Validating the Health Literacy Survey (HLS)-Child-Q15 tool in English to assess paediatric health Literacy

This study has 3 stages: Stage 1: The Formal translation of the HLS-Child-Q15 health literacy tool into English. This stage will take 1 month approximately. Stage 2: Conduct a qualitative pre-test of the translated items. This stage will take approximately 2 months. Stage 3: Validate the English translation of the HLS-Child-Q15 health literacy tool. This stage will take approximately 9 months. Stage 1 – Translation While an existing English translation of the HLS-Child-Q15 was published with the initial German version, this translation was not done according to a rigorous process for conceptual equivalence. Our translation methods are based on those published by Sousa & Rojjanasrirat in 2011. The steps below may need to be revisited if major discrepancies occur in translation. Forward Translation An initial English translation has been published by the authors of the German validation. The original German-language items of the HLS-Child-Q15 will be retranslated by a health professional who is fluent in German but also a native English speaker as per guidelines for the translation of instruments. The translator will not be provided with the previously published English translation. The translator will be instructed to aim for conceptual equivalence rather than literal word-for-word translation. Expert Panel A panel consisting of members of the research team including both native English and native German speakers will deliberate over the translations to identify and resolve any inadequate expressions or inconsistencies. The Forward Translation will be compared to the translated items reported in the English-language publication of the original validation of the HLS-Child-Q15. Discrepancies will be resolved by consensus of the team. Back-Translation The consensus translation will then be translated from English back to German by a health professional who is a native German speaker. This is to ensure the conceptual integrity of the items is retained throughout translation. Discrepancies from the original items will be examined and, if necessary, the translated items will be revised. Stage 2 – Qualitative Pre-Test In order to ensure that the translated questionnaire is suitable for the target population, we will conduct a qualitative pre-test and cognitive debrief. In doing so we will ensure that the items are understood by children, and that the received meaning is the same as in intended meaning for each item. The outcomes of the pre-test may require that the questionnaire items are adjusted prior to validation of the tool. Children and parents will be recruited at Perth Children’s Hospital. Recruited participants will be asked to complete a semi-structured interview lasting approximately 15 minutes, conducted by a trained member of the research team. Interviews will be audio recorded for subsequent transcription. Interviews will take place in an appropriate private space within the wards of Perth Children's Hospitals. The interview will include collection of demographics for children (age, gender). The items of the translated HLS-Child-Q15 health literacy tool will be administered. The time taken to do so will be recorded. The remainder of the interview will consist of debriefing each item of the tool following the Interview Guide. There is no other activity or treatment involved in participation in this study. Translation Refinement The results of the qualitative pre-test will be used to assess the items of the translated questionnaire, and if deemed necessary modifications will be made to the items. These changes will be made by consensus of the research team. Stage 3 - Validation Following translation and qualitative pre-testing the tool will be subject to validation of psychometric properties, and test-retest reliability will be assessed in an opt-in subset of participants. Children and parents will be recruited from all areas of Perth Children’s Hospital. Recruited participants will be asked to complete an online questionnaire. This study will use the REDCap e-consent framework to provide study information and collect consent for participation. Participants will be able to self-enrol in the study via a poster with QR codes, or may be approached to participate by the study team. The online survey will close after 200 participants successfully complete the full questionnaire. The questionnaire will include collection of demographics (age, gender), school year, primary caregiver’s highest education attainment, the Home Literacy Environment (HLE) single-item measure (number of children’s books in the home), and each item of the translated HLS-Child-Q15. Three questions designed to measure self-efficacy (“I can trust in my knowledge and abilities,” “I can find a solution for most problems,” and “If I make an effort, I will succeed”, measured on a four-point scale of agreement) will also be included in the online questionnaire. The questionnaire should take approximately 10 to 15 minutes. To assess test-retest reliability (the consistency of HLS-Child-Q15 scores for the same child over time), responding parents will optionally be able to consent to a follow-up survey and provide their email address or phone number. These participants will automatically be sent a follow-up survey after 2 weeks containing each item of the translated HLS-Child-Q15. There will be a separate option to opt-in and provide an email address to receive a lay summary of findings at the conclusions of the research. There is no other activity or treatment involved in participation in this study. We anticipate that the project will be completed within 12 months, with an additional 3 months for data analysis and manuscript preparation.