Development and psychometric testing of the Health Literacy Index for Female Marriage Immigrants (HLI-FMI) in Korea

This study aimed to develop and examine the psychometric properties of the Health Literacy Index for Female Marriage Immigrants (HLI-FMI). Study participants were 282 women who migrated to Korea from Asian countries to marry and had a mean age of 33.24 years and had immigrated a mean of 5.58 years ago. Data were collected between March 2013 and May 2013. An initial 31 preliminary items were developed based on literature reviews and focus group interviews, including three constructs of health literacy: skills (print, numeracy), tasks (access, understand, appraise, apply), and health contexts (health promotion and disease prevention, health care maintenance and treatment, health system navigation). Exploratory factor analyses of the HLI-FMI yielded 12 items in two factors: Access-Understand Health Literacy (seven items) and Appraise-Apply Health Literacy (five items; Cronbach’s alpha = 0.74). Criterion validity was supported through a significant correlation with the Rapid Estimate of Adult Literacy in Medicine-Short Form. Guided by a classical test theory and item response theory, item difficulty and discrimination were within acceptable ranges. HLI-FMI scores were positively associated with participant education and Korean proficiency. The HLI-FMI appears to be the first valid and reliable comprehensive health literacy measure for evaluating health literacy in Korean female marriage immigrants.