Measuring functional health literacy in hungary: Validation of s-tofhla and chew screening questions

Lilla Náfrádi, Orsolya Papp-Zipernovszky, Peter J. Schulz, Márta Csabai

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objectives: The first efforts to measure health literacy have recently started in Hungary, thus there remains a need for tools that can be effectively used in the clinical setting. The goal of the present study was two-fold: to validate tools for measuring functional health literacy in Hungary using the Short Test of Functional Health Literacy (S-TOFHLA) and the Chew screening measure, and to provide an overview of the health literacy level of the Hungarian population. Methods: The original English versions of both instruments were translated following the principles of cultural adaptation and standardized translation methods. The measures were administered to a random sample (N = 302) that was close to representative of the Hungarian population regarding age, gender and educational background. The Newest Vital Sign functional health literacy test and numerous socio-demographic variables (such as age, gender, education and income) were also administered to test convergent validity. Results: The Hungarian version of the S-TOFHLA and the Chew questions showed adequate internal consistency. Lower functional health literacy scores showed the expected association with known predictors of health literacy: higher age, male gender and lower education. Especially people above 65 years of age and individuals with a low level of educational attainment or being chronically ill are vulnerable to have marginal health literacy. Conclusion: The Hungarian version of the S-TOFHLA is a valid and reliable measure of health literacy. Moreover, the Hungarian version of the Chew screening questions provides a valid self-reported assessment, which is particularly useful to rapidly detect patients with inadequate health literacy in hospitals. It is expected that these health literacy measurements will be used for not only scientific purposes, but also serve as tools for developing public health policy, especially health education and campaigns reducing potential health disparities in Hungary.

Original languageEnglish
Pages (from-to)320-325
Number of pages6
JournalCentral European Journal of Public Health
Issue number4
StatePublished - Dec 2019

Bibliographical note

Publisher Copyright:
© 2019, Czech National Institute of Public Health. All rights reserved.


  • Chew screening measure
  • Health literacy
  • Measurement
  • Validation


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