Culturally responsive health literacy measurement for diabetes: translation and validation of the My-DHLS

Diabetes remains a major public health concern in Malaysia, where challenges in understanding treatment information and communicating with healthcare providers continue to shape inequities in diabetes care. Assessing diabetes-related health literacy using culturally appropriate tools is therefore essential. This study aimed to translate, culturally adapt, and validate the Diabetes Health Literacy Scale into Malay (My-DHLS). Translation and cultural adaptation followed ISPOR guidelines. A cross-sectional validation study was conducted among 200 adults with type 2 diabetes attending 55 public health clinics in Terengganu between April and May 2025. Content validity was assessed by ten experts, face validity by thirty patients, and construct validity using Confirmatory Factor Analysis (CFA). Minor linguistic refinements were made, and one item was removed due to limited contextual relevance. The My-DHLS demonstrated strong content validity (S-CVI/Ave = 0.92) and face validity (S-FVI/Ave = 0.93). CFA supported a three-domain structure encompassing informational, numeracy, and communicative health literacy, with good model fit indices (CFI = 0.959; TLI = 0.948; RMSEA = 0.062; SRMR = 0.044). The My-DHLS is a valid and reliable instrument for assessing diabetes-related health literacy among Malaysian adults and offers a context-sensitive tool to support research and practice aimed at reducing communication-related inequities in diabetes care.