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. 2025 Aug 5;13(15):1903.
doi: 10.3390/healthcare13151903.

Cross-Cultural Adaptation and Validation of the Spanish HLS-COVID-Q22 Questionnaire for Measuring Health Literacy on COVID-19 in Peru

Manuel Caipa-Ramos  1 , Katarzyna Werner-Masters  2 , Silvia Quispe-Prieto  3 , Alberto Paucar-Cáceres  2 , Regina Nina-Chipana  3
Affiliations

Cross-Cultural Adaptation and Validation of the Spanish HLS-COVID-Q22 Questionnaire for Measuring Health Literacy on COVID-19 in Peru

Manuel Caipa-Ramos et al. Healthcare (Basel). .

Abstract

Background/Objectives: The social importance of health literacy (HL) is widely understood, and its measurement is the subject of various studies. Due to the recent pandemic, several instruments for measuring HL about COVID-19 have been proposed in different countries, including the HLS-COVID-Q22 questionnaire. The diversity of cultures and languages necessitates the cross-cultural adaptation of this instrument. Thus, the present study translates, adapts, and validates the psychometric properties of the HLS-COVID-Q22 questionnaire to provide its cross-cultural adaptation from English to Spanish (Peru). Methods: As part of ensuring that the final questionnaire accommodates the cultural nuances and idiosyncrasies of the target language, the following activities were carried out: (a) a survey of 40 respondents; and (b) a focus group with 10 participants, followed by expert approval. In addition, the validity and reliability of the health instrument have been ascertained through a further pilot test administered to 490 people in the city of Tacna in southern Peru. Results: The resulting questionnaire helps measure HL in Peru, aiding better-informed decision-making for individual health choices. Conclusions: The presence of such a tool is advantageous in case of similar global health emergencies, when the questionnaire can be made readily available to support a promotion of strategies towards better self-care. Moreover, it encourages other Latin American stakeholders to adjust the instrument to their own cultural, language, and socio-economic contexts, thus invigorating the regional and global expansion of the HL study network.

Keywords: COVID-19; Peru; Spanish; cross-cultural adaptation; health literacy; pandemic; psychometric properties.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Cross-cultural adaptation process (adapted from [26]).
Figure 2
Figure 2
Original HLS-COVID-Q22 [1].
Figure 3
Figure 3
HLS-COVID-Q22 instrument, linguistically adapted to Spanish.
Figure 4
Figure 4
Factor structure respecified to 18 items, with items 2, 8, 12, and 20 removed; acc = access; und = understand; appr = appraise; appl = apply.
Figure 5
Figure 5
Model 2 respecified (HLS-COVID-Q18).
See this image and copyright information in PMC

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