Structural Analysis of the Health Literacy Facet Access to Information on General Health, COVID-19 Infection Prevention, and Early Childhood Allergy Prevention in Pregnant Women and Mothers of Infants

Abstract. The health literacy (HL) facet Access to health information is measured in the European Health Literacy Survey (HLS-EU-Q47) by 12 items. To assess Access, we developed adapted item formulations for COVID-19 infection prevention (COVID-19-IP) and early childhood allergy prevention (ECAP) in addition to the original 12 items on General Health (GH). N = 343 (expectant) mothers of infants answered the items in an online assessment. Confirmatory structural analyses for ordinal data were adopted (WLSMV-algorithm). Women’s item ratings varied significantly across domains (η2 = .017 – .552). Bi-factor models exhibited the best data fit (GH / COVID-19-IP / ECAP: CFI = .964 / .968 / .977; SRMR: .062 / .069 / .035): The general factor Access most strongly determined item information. Additionally, three subfactors contributed significantly (but rather weakly) to the item information in each domain. The overall score Access proved to be internally consistent (McDonald’s ωGH/COVID-19-IP/ECAP = .874 / .883 / .897) and was associated with socioeconomic state (McArthur scale; rGH/COVID-19-IP/ECAP = .218 / .210 / .146). Access correlated not or only weakly with the other HL facets Understand, Appraise, and Apply. The health domains GH, COVID-19-IP, and ECAP moderated both the difficulty and the dimensional structure of the 12 Access items. This suggests that in the HLS-EU Access reflects not only the search competence but also the availability of health information.