Journal of Health Literacy

Journal of Health Literacy

Examining psychometric properties Iranian Version of the Health Literacy of Caregiver Scale- Cancer (HLCS-C)

Articles in Press

Document Type : Original Article

Authors
Hamideh Zahedi 1, 2
Mohammad Hasan Sahebihagh 3
Mojgan Mirghafourvand 4
Mina Hosseinzadeh 5, 6
Zohreh Sanaat 7
1 PhD Candidate, Department of Community Health Nursing, Nursing & Midwifery Faculty, Tabriz University of Medical sciences, Tabriz, Iran.
2 Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
3 Professor, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
4 Professor, Social determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
5 Associate Professor, Department of Community Health Nursing, Nursing & Midwifery Faculty, Tabriz University of Medical sciences, Tabriz, Iran.
6 Research Center of Psychiatry and Behavioral Sciences, Razi Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
7 Professor, Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
10.22038/jhl.2026.95937.1975
Abstract
Background and Objective: Caregiver’s health literacy is a crucial factor in fulfilling caregiving responsibilities for patients with cancer. Assessing different dimensions of caregiver health literacy can help identify educational needs and guide targeted interventions to improve patient care outcomes. The Health Literacy of Caregiver Scale–Cancer (HLCS-C), the only disease-specific instrument for assessing caregiver health literacy, has not previously been validated in Iran. This study aimed to examine the psychometric properties of the Iranian version of the Health Literacy of Caregiver Scale–Cancer (HLCS-C).

Materials and Methods: This methodological cross-sectional validation study was conducted between March 2023 and January 2024 among 354 family caregivers of patients with breast cancer recruited through convenience sampling. The total sample was randomly divided into two independent subsamples: 172 participants for exploratory factor analysis (EFA) and 182 participants for confirmatory factor analysis (CFA). Content validity was assessed using the Content Validity Index (CVI) and Content Validity Ratio (CVR). Internal consistency was evaluated using Cronbach's alpha, and test–retest reliability was assessed using the Intraclass Correlation Coefficient (ICC).

Results: The CVI and CVR of the HLCS-C were 0.92 and 0.98, respectively. Although the original HLCS-C consists of 10 dimensions, EFA in the Iranian sample identified a 9-factor structure, explaining 57% of the total variance. CFA confirmed the adequacy of the 9-factor model (CFI = 0.94, TLI = 0.93, χ²/df = 2.48, RMSEA = 0.06, SRMR = 0.07). The overall Cronbach's alpha coefficient was 0.93, and the ICC was 0.89 (95% CI: 0.79–0.95), indicating excellent reliability.

Conclusion: The Persian version of the HLCS-C is a valid and reliable instrument for assessing caregiver health literacy among Iranian family caregivers of patients with cancer. The identified 9-factor structure suggests a culturally adapted construct in the Iranian context. This instrument can be used in clinical practice and research to identify caregivers' health literacy needs and to design targeted educational and supportive interventions.
Keywords
Breast cancer
Family caregiver
Health literacy
Health literacy of Caregiver Scale-Cancer (HLCS-C)
Iran
psychometrics

Acknowledgments: The authors would like to thank the Vice‑chancellor for Research of Tabriz University of Medical Sciences for their financial support, public (Shahid Ghazi, Shahid Madani and Alzahra) and private (Shams and International Valiasr) hospitals in Tabriz, Iran, and Tabriz University of Medical Sciences, Tabriz, Iran for scientific support.


Availability of data and materials: The datasets will generate and/or analyses during the current study will not be publicly available due to limitations of ethical approval involving the patient data and anonymity but will be available from the corresponding author on reasonable request.


Conflicts of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Consent for publication: Not applicable.


Ethics approval and consent to participate: This study was conducted in accordance with the ethical standards laid down in the Declaration of Helsinki and its later amendments. The research protocol was approved by the Ethics Committee of Tabriz University of Medical Sciences, Tabriz, Iran (approval code: IR.TBZMED.REC.1401.1099). Written informed consent was obtained from all participants prior to their enrolment in the study. All procedures were performed in compliance with the relevant guidelines and regulations. We also express our gratitude to our colleagues in the Clinical Research and Development Unit, Razi Psychiatric Hospital, Tabriz University of Medical Sciences.


Funding: This research was supported by the Tabriz University of Medical Sciences (Number Grant: 71155). The funding source was not involved in the design, data collection, analysis, and manuscript development. 


Author Contributions: HZ has contributed to the conception, design, manuscript preparation, editing. MH contributed to the conception, design, manuscript editing, and review. MM has contributed to the design, acquisition, and interpretation of data and prepared the first draft. MHS did the manuscript preparation, editing, and review. MAJ did the data analysis. ZS revised the final draft of the manuscript. All Authors have 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 03 October 2026