Validation of the Spanish Subjective End-of-Life Health Literacy Scale through community-based workshops in Argentina.

Abstract

Objectives: To culturally adapt and validate the Spanish version of the Subjective End-of-Life Health Literacy Scale (S-EOL-HLS) through community-based workshops in Argentina.

Methods: The S-EOL-HLS was translated following the forward-backward method and iteratively refined through community workshops conducted in urban and rural settings. Initial testing took place in 5 workshops (n = 57), followed by face validity assessment by an expert panel (n = 11). Based on this feedback, additional workshops were conducted alongside cognitive interviews, and a subset of participants completed a test-retest assessment. Participants completed the adapted scale and a brief sociodemographic questionnaire. Psychometric evaluation was performed using exploratory factor analysis on the initial sample and confirmatory factor analysis on a second sample (n = 120), together with assessments of internal consistency and construct validity.

Results: The analyses supported a 3-factor structure representing functional, interactive, and critical dimensions of end-of-life health literacy. Factor loadings ranged from 0.57 to 0.91, with items loading primarily on their intended domains. The model demonstrated acceptable fit and high internal consistency (Cronbach's α = 0.89). Qualitative feedback from participants and experts improved the clarity and contextual relevance of the Spanish version. While most participants reported ease in understanding technical end-of-life terminology, greater uncertainty was observed for interactive and decision-making items, indicating challenges in applying information to personal treatment choices.

Significance of results: The Spanish S-EOL-HLS demonstrated evidence of content validity, construct validity, and good psychometric performance in an Argentine context. Beyond its measurement properties, the scale also served as a structured prompt for reflection and dialogue in community settings.