YI-JING HUANGChen C.-T.Lin G.-H.Wu T.-Y.Chen S.-S.Lin L.-F.Hou W.-H.CHING-LIN HSIEH2020-04-082020-04-0820181178-1653https://www.scopus.com/inward/record.uri?eid=2-s2.0-85023746197&doi=10.1007%2fs40271-017-0267-3&partnerID=40&md5=08fb90817875604a8d0c495bb50d3934https://scholars.lib.ntu.edu.tw/handle/123456789/483810Background: The effective self-management and treatment of long-term disability after stroke depends greatly on the health literacy of patients. The European Health Literacy Survey Questionnaire (HLS-EU-Q) is a comprehensive and theory-based measure that captures multiple self-perceived competencies of health literacy and covers a diverse range of health contexts. However, there is no psychometric evidence on the HLS-EU-Q in the stroke population. Objective: The aim of this study was to examine the validity of the HLS-EU-Q in patients with stroke using Rasch analysis. Methods: We compared the model deviance among the one-domain, three-domain, four-domain, and 12-domain structures using likelihood ratio tests to determine the dimensionality of the HLS-EU-Q. Thereafter, we examined the unidimensionality of each domain, local independence, item fit, response categories, and differential item functioning (DIF) for the best fitting structure. Results: A total of 311 patients with stroke participated in this study. Rasch analysis revealed that the 12-domain HLS-EU-Q demonstrated the best data–model fit. The original 4-point scales showed disordering, which can be corrected by rescaling them as 3-point scales with the two middle categories collapsed. All 47 items in the rescaled HLS-EU-Q fit the 12-domain Rasch model, demonstrated local independence, assessed the 12 unidimensional domains respectively, and had invariant difficulties between different age or education groups of the patients with stroke. Conclusion: We recommend using the 12-domain scores of the rescaled HLS-EU-Q to comprehensively and accurately capture the competencies to access, understand, appraise, and apply health information within the three health contexts of healthcare, disease prevention, and health promotion for patients with stroke. ? 2017, Springer International Publishing AG.[SDGs]SDG3Article; brain ischemia; education; European Health Literacy Survey Questionnaire; female; health care access; health literacy; health promotion; health survey; human; major clinical study; male; Mini Mental State Examination; priority journal; prospective study; questionnaire; Rasch analysis; stroke patient; aged; attitude to health; cerebrovascular accident; chronic disease; clinical trial; health literacy; interpersonal communication; middle aged; multicenter study; patient education; psychology; psychometry; questionnaire; reproducibility; self care; standards; teaching hospital; Aged; Chronic Disease; Communication; Female; Health Knowledge, Attitudes, Practice; Health Literacy; Hospitals, Teaching; Humans; Male; Middle Aged; Patient Education as Topic; Prospective Studies; Psychometrics; Reproducibility of Results; Self-Management; Stroke; Surveys and Questionnairesjournal article10.1007/s40271-017-0267-3287106812-s2.0-85023746197