Development of a health literacy questionnaire for Taiwanese hemodialysis patients

Background: Dialysis has long been a critical issue in the field of nephrology, though the burden this lifesaving technology places on society can be immense. Effectively increasing the health literacy of hemodialysis patients can be beneficial for their health outcomes and self-care abilities. Thus, the aims of this study are to: (1) develop a health literacy assessment tool in Chinese for patients receiving hemodialysis treatment; (2) assess the health literacy level of the Taiwanese hemodialysis population using the tool developed. Methods: The questionnaire was developed based on Nutbeam's three constructs of health literacy and seven sub-constructs identified for the purposes of this study. Experts were consulted for content validity assessment. The questionnaire then was used to conduct a census study at six hospitals and one dialysis clinic that provide hemodialysis treatment in the Taipei area (urban northern Taiwan). To be included, patients must have been at least 18 years old and receiving hemodialysis treatment at the time of the study. 468 eligible respondents were included in the analysis. Results: The reliability of the tool was 0.81 and the confirmatory factor analysis indicated good construct validity. The mean literacy score for the sample was 19.7 (SD = 4.61) out of a maximum of 26 points, and the median was 21 (range from 6 to 26). Age, education level, primary language, primary caregiver identity, and willingness to receive a transplant were all factors that showed significant association to health literacy level in multiple categories. Conclusions: The health literacy assessment tool developed in this study is the first health literacy assessment instrument to be made available for a specific patient group in Taiwan. Hemodialysis patients' knowledge of day-to-day care practices is satisfactory, while their critical literacy is weak.