Psychometrics Properties of Health Literacy Measurements in Diabetes Mellitus Patients: A Systematic Review

Articles in Press

Document Type : Systematic Review

Authors

University of Medicine and Pharmacy, Vietnam National University, Hanoi, 144 Xuan Thuy street, Cau Giay district, Hanoi, Vietnam

Abstract

Background and Objective: Diabetes mellitus is a global health challenge, and inadequate health literacy contributes to poor self-care, suboptimal glycemic control, and higher complication risks. Accurate measurement of health literacy is vital, yet the psychometric quality of existing tools for diabetes remains uncertain. To identify instruments with the strongest psychometric support to guide future research and clinical practice among patients with diabetes mellitus. 

Material and Methods: A systematic review was conducted in PubMed, Scopus, ScienceDirect, ProQuest, and Wiley Online Library from inception to September 2025. Eligible studies involved the development, translation, or validation of health literacy instruments in diabetes populations. Psychometric quality was assessed using the COSMIN checklist.

Results: Twelve studies describing 10 instruments were included, most of which were diabetes-specific. Internal consistency and construct validity were the most frequently evaluated properties, whereas measurement error, responsiveness, and test–retest reliability were seldom examined. The Diabetes Health Literacy Scale showed the strongest evidence, covering functional, communicative, and critical domains. Other instruments, such as the Functional, Communicative and critical Health literacy; Chinese Health Literacy scale for Diabetes; Korean Health Literacy scale for Diabetes Mellitus; and Health literacy related to adherence to drug treatment, demonstrated moderate evidence but lacked full validation. Domain-specific measures, including the Food Literacy Questionnaire and Oral Health Literacy tool, had limited psychometric support.

Conclusion: Ten instruments are available for assessing health literacy in diabetes, yet none has undergone comprehensive psychometric evaluation. The Diabetes Health Literacy Scale appears most suitable for practice and research, though further studies are needed to confirm its structural validity and adaptability across cultures. Continued instrument development and validation are essential for accurate measurement in diverse populations.

Keywords

Acknowledgements: Not applicable.


Availability of Data and Materials: All data generated or analyzed during this study are included in this published article.


Conflicts of interest: This study has no conflict of interest.


Consent for publication: Not applicable. 


Ethical Approval and consent to participate: were not required for this study, as it is a systematic review of previously published research and does not involve human participants.


Funding: This study did not receive external funding.


Author Contributions:- Ha Thi Thu Trang: Conceptualization; Method and Design; Literature Search; Data Extraction; Quality Appraisal; Analysis and Interpretation; Drafting the Manuscript; Revised Manuscript; Final Approval of the Submitted Version.- Do Anh Tien: Supervision; Method and Design; Tool Validation Review; Interpretation; Revised Manuscript; Edited Manuscript; Final Approval. - Nguyen Thai Ha Duong: Critical Review of Analysis and Interpretation; Revising the Manuscript; Final Approval.

 

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

Articles in Press, Accepted Manuscript
Available Online from 25 November 2025

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