter travel time > longer travel time, p < 0.001). Health literacy decreased with age (r = −0.13, p < 0.001) and was higher in people with greater access and economic stability. No significant differences were observed by sex or ethnicity.

The HLS-EU-Q16 demonstrates excellent validity and reliability for assessing health literacy in Peru. Significant health-literacy inequalities were identified, influenced by education, income, and access to services. These findings highlight the need for targeted strategies to improve health literacy and reduce disparities in access to and use of health information.