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Background <p>Health literacy is a major determinant of health outcomes and health equity. However, culturally appropriate and psychometrically validated instruments remain limited in many low- and middle-income settings. In Morocco, no validated Moroccan Arabic version of the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16) was previously available. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the HLS-EU-Q16 for use in the Moroccan context.</p> Methods <p>We conducted a cross-sectional psychometric study in primary health care centers in the Agadir Ida-Outanane prefecture between December 2024 and June 2025. The questionnaire was translated and culturally adapted using forward–backward translation and cognitive pretesting. Psychometric evaluation included internal consistency, test–retest reliability, floor and ceiling effects, and construct validity assessed by confirmatory factor analysis using a weighted least squares mean and variance adjusted estimator.</p> Results <p>A total of 460 adults were included, of whom 59.6% were women. The Moroccan Arabic HLS-EU-Q16 showed good internal consistency (Cronbach’s alpha = 0.869) and excellent test–retest reliability (ICC range: 0.925–0.978). Item-level floor and ceiling effects were acceptable overall. Confirmatory factor analysis supported the expected three-factor structure, with satisfactory standardized loadings and good model fit indices (CFI = 0.95, TLI = 0.94, RMSEA = 0.025, SRMR = 0.034). Health literacy scores varied significantly according to sex, educational level, and geographical origin.</p> Conclusion <p>The Moroccan Arabic version of the HLS-EU-Q16 demonstrated satisfactory reliability and construct validity in a primary care population. It may serve as a useful instrument for health literacy assessment in Moroccan research, primary care, and public health practice.</p>

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Psychometric validation of the Moroccan Arabic HLS EU Q16 health literacy questionnaire in primary health care settings

  • 期刊论文

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  • 发表日期：

    2026年6月23日

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  • Mohamed Amine Baba,
  • Ahmed Kharbach,
  • Mounya Bouzit,
  • Noura Taalaouente,
  • El Hassane Ouaalaya,
  • Soufiane Bigi,
  • Soukaina Wakrim,
  • Nawal Adali,
  • Rachid Razine,
  • Majoudline Obtel

摘要

Background

Health literacy is a major determinant of health outcomes and health equity. However, culturally appropriate and psychometrically validated instruments remain limited in many low- and middle-income settings. In Morocco, no validated Moroccan Arabic version of the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16) was previously available. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the HLS-EU-Q16 for use in the Moroccan context.

Methods

We conducted a cross-sectional psychometric study in primary health care centers in the Agadir Ida-Outanane prefecture between December 2024 and June 2025. The questionnaire was translated and culturally adapted using forward–backward translation and cognitive pretesting. Psychometric evaluation included internal consistency, test–retest reliability, floor and ceiling effects, and construct validity assessed by confirmatory factor analysis using a weighted least squares mean and variance adjusted estimator.

Results

A total of 460 adults were included, of whom 59.6% were women. The Moroccan Arabic HLS-EU-Q16 showed good internal consistency (Cronbach’s alpha = 0.869) and excellent test–retest reliability (ICC range: 0.925–0.978). Item-level floor and ceiling effects were acceptable overall. Confirmatory factor analysis supported the expected three-factor structure, with satisfactory standardized loadings and good model fit indices (CFI = 0.95, TLI = 0.94, RMSEA = 0.025, SRMR = 0.034). Health literacy scores varied significantly according to sex, educational level, and geographical origin.

Conclusion

The Moroccan Arabic version of the HLS-EU-Q16 demonstrated satisfactory reliability and construct validity in a primary care population. It may serve as a useful instrument for health literacy assessment in Moroccan research, primary care, and public health practice.