Development and preliminary psychometric evaluation of a Tuberculosis-Specific Health Literacy Questionnaire based on the integrated model: A phase 1 pilot study in Indonesia

Vollständiger Abstract

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Tuberculosis-specific health literacy is critical for treatment adherence, yet Indonesia lacks a context-specific instrument grounded in a comprehensive framework. This pilot study aimed to develop and preliminarily evaluate a tuberculosis-specific health literacy questionnaire based on the Integrated Model of Health Literacy. A cross-sectional Phase 1 instrument-development study was conducted among former tuberculosis patients in Jember Regency, Indonesia. The 46-item questionnaire was mapped to four domains: access, understand, appraise, and apply. Content validity was assessed by five experts using Item-Level and Scale-Level Content Validity Indices. Forward-backward translation ensured semantic equivalence. Interrater reliability was evaluated by three independent raters using the Intraclass Correlation Coefficient. Internal consistency was examined using Cronbach's alpha. The instrument demonstrated excellent content validity with a Scale-Level Content Validity Index average of 0.99. Overall interrater reliability was good, yielding an Intraclass Correlation Coefficient of 0.81. Internal consistency was exceptionally high, with a total Cronbach's alpha of 0.97. Domain-specific alphas ranged from 0.89 to 0.96. Two items met the minimum Item-Level Content Validity Index threshold of 0.80 and were retained for further refinement. The newly developed tuberculosis-specific health literacy questionnaire exhibits promising preliminary psychometric properties. Subsequent large-scale validation studies must evaluate factor structure, test-retest reliability, and potential item reduction before the instrument can be utilized for routine clinical or public health decision-making.