374 Understanding questionnaire translation and cultural adaptation challenges in migrant populations: insights from validity evidence for the Health Literacy Questionnaire (HLQ)

Abstract OP 13: Research Methods, B304 (FCSH), September 3, 2025, 17:00 - 18:00 Aims: The Health Literacy Questionnaire (HLQ) is a widely used tool for assessing health literacy across diverse populations, translated into 47 languages and used in over 80 countries. HLQ translation uses the Translation Integrity Protocol for linguistic and cultural adaptation to maximise construct equivalence. This study reviews HLQ validity evidence and explores key considerations for its use in migrant populations. Methods: A PRISMA systematic review (registered on PROSPERO) identified 257 studies on psychometric properties, with 22 articles across 15 countries/languages included in the analysis. Studies used factor analysis (n = 18), Rasch modelling (n = 3), and reported reliability indices, mainly Cronbach’s alpha (range: 0.57 to 0.95). Additional insights were drawn from translation and cognitive interview studies focusing on construct equivalence. Results: Most studies reported strong psychometric properties of the HLQ, though some required modifications (e.g., correlated residuals or item refinements) to achieve model fit. Professional interpreters often focused on linguistic adaptation and accuracy rather than ensuring construct equivalence in the new cultural and health system context. A main issue that requires careful consideration for migrant populations is the challenge of navigating foreign healthcare systems, not just language barriers. The findings recommend that effective linguistic and cultural adaptation strategies need to include (1) engaging clinicians who are familiar with local health systems, (2) prioritising commonly used language and terminology to ensure accessibility, and (3) involving migrants with lived experience of health issues. Conclusions: The HLQ demonstrates strong psychometric robustness across languages and cultures. We know it is being used in migrant populations in Europe, Africa, Asia and Australia. However, for migrant populations, translation alone may not be sufficient. Cognitive interviews need to extend beyond language comprehension to assess how migrants interpret health literacy constructs. Future adaptations should emphasise cultural and systemic navigation challenges to ensure meaningful health literacy assessment for intervention development.