195 Validation of the 12-item version of the Health Literacy Survey (HLS19-Q12) in Finland: general and foreign-born populations

Abstract PTH 9: Miscellaneous 2, B302 (FCSH), September 5, 2025, 11:30 - 12:24 Aims Health Literacy (HL) has received much attention in the context of public health in the past couple of decades. Among migrants, HL is particularly relevant as a protective factor for health. The HLS19-Q12 was developed with the purpose of supporting the availability of high-quality internationally comparable data on population HL. This study presents the Finnish version of HLS19-Q12 and its psychometric properties in local and foreign-born samples of the working aged population of Finland. Methods Data on HL was collected in national Finnish population surveys in 2022-2023. Psychometric functioning was analyzed via subsamples from the Healthy Finland (n = 4028) and MoniSuomi (n = 4190) population surveys. We applied the unidimensional Nominal Response Model (NRM) to examine psychometric functioning of the response categories and investigated measurement invariance and differential item functioning (DIF). Results Item distributions were asymmetric or J-shaped. The NRM showed adequate fit in all subsamples and revealed differences in the functioning of the opt-out response category across groups. We observed equivalent functioning of the test between English native and non-native speaking groups. DIF analyses flagged three items (3, 4, 5) for response style bias. No item was flagged for DIF when comparing migrant and general Finnish populations. Conclusions Our results suggest that HLS19-Q12 can be used to compare HL scores between native and foreign-born populations of Finland. However, it is worth to consider removing the opt-out response for its wide variation across language versions and because it would resolve sparsity of data, improving the Test Information particularly at lower and average levels of the latent trait. Implications of the heterogeneity introduced by cross-cultural measurement are discussed.