Adaptation of the Health Literacy Survey Questionnaire (HLS19-Q) for Russian-Speaking Populations—International Collaboration across Germany, Israel, Kazakhstan, Russia, and the USA
Abstract
:1. Introduction
2. Materials and Methods
2.1. HLS19 Questionnaire
2.2. Methods of HLS19-Q Adaptation
- (1)
- Two forward translations;
- (2)
- Comparison of two translations and decision on the most appropriate translation in the case of differences, based on expert consensus;
- (3)
- Final check of comprehensibility of the translated version through a focus group discussion with participants similar to potential survey respondents;
- (4)
- Pretest of the translated national HLS19-Q version based on a field-test including at least 30 interviews.
2.3. Adaptation of the HLS19 Questionnaire for Russian Speakers
2.3.1. Adaptation in Russia and Kazakhstan for Russian-Speaking Population
2.3.2. Adaptation in Germany and the USA for Russian-Speaking Migrants
2.3.3. Adaptation in Israel for Russian-Speaking Migrants
3. Results and Discussion
4. Conclusions
- In addition to two forward and one back-translations, use a “team approach” as the best practice to contextualize survey questions to the national context. The case for conducting more than one forward translation is that if there are flaws detected, the back-translation will not serve its main purpose. Therefore, two forward translations are recommended;
- Choose professional translators who are familiar with the healthcare system, or have worked in health care, with experience in translating health-related materials;
- Conduct pretests and/or focus groups to evaluate survey questions;
- Invite experts in the field to offer their feedback about linguistic, stylistic, data collection methodology, and cultural adaptation categories;
- Engage international researchers to gain “outside the box” perspectives and gather insightful adaptation recommendations.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
Appendix A. HLS19 Study Design in Germany, Israel, Russia, and the USA
Russia | Germany | US | Israel | |
Target population | Adult residents 18+ in three regions (Novosibirsk, Karelia, and Tatarstan) | Adult FSU migrants (personal or parental migration experience) speaking Russian | Russian-proficient adult immigrants who had emigrated at age of 14+ years (available to respondents from any state) | Russian-speaking population |
Mode of data collection | PAPI | PAPI with Russian-speaking interviewers | CAWI | CAWI |
Time of data collection | 1 November–20 December 2019 | 14 August–30 September 2020 | 17 September–11 October 2020 | 15 December 2020–10 January 2021 |
Instruments | ||||
HLS19 General HL | HLS19-Q22 + 7 items | HLS19-Q47 | HLS19-Q12 | HLS19-Q22 |
HLS19 Correlates | 31/31 | 25/31 (missing: absence from work due to illness, limitation in activities due to health problems, weight and height, difficulties to pay for medical treatments and bills) | 7/31 (gender, country of origin, education, social status, employment, problems with paying bills, health status) | 31/31 |
HLS19 Optional correlates | Partnership, parenthood | Partnership, parenthood, citizenship, duration of residence in country | - | - |
National add-ons | - | “E. g. health information use in Russian language/from Russian speaking countries, health system knowledge, difficulties in understanding explanations from health professionals, self-efficacy. | Number of American friends and social circles, use of medical services or medications from a native country. | Topics of religion, religiosity, and distance of residence from major residence areas (peripheriality) |
Appendix B. Results of Focus Group Analysis and Contribution to the Development of the Questionnaire in Russia (Cultural Adaptation)
Initial Variant of the Question | Suggestions after Focus Group in Russia | Changes | |
Q6 | Core questions | The response depends on what exactly the respondent has problems with while reading a leaflet: the size of letters or the content (readability)/instructions (content)? Suggestion: make instructions for interviewers | …to understand the instruction leaflets that come with your medicine? (Instruction: information or instructions given in the leaflets) |
Q23 | …understand why you need health screenings? (Instructions: breast exam, blood sugar test, blood pressure) | It was unclear for male respondents why should they have a breast exam. Suggestion: to add a type of screening suitable for both sexes. | …understand why you need health screenings? (Instructions: e.g., colorectal cancer screening, blood sugar test, blood pressure) |
Q40 | …understand information on how to keep your mind healthy? | It was unclear for respondents: what sources of information are meant: media/friends/family? Suggestion: to add the instruction: from any source of information. | …understand information on how to keep your mind healthy? (Instruction: specifically on mental health and well-being from any source) |
CORRELATES | |||
C-DET3 | What citizenship do you hold? | The purpose of the question is unclear whether it is about the name of the country of citizenship or the status (like resident, non-resident, etc). Suggestion: in case of the second variant to give options | The question was changed to optional |
C-DET7 | Was the first language (mother tongue) you learnt and spoke in your family another one than the common language(s) spoken in the country you live in now? | Russia is a multi-national country and within one country there is a number of nations who speak their own language as national being Russian citizens at the same time. Suggestion: to limit all migration questions to one—the status of citizenship. | The question was moved to optional |
C-DET11 | Are you able to pay for prescribed medication if needed? | The question caused confusion: it depends on the medication (there is a huge difference between medication for cancer and for flu). Suggestion: to use the word usually | How easy or difficult is it usually for you to afford medication if needed [Interviewer instruction: e.g., co-payment for prescribed medication or paying for over the counter medication] |
C-DET12 | How easy or difficult is it for you to afford medical examinations and treatments, if needed? | Same as previous and covers the difference in healthcare systems: some basic medical examinations and treatments are offered by the government for free. | How easy or difficult is it usually for you to afford medical examinations and treatments if needed? |
C-SSUP2: | Do you have a family member or a friend to take with you to a doctor’s appointment? | The question caused confusion what is the purpose of taking a family member or a friend to a doctor. All respondents understood it as a question of trust and suggested to change to: do you have a family member or a friend to share information regarding personal health? No one understood it as accompanying to a doctor, which is more relevant to older people. | Moved to optional |
C-SSUP3: | Are you actively involved in your community, for example, do you volunteer or take part in activities? | The question caused confusion: which activities are meant. Health-related or any? Suggestion: to add the instruction for an interviewer. | Moved to optional |
Appendix C. The Input to the Development of the Questionnaire Based on the Focus Group Analysis in Russia (Linguistic Adaptation)
Question Number | Initial Variant of the Question | Suggestions after Focus Group in Russia | Changes |
Q20 | …find information on how to prevent or manage health risks like being overweight, having high blood pressure, or high cholesterol? | Two categories in one question “to prevent or manage” were unclear for respondents. Suggestion: use one word “handle” instead of two categories in one question | …find information on how to handle health risks like being overweight, having high blood pressure or high cholesterol? |
Q32 | …find information on healthy activities such as exercise, healthy food, or nutrition? | It was unclear if healthy food is considered a type of activity. Suggestion: change “activities” for “lifestyle” | …find information on healthy lifestyles such as physical exercise, healthy food or nutrition? |
Q43 | …judge which everyday behaviour is related to your health? (Instructions: drinking and eating habits, exercise etc.) | The word “behavior” is not clear and popular in relation to health Suggestion: to change “behavior” to “habits” and substitute “related to” for “affect” | …judge which everyday habits affect your health? (Instructions: Drinking and eating habits, exercise, etc.) |
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Lopatina, M.; Berens, E.-M.; Klinger, J.; Levin-Zamir, D.; Kostareva, U.; Aringazina, A.; Drapkina, O.; Pelikan, J.M. Adaptation of the Health Literacy Survey Questionnaire (HLS19-Q) for Russian-Speaking Populations—International Collaboration across Germany, Israel, Kazakhstan, Russia, and the USA. Int. J. Environ. Res. Public Health 2022, 19, 3572. https://doi.org/10.3390/ijerph19063572
Lopatina M, Berens E-M, Klinger J, Levin-Zamir D, Kostareva U, Aringazina A, Drapkina O, Pelikan JM. Adaptation of the Health Literacy Survey Questionnaire (HLS19-Q) for Russian-Speaking Populations—International Collaboration across Germany, Israel, Kazakhstan, Russia, and the USA. International Journal of Environmental Research and Public Health. 2022; 19(6):3572. https://doi.org/10.3390/ijerph19063572
Chicago/Turabian StyleLopatina, Maria, Eva-Maria Berens, Julia Klinger, Diane Levin-Zamir, Uliana Kostareva, Altyn Aringazina, Oxana Drapkina, and Jürgen M. Pelikan. 2022. "Adaptation of the Health Literacy Survey Questionnaire (HLS19-Q) for Russian-Speaking Populations—International Collaboration across Germany, Israel, Kazakhstan, Russia, and the USA" International Journal of Environmental Research and Public Health 19, no. 6: 3572. https://doi.org/10.3390/ijerph19063572
APA StyleLopatina, M., Berens, E.-M., Klinger, J., Levin-Zamir, D., Kostareva, U., Aringazina, A., Drapkina, O., & Pelikan, J. M. (2022). Adaptation of the Health Literacy Survey Questionnaire (HLS19-Q) for Russian-Speaking Populations—International Collaboration across Germany, Israel, Kazakhstan, Russia, and the USA. International Journal of Environmental Research and Public Health, 19(6), 3572. https://doi.org/10.3390/ijerph19063572