Cultural and linguistic appropriateness of the HLS19-Q12 health literacy scale items among people in Norway with a Somali background

Although health literacy (HL) is essential for achieving health equity, limited knowledge exists about HL among migrant populations. The cultural and linguistic appropriateness of existing HL measurement scales is scarce. Hence, the aim of this study was to explore the cultural and linguistic appropriateness of HLS19-Q12 scale items among individuals of Somali background living in Norway. The HLS19-Q12 measure general HL and is a short version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47). By using a sequential mixed methods approach, we present results from quantitative, qualitative and mixed methods meta-inferences perspective. We used data from the Somali diaspora in the Norwegian part of the Health Literacy Survey 2019 (HLS19) and tested the data against the partial credit Rasch model. Cross-cultural cognitive interviews (CCCI) were then conducted, in which data were analysed using reflexive thematic analysis. The mixed methods approach gave us a comprehensive understanding. The CCCIs provided detailed insights into deviating items identified by the Rasch modelling, and the CCCIs revealed that more items were problematic than those flagged by Rasch modelling. A large body of literature examine psychometric properties of different scales. While this is important, this article also shows the challenges and implications in HL surveys regarding developing health equity policies for all. Hence, exploring the cultural and linguistically validation of scale items should be a standard. The Somali version of the HLS19-Q12 scale items could not be considered culturally or linguistically appropriate for people with a Somali background living in Norway.