Validation of health literacy competencies for healthcare professionals in Korea: a psychometric evaluation study

Although health literacy is critical for determining the quality and outcomes of healthcare, research on the health literacy competencies (HLCs) of healthcare professionals tasked with identifying and educating vulnerable populations remains limited. This study aimed to validate and refine a previously developed HLCs instrument for use among healthcare professionals in Korea. The original instrument was based on the conceptualization of HLCs, and included four domains: knowledge, attitudes, skills, and practices. Following translating and back-translating, a three-round Delphi survey was conducted with 20 health literacy experts from diverse fields between October 2022 and September 2023. The experts rated each item on a four-point Likert scale to compute the content validity index (CVI) and content validity ratio (CVR), and provided written feedback and recommendations, retaining 61 items for field testing. After expert panel review, a web-based survey was administered from October to December 2023 to physicians, registered nurses, pharmacists, and dietitians with ≥ 6 months of experience and routine direct patient contact. Of the 391 respondents, 359 were included in the final analysis. Validity and reliability were assessed using confirmatory factor analysis (CFA), Cronbach’s alpha, and test–retest reliability. Most participants were female (79.7%), and nurses represented 54.3% of the participants. The final instrument comprised 43 items across four domains: knowledge (11 items), attitudes (8 items), skills (12 items), and practices (12 items). CFA indicated a good model fit (χ² = 1534.94, df = 854, p < 0.001, root mean square error of approximation = 0.047, comparative fit index = 0.939, Tucker–Lewis index = 0.936, and standardized root mean residual = 0.070). The scale also showed good internal reliability (Cronbach’s alpha = 0.93), strong test-retest reliability (r = 0.85, p < 0.001), good intraclass correlation coefficient = 0.83 (95% confidence interval: 0.72–0.90), F (1, 68) = 35.62, and p < 0.001. The Korean version of the HLCs demonstrates strong validity and reliability for use among healthcare professionals in Korea. However, given the predominance of nurses in the validation sample, future research should consider including diverse groups of healthcare professionals, such as pharmacists, doctors, and allied health practitioners.