Evaluation of the Psychometric Properties of the Persian Version of the Occupational Health and Safety Literacy Questionnaire among Process Industry Workers

Document Type : Original Article


1 HSE Group, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Statistics, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran.

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

4 M.Sc, HSE department, Shahid Hashmi Nejad Gas Refinery, Razavi Khorasan, Iran.

5 Department of Occupational Health and Safety, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran.


Background and Objective: Health and safety literacy is an essential aspect of the employees’ awareness level. Since an estimate of the literacy level can be effective in increasing the level of personnel awareness of safe and health behavior, the purpose of this study is to provide a tool in the form of a valid and reliable questionnaire in the field of occupational health and safety literacy.

Materials and Methods: The current research was conducted to examine feasibility of the Persian version of the occupational health and safety literacy assessment questionnaire in employees in 2023. After translating the tool using the translation-retranslation, quantitative and qualitative validity of the questionnaire were assessed by 10 experts. Repeatability and internal consistency were examined by 30 employees, and item analysis as well as construct validity by 410 employees.

Results: The impact score, CVR and CVI of the questionnaire were 3.51, 0.96 and 0.91, respectively. The construct validity confirmed the final version of the questionnaire contains 34 questions in 4 dimensions including access, review, evaluation, and use of health and job information. The ratio of the chi-square test to the degree of freedom (χ2⁄df) was equal to 3.71. and the RMSEA index was 0.08. The internal consistency of the questionnaire was (⍺=0.923), and repeatability (ICC= 0.98) which were within the acceptable range. 

Conclusion: The Persian version of occupational safety and health literacy questionnaire with 34 items and 4 dimensions was confirmed by the concept of Iranian occupational safety and health literacy. Iranian occupational health and safety specialists can use this valid and reliable tool to assess the occupational health and safety literacy and the findings can be applied for occupational health and safety interventions. 


Acknowledgements: This study was carried out with funding from Mashhad University of Medical Sciences with grant number of 4011424. The authors are also deeply grateful to all those who helped in this study, particularly from Shahid Hashminejad Sarkhes Gas Refinery. Special thanks to Mr. Suthakorn, the main designer of the original questionnaire, who gave a written permission for application of the original questionnaire.

Availability of data and materials: The nameless datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Conflicts of interests: The authors declare that there is no conflict of interest regarding the publication of this research.

Consent for publication: Not applicable.

Ethical approval and consent to participate: The study adhered to the principles of the Helsinki Declaration. All participants completed the informed consent form. In this form were emphasized on the willingness to participate in this study, the absence of costs, and the confidentiality of personal information. Also, the protocol of this study was approved by the ethics committee of Mashhad University of Medical Sciences with code of IR.MUMS.FHMPM.REC.1401.161.

Funding: This research was supported by Mashhad University of Medical Sciences with grant number of 4011424.

Author contributions: Mohaddeseh Noori: Data curation, Formal analysis, Writing original draft. Jamshid Jamali: Data curation, Formal analysis, Methodology, Validation, Writing: review & editing. Zahra Rezvani: review & editing the English draft. Ali Gharaee: Data curation, Formal analysis. Seifollah Gharib: Conceptualization, Methodology, Project administration, Supervision, Validation, Writing: review & editing.

1- Tavousi M, Haeri-Mehrizi AA, Sedighi J, Montazeri A, Mohammadi S, Ardestani MS, et al. Health Literacy Instrument for Adults-Short Form (HELIA-SF): Development and psychometric properties. Payesh (Health Monitor). 2022;21(3):309-19. https://doi.org/10.52547/payesh.21.3.309
 2- Lee Y-M, Yu HY, You M-A, Son Y-J. Impact of health literacy on medication adherence in older people with chronic diseases. Collegian. 2017;24(1):11-8. https://doi.org/10.1016/j.colegn.2015.08.003 PMid:29218957    
 3- Berkman ND, Davis TC, McCormack L. Health literacy: what is it? Journal of health communication. 2010;15(S2):9-19. https://doi.org/10.1080/10810730.2010.499985 PMid:20845189    
 4- Ghanbari S, Ramezankhani A, Montazeri A, Mehrabi Y. Health literacy measure for adolescents (HELMA): development and psychometric properties. PloS one. 2016;11(2):e0149202. https://doi.org/10.1371/journal.pone.0149202 PMid:26881933 PMCid:PMC4755574    
 5- Schnitzer AE, Rosenzweig M, Harris B. Health literacy: a survey of the issues and solutions. Journal of Consumer Health on the Internet. 2011;15(2):164-79. https://doi.org/10.1080/15398285.2011.573347
 6- Ghanbari S, Ramezankhani A, Mehrabi Y, Montazeri A. The health literacy measure for adolescents (HELMA): development and psychometric evaluation. Payesh (Health Monitor). 2016;15(4):404-10. https://doi.org/10.1037/t52460-000
 7- Storms H, Claes N, Aertgeerts B, Van den Broucke S. Measuring health literacy among low literate people: an exploratory feasibility study with the HLS-EU questionnaire. BMC public health. 2017;17:1-10. https://doi.org/10.1186/s12889-017-4391-8 PMid:28526009 PMCid:PMC5438531    
 8- Nath CR, Sylvester ST, Yasek V, Gunel E. Development and validation of a literacy assessment tool for persons with diabetes. The Diabetes Educator. 2001;27(6):857-64. https://doi.org/10.1177/014572170102700611 PMid:12211925    
 9- Masoudi R, KHEIRI S, ALIAKBARI F, ESLAMI AA, RABIEI L. Psychometrics And Validation Of The Iranian Version Of The Diabetes Health Literacy Assessment Questionnaire. 2020.    
 10- Samadbeik M, Garavand S, Sohrabi Zadeh M, Koshki N, Mohammadi Z. Health Literacy Instruments for Computer-Based Applications: A Review Article. Journal of Health and Biomedical Informatics. 2015;2(3):195-203.    
 11- Nouri M. The efficacy emotion regulation training sequel of gross on safety behavior nurses. J Neyshabur Univ Med Sci. 2020;8(3):87-95.    
 12- Ozaydin F, Demirci H, Karayurek Y. Relatıonship Between Occupational Accidents of Industrial Workers and Health Literacy and Workplace Safety Climate. Eur Health Liter J. 2021;1:47-57. https://doi.org/10.29228/ehlj.51105
 13- Witschen S. Which Labour Rights Are Fundamental Rights? Horizontal Direct Effect of the Charter of Fundamental Rights of the EU. International Journal of Comparative Labour Law and Industrial Relations. 2023;39(2). nhttps://doi.org/10.54648/IJCL2023015
 14- Kickbusch IS. Health literacy: addressing the health and education divide. Health promotion international. 2001;16(3):289-97. https://doi.org/10.1093/heapro/16.3.289 PMid:11509466    
 15- Dasgupta P, Dickey AM. Health literacy as a predictor of worker perceptions of safety in the workplace. Professional Safety. 2021;66(08):30-4.    
 16- Ozdemir H, Alper Z, Uncu Y, Bilgel N. Health literacy among adults: a study from Turkey. Health education research. 2010;25(3):464-77. https://doi.org/10.1093/her/cyp068 PMid:20080808    
 17- Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). The European journal of public health. 2015;25(6):1053-8. https://doi.org/10.1093/eurpub/ckv043 PMid:25843827 PMCid:PMC4668324    
 18- Beauchamp A, Buchbinder R, Dodson S, Batterham RW, Elsworth GR, McPhee C, et al. Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ). BMC public health. 2015;15(1):1-13. https://doi.org/10.1186/s12889-015-2056-z PMid:26194350 PMCid:PMC4508810    
 19- Suthakorn W, Songkham W, Tantranont K, Srisuphan W, Sakarinkhul P, Dhatsuwan J. Scale development and validation to measure occupational health literacy among Thai informal workers. Safety and Health at Work. 2020;11(4):526-32. https://doi.org/10.1016/j.shaw.2020.06.003 PMid:33329920 PMCid:PMC7728703    
 20- Jamali J, Ayatollahi SMT, Jafari P. The effect of small sample size on measurement equivalence of psychometric questionnaires in MIMIC model: A simulation study. BioMed Research International. 2017;2017. https://doi.org/10.1155/2017/7596101 PMid:28713828 PMCid:PMC5496316    
 21- Afrasiabifar A, YAGHMAEI F, ABDOLI S, ABED SZ. Research tool translation and cross-cultural adaptation. 2006.    
 22- Polit DF, Yang F. Measurement and the Measurement of Change: A Primer for the Health Professions: Wolters Kluwer; 2016.    
 23- Lawshe CH. A quantitative approach to content validity. Personnel psychology. 1975;28(4):563-75. https://doi.org/10.1111/j.1744-6570.1975.tb01393.x
 24- Waltz CF, Bausell BR. Nursing research: design statistics and computer analysis: Davis Fa; 1981.    
 25- Tinsley HE, Kass RA. The latent structure of the need satisfying properties of leisure activities. Journal of Leisure Research. 1979;11(4):278-91. https://doi.org/10.1080/00222216.1979.11969406
 26- Duncan DJ. Leisure types: Factor analyses of leisure profiles. Journal of leisure Research. 1978;10(2):113-25. https://doi.org/10.1080/00222216.1978.11969342
 27- Byrne BM. Structural equation modeling with LISREL, PRELIS, and SIMPLIS: Basic concepts, applications, and programming: psychology press; 2013. https://doi.org/10.4324/9780203774762
 28- Tabachnick BG, Fidell LS, Ullman JB. Using multivariate statistics: pearson Boston, MA; 2013.    
 29- Azizi N, Karimy M, Abedini R, Armoon B, Montazeri A. Development and validation of the health literacy scale for workers. the international journal of occupational and environmental medicine. 2019;10(1):30. https://doi.org/10.15171/ijoem.2019.1498 PMid:30685775 PMCid:PMC6522212    
 30- Durlak JA, DuPre EP. Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American journal of community psychology. 2008;41:327-50. https://doi.org/10.1007/s10464-008-9165-0 PMid:18322790    
 31- Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, et al. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC medicine. 2010;8:1-11. https://doi.org/10.1186/1741-7015-8-63 PMid:20961442 PMCid:PMC2978112    
 32- McCormack L, Bann C, Squiers L, Berkman ND, Squire C, Schillinger D, et al. Measuring health literacy: a pilot study of a new skills-based instrument. Journal of health communication. 2010;15(S2):51-71. https://doi.org/10.1080/10810730.2010.499987 PMid:20845193    
 33- Greenhalgh T. Health literacy: towards system level solutions. British Medical Journal Publishing Group; 2015.    
 34- Organization WH. Health literacy toolkit for low-and middle-income countries: A series of information sheets to empower communities and strengthen health systems. 2015.    
 35- Fiedler S, Pfaff H, Petrowski K, Pförtner T-K. Effects of a classroom training program for promoting health literacy among IT managers in the workplace: a randomized controlled trial. Journal of occupational and environmental medicine. 2019;61(1):51-60. https://doi.org/10.1097/JOM.0000000000001471 PMid:30335676    
 36- Wagner A, Schöne L, Rieger MA. Determinants of occupational safety culture in hospitals and other workplaces-results from an integrative literature review. International journal of environmental research and public health. 2020;17(18):6588. https://doi.org/10.3390/ijerph17186588 PMid:32927758 PMCid:PMC7559364