Development and Psychometric Assessment of the COVID-19 Health Literacy Scale: Preliminary Testing and Factor Structure

Document Type : Original Article


1 Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences Tehran, Iran

2 Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran.

3 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC USA

4 Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan

5 Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran


Background and Objective: Improving the health literacy in the different   populations regarding COVID-19 may be useful in the control of its prevalence. This study examined the psychometric properties of a newly developed disease-specific measure of health literacy related to COVID-19 to be used as a standard measure.

Materials and Methods: Relevant literature was reviewed to identify an item pool, and an expert panel was convened to choose items that might be included in the scale. Content validity ratio (CVR) and content validity index (CVI) was determined and face validity was examined by calculating the impact score in a group of social media users. The factor structure of the initial scale was examined in 590 Iranian individuals participating in online social networks in September 2020. Internal consistency of the scale was assessed by Cronbach’s alpha and test-retest reliability of responses was measured by Pearson correlation coefficients. 

Results: A five-factor solution for the 51-items scale was obtained through exploratory factor analysis. The five main dimensions were understanding, communication, information seeking, analysis, and behavior. The dimensions explained 47% of the variance in scale scores. Participants whose scores fell in the high category (27%) were significantly different compared to those whose scores fell in the low category (27%) on all dimensions (p<0.001). The CVR values for all items were greater than 0.85 and all items also got CVI values higher than 0.79 based on nine-person expert panel.  The Cronbach’s alpha for the overall scale was 0.89, and it was ranged from 0.71 to 0.90. Test-retest reliability for the scale was high (r=0.89).     

Conclusion: Health Literacy Scale for protect against COVID-19is a valid and reliable measure for Iranian population.  This measure should be translated, and administered, in other settings to replicate the results obtained here.


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