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. 2025 May 31;66(1):E9-E19.
doi: 10.15167/2421-4248/jpmh2025.66.1.3520. eCollection 2025 Mar.

Network Analysis of the HLS19-Q12 Health Literacy Questionnaire: insights from an Italian Pilot Study

Sara Maria Pani  1 , Stefania Matta  1 , Matteo Fraschini  2 , Claudia Sardu  1 , Alessandra Mereu  1 , Paolo Contu  1
Affiliations

Network Analysis of the HLS19-Q12 Health Literacy Questionnaire: insights from an Italian Pilot Study

Sara Maria Pani et al. J Prev Med Hyg. .

Abstract

Background: The widespread use of the internet and social media has transformed how people access health information impacting health literacy. Health literacy, the ability to access, understand, and use health information, is crucial to promote and maintain good health. This study is the first exploring with network analysis the correlation and distribution of the items of the Health Literacy Survey Questionnaire (HLS-Q) 12 short form to verify their correspondence to the principal domains of the health literacy conceptual model proposed by Sorensen et al. in 2013.

Materials and methods: A digital version of the Italian HLS19-Q12 questionnaire was distributed online through social media and informal channels in May 2024. The sample consisted of 352 participants from the metropolitan area of Cagliari, Italy. Network analysis was employed to examine the clustering and relationships between the questionnaire items, via JASP using the Ising Fit method.

Results: Key findings include significant difficulties in accessing professional help and understanding medical emergencies. Network centrality measures highlighted the prominence of items related to understanding medical emergencies and making health decisions. Three clusters corresponding to healthcare, disease prevention, and health promotion, were visually identified with the last two closely interconnected. The item "making decisions to improve health" is crucial, acting as a bridge between clusters. Some items traditionally belonging to one domain shifted to another.

Conclusions: The network analysis provided a clear depiction of health literacy as complex system, emphasizing interactions. Health literacy involves accessing, evaluating, and applying information, with empowerment playing a key role according to our findings. By addressing identified needs and focusing on prominent items, healthcare professionals and policymakers can enhance health literacy and improve health outcomes for individuals and communities. This pilot study's findings could benefit future research and interventions to improve health literacy.

Keywords: HLS-Q12; Health Literacy Survey Questionnaire; Health literacy; Network analysis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Centrality plot.
Fig. 2.
Fig. 2.
Network plot.
Fig. S1.
Fig. S1.
Centrality Plot
Fig. S2.
Fig. S2.
Edge Stability – Network.
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See this image and copyright information in PMC

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