Functional health literacy in Switzerland-Validation of a German, Italian, and French health literacy test

Objective: This study aimed to translate and validate German, Italian, and French versions of the Short-Test of Functional Health Literacy (S-TOFHLA), to be used in Switzerland and its neighboring countries. Methods: The original English version of the S-TOFHLA was translated by applying standardized translation methods and cultural adaptations. 659 interviews were conducted with Swiss residents in their preferred language (249 German, 273 Italian, and 137 French). To assess the validity of the measures, known predictors for health literacy (age, education, and presence of a chronic condition) were tested. Results: For all three language versions, results show that younger participants, participants with a higher education and participants with chronic medical conditions had significantly higher levels of health literacy. Furthermore, the three health literacy scales categorized participants into three health literacy levels with most people possessing either inadequate or adequate levels. The highest levels of health literacy were found in the Swiss-German sample (93%), followed by the Swiss-French (83%) and Swiss-Italian (67%) samples. Conclusion: The German, Italian, and French versions of the S-TOFHLA provide valid measures of functional health literacy. Practice implications: The translated versions can be used in the three different language regions of Switzerland as well as in neighboring countries following 'country specific' adjustments and validations.