Reliability and Validity of the Persian Version of the Short Health Literacy Questionnaire for Musculoskeletal Patients

Articles in Press

Document Type : Original Article

Authors

1 Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, IR, Iran

2 Department of Rheumatology, School of Medicine, Hamadan University of Medical Science, Hamadan, Iran.

3 Social Determinants of Health Research Center, Hamadan University of Medical Sciences Hamadan, IR, Iran.

4 Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.

5 Department of Nursing, Faculty of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran.

Abstract

Background and Objective: This study aimed to evaluate the reliability and validity of the Persian version of the osteoarthritis short health literacy questionnaire (OSHL) for musculoskeletal patients (LiMP) among individuals with osteoarthritis in Iran.

Material and Methods: A cross-sectional validation study was conducted with 420 patients aged 45–75 years, recruited from the rheumatology clinic of Shahid Beheshti Hospital in Hamadan. The LiMP questionnaire underwent a rigorous translation and back-translation process. Psychometric evaluation included assessments of face validity (qualitative interviews and item impact scores), content validity (expert panel review, Content Validity Ratio [CVR], and Content Validity Index [CVI]), and construct validity (exploratory and confirmatory factor analyses). Reliability was examined using Cronbach’s alpha for internal consistency and the intraclass correlation coefficient (ICC) for test-retest stability.

Results: The Persian LiMP demonstrated strong face and content validity, with all items achieving impact scores above 1.5, a CVR of 0.86, and a CVI of 0.95. Exploratory factor analysis identified a three-factor structure: Musculoskeletal Conditions, F2: Musculoskeletal Diagnosis and treatment, and F3:Anatomy and terminology; accounting for 71.07% of the variance, confirmed by confirmatory factor analysis with good model fit indices (e.g., the Comparative Fit Index  = 0.962, the root mean square error of approximation = 0.083). All subscales showed high internal consistency (Cronbach’s alpha > 0.70) and satisfactory test-retest reliability (mean the Intraclass correlation coefficient = 0.789). Convergent and discriminant validity were generally supported.

Conclusions: The Persian version of the LiMP for musculoskeletal patients is a reliable and valid instrument for assessing health literacy in this population. Its use can facilitate targeted interventions and improve patient outcomes. 

Keywords

Acknowledgements: We express appreciation to the participants in this study.


Availability of Data and Materials: The datasets used and/or analyzed during the current study can be made available by the corresponding author on reasonable request.


Conflicts of interest: The authors have no conflicts of interest to declare.


Consent for publication: Not applicable.


Ethical Approval and consent to participate: The study procedures were carried out following the Declaration of Helsinki. This study was approved by the Ethics Committee of Hamadan University of Medical Sciences with special code IR.UMSHA.REC.1401.390. Informed consent was taken from all the participants. There was an emphasis on maintaining privacy in keeping and delivering the information accurately without mentioning the names of the participants. 


Funding: The present study was approved by the Vice-Chancellor for Research and Technology of Hamadan University of Medical Sciences (No, 140105183544), which participated in the financial support of this study. This funding source had no role in the analysis and interpretation of data, in the article's writing, nor in the decision to submit it for publication.


Author Contributions: Authors’ contributions H.J, Z.B, M.B, S.KH, M.R and N.M.N conceived and designed the study. H.J, M.B, S.KH,and Z.B analyzed and interpreted the data, and drafted the manuscript. H.J, Z.B, M.B and S.KH were involved in the composition of the study tool, supervision of the research process, and critical revision and review of the manuscript. All the authors read and approved the final manuscript.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Journal of Health Literacy

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Available Online from 23 November 2025

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