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Refining the Factor Structure of the All Aspects of Health Literacy Scale

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Objective: Although the All Aspects of Health Literacy Scale (AAHLS) is a commonly used measure of health literacy, the psychometric evaluation approach employed in its original validation is questionable. In this study, we evaluated the psychometric properties and factor structure of the AAHLS using widely-accepted analytic methods. Methods: We collected data from 393 students from a Mid-Atlantic university. Participants completed the AAHLS in an online format. We conducted an exploratory factor analysis (EFA) to determine whether a different factor/subscale structure emerged in this sample than in the original validation sample. We ran follow-up confirmatory factor analyses (CFAs). Results: The EFA suggested an 11-item, 4-factor model. The CFA of the 4-factor model had adequate model fit but evidenced several low item loadings, suggesting that several items did not perform well. We tested a modified 8-item, 3-factor model that had good fit and high item loadings. Compared to the original factor structure, the functional health literacy subscale was removed. Conclusions: The newly proposed 3-factor/subscale model with 8 items captures communicative health literacy and 2 separate aspects of critical health literacy. Further replication in other diverse samples is warranted to investigate the psychometric properties of the AAHLS, although we recommend use of the revised version over the original.
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Document Type: Research Article

Affiliations: 1: Virginia Commonwealth University, Department of Psychology, Richmond, VA 2: Associate Professor, Virginia Commonwealth University, Department of Psychology, Richmond, VA

Publication date: March 1, 2020

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  • The American Journal of Health Behavior seeks to improve the quality of life through multidisciplinary health efforts in fostering a better understanding of the multidimensional nature of both individuals and social systems as they relate to health behaviors.

    The Journal aims to provide a comprehensive understanding of the impact of personal attributes, personality characteristics, behavior patterns, social structure, and processes on health maintenance, health restoration, and health improvement; to disseminate knowledge of holistic, multidisciplinary approaches to designing and implementing effective health programs; and to showcase health behavior analysis skills that have been proven to affect health improvement and recovery.

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