The Health Information Literacy Knowledge Test (HILK ...?The Health Information Literacy Knowledge Test ... Need for a knowledge test which goes beyond basic literacy and which is

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  • The Health Information Literacy Knowledge Test (HILK):

    Construction and results of a pilot study

    Leibniz Institute for Psychology Information (ZPID)

    Trier, Germany

    Anne-Kathrin Mayer & Julia Holzhuser

    Health information literacy (HIL) comprises a set of abilities needed to recognize a health information need, search and evaluate relevant health information, and to use this information to make appropriate health decisions

    relevant for peoples autonomy regarding health decisions

    Everyday HIL is usually assessed by self-report measures or measures of basic reading skills and numeracy (e.g., TOFHLA, Parker et al., 1995; REALM, Davis et al., 1993)

    So far no validated achievement test exists in the international research literature which is not focused on the academic context

    Need for a knowledge test which goes beyond basic literacy and which is appropriate for adults of different age groups with middle to higher levels of education (adequate level of reading skills is assumed)

    Importance of a knowledge test for research purposes: measurement of HIL in the general population to identify people with low HIL, determine a need for training programs of HIL and evaluate such interventions


    Development of an economic test of knowledge about seeking and evaluating everyday health information of adults based on a skill decomposition

    Empirical construction in two steps:

    1) Expert study: examination of the correctness of the answers and refinement of item formulations

    2) Pilot study: considerable shortening of the test based on psychometric properties of the items and first examination of its validity


    Construction of items was based on a skill decomposition derived from models of information problem solv-

    ing as well as general models of information literacy (e.g. IPS, Brand-Gruwel et al., 2009; Big6, Eisenberg

    & Berkowitz, 1990)

    Skill decomposition (Four skills with two subskills each):

    1. Definition of information need (1.1 Define the information problem / 1.2 Identify information needed),

    2. Planning the search (2.1 Knowledge of information resources / 2.2 Determine search strategy),

    3. Accessing information sources (3.1 Identify type of source / 3.2 Gain access (full text)),

    4. Scanning information (4.1 Assessment of relevance and quality / 4.2 Orientation within source)

    Questions require participants, e.g., to recognize adequate sources to satisfy a specific information need, or

    to evaluate health materials with regard to their relevance or quality

    The test focuses on different types of information sources and providers, e.g. books, libraries, and the inter-


    Multiple choice questions with three answer options and an I dont know-category (number of correct

    answers ranging from 0 to 3)

    Example items:

    Test Construction

    Subjects: N = 11 psychologists from the field of information literacy research (6 male, 5 female)

    Materials: The experts worked on a preliminary paper-and-pencil test version of the HILK with 57 items


    Four items were dropped because experts did not reach an acceptable consensus about the correct


    Experts feedback was used to refine several item formulations

    Resulted in a revised test version with 53 items

    Expert Study

    Subjects and Procedure:

    N = 138 psychology students, 70.3% Bachelor, 28.3% Master

    Age: between 18 and 33 years (M = 22.61, SD = 2.71)

    87% female and 13% male

    Data was collected in computer laboratories or classrooms at the University of Trier in groups of up to 20 sub-

    jects; the sessions took between 90 and 120 minutes

    Participants were paid for their participation


    HILK: revised version with 53 items

    Test of domain-specific scholarly information literacy (Leichner et al., 2013; k = 35)

    Battery of self-report questionnaires assessing :

    1) self-efficacy beliefs related to health-related information: SWE-IB-16 (Behm, 2015; k = 16), eHEALS (Soellner et al., 2014; k = 8)

    2) current health status SF-12 (Bullinger & Kirchberger, 1998; k = 12) 3) health related control beliefs: FEGK (Ferring & Filipp, 1989; k = 29) 4) health anxiety: MK-HAI (Bailer & Witthft, 2006; k = 14)

    The HILK could be successfully shortened to a 24-item version based on psychometric properties of the items

    (Item-total correlations range from rit = .11 to .38)


    The shortened version demonstrates acceptable internal consistency (Cronbachs Alpha = .71)

    Guttmans Lambda 6 of 6 = .78 more suitable measure of reliability for heterogeneous constructs

    Validity and associations with other measures:

    The HILK is moderately correlated with the scholarly information literacy test for psychology (see Table 1 for


    sign for convergent validity

    Significant correlation with a measure of self-efficacy beliefs related to health-related information (SWE-IB-

    16), but not with self-efficacy beliefs focused on the internet and electronic resources (eHEALS)

    No significant correlations found between achievement in the HILK and health related control beliefs, health

    anxiety and the current health status

    Significant group difference in HILK test performance between Bachelor (M = .79; SD = .09) and Master stu-

    dents (M = .82; SD = .11; t(134) = 1.69; p < .05, one-tailed)


    Pilot Study

    3rd European Health Literacy Conference, November 17-18, Brussels

    References Bailer, J. , Witthft, M. (2006). Modifizierte Kurzform des Health Anxiety Inventory (MK-HAI) [The health anxiety inventory - German modified version]. In A. Glckner-Rist (Ed.), ZUMA-Informationssystem. Elektronisches Handbuch sozialwissenschaftlicher Erhebungsinstrumente. Version 10.0. Mannheim: Zentrum

    fr Umfragen, Methoden und Analysen. Behm, T. (2015). Informationskompetenz und Selbstregulation: Zur Relevanz bereichsspezifischer Selbstwirksamkeitsberzeugungen [Information competence and self-regulation: The relevance of domain-specific self-efficacy] . In A.-K. Mayer (Ed.) Informationskompetenz im Hochschulkontext Interdisziplinre

    Forschungsperspektiven (S. 151-162). Lengerich: Pabst Science Publishers. Brand-Gruwel, S., Wopereis, I., & Walraven, A. (2009). A descriptive model of information problem solving while using internet. Computers & Education, 53(4), 1207-1217. Bullinger, M., & Kirchberger, I. (1998). Fragebogen zum Gesundheitszustand - Manual [Health survey - Manual]. Gttingen: Hogrefe-Verlag. Davis, T. C., Long, S. W., Jackson, R. H., Mayeaux, E. J., George, R. B., Murphy, P. W., & Crouch, M. A. (1993). Rapid estimate of adult literacy in medicine: a shortened screening instrument. Family medicine, 25(6), 391-395. Eisenberg, M. B., & Berkowitz, R. E. (1990). Information Problem Solving: The Big Six Skills Approach to Library & Information Skills Instruction. Norwood, NJ: Ablex Publishing Corporation. Ferring, D., & Filipp, S. H. (1989). Der Fragebogen zur Erfassung gesundheitsbezogener Kontrollberzeugungen (FEGK): Kurzbericht [The Health-Related Locus of Control Questionnaire (FEGK)]. Zeitschrift fr Klinische Psychologie, Psychopathologie und Psychotherapie, 18, 285-289. Leichner, N., Peter, J., Mayer, A.-K., & Krampen, G. (2013). Assessing information literacy among German psychology students. Reference Services Review, 41(4), 660-674. doi:10.1108/RSR-11-2012-0076 Parker, R. M., Baker, D. W., Williams, M. V., & Nurss, J. R. (1995). The test of functional health literacy in adults. Journal of General Internal Medicine, 10(10), 537-541. Soellner, R., Huber, S., & Reder, M. (2014). The concept of eHealth Literacy and its measurement. Journal of Media Psychology, 26, 29-38.


    = .85


    = .77


    = .67

    FEGK internal

    = .83

    FEGK external

    = .81

    SF-12 physical

    SF-12 mental


    = .89 HILK .15* -.02 .49** .07 -.08 .06 .17 -.08

    Table 1. Correlations between HILK test performance and self-efficacy beliefs related to health-

    related information (SWE-IB-16 and eHEALS), information literacy test (ILT), health related control be-

    liefs (FEGK), current health status (SF-12) and health anxiety (MK-HAI).

    * p < .05; ** p < .01 (one-tailed)

    Book 1 Book 2 Book 3

    Additional materials provided in a supplement Questions

    The 24-item version of the HILK is an economic test of knowledge about seeking and evaluating everyday

    health information which may be used for research purposes

    More evidence is needed before applying it in research:

    Studies needed with people from different age groups, fields of studies, and without academic background

    Stronger indicators of validity needed, e.g. search tasks or measures of the general cognitive level


    8. Look at the book covers on page 3 in the supplement. Which book contains

    or which books contain probably the most balanced information (naming pros

    and cons) about the topic health outcomes of sport in older age?

    True Not true

    Book 1

    Book 2

    Book 3

    I dont know

    22. Please look at the list of contents on page 5 in the supplement. You would

    like to find other publications about the treatment options for lung cancer as

    easily as pos