The Health Literacy Instruments for Adults (HELIA): Comparison of the Multiple Indicators Multiple Causes (MIMIC) Model and Multi-Group Confirmatory Factor Analysis (MG-CFA) - Payesh (Health Monitor)
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Ethics code: IR.MUMS.FHMPM.REC.1400.127

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1- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
2- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract:   (93 Views)
Objective(s): Currently there are various methods to analyze Differential Item Functioning(DIF) and to evaluate the similarity of people's understanding of a questionnaire’s items in different subgroups, among them are the Multi-Group Confirmatory Factor Model (MG-CFA) and the Multiple Indicators Multiple Causes (MIMIC). The purpose of this study was to investigate and compare the perception of adult women and men of the rural population of Iran on Health Literacy Instrument for Adults (HELIA).
Methods: In this cross-sectional study, a sample of 5675 adults from East Azarbaijan, Khorasan Razavi, Sistan and Baluchistan, Mazandaran, and Fars provinces was selected through a multi-stage cluster sampling technique. Confirmatory factor analysis and evaluation of equivalence of measurement based on gender using MIMIC and MG-CFA methods for the HELIA has been done using M-plus and AMOS software.
Results: The overall mean (SD) score of the HELIA was at a low level (59.64±22.85). The mean score did not show a significant difference in men and women (p=0.624). The overall mean score of the HELIA was significantly higher in people with university education, employed, and unmarried people (P<0.001). The results of the MG-CFA model fitting indicated the presence of DIF in items 10, 22, 28, and 29, and the MIMIC model fitting indicates the presence of DIF in items 1, 4, 26, and 27 of the questionnaire.
Conclusion: By highlighting gender differences in the understanding of HELIA items, our findings emphasize the need for culturally appropriate approaches to assess health literacy and develop targeted interventions to promote health literacy among rural communities in Iran.
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type of study: Descriptive | Subject: Health Metrics
Received: 2024/04/24 | Accepted: 2025/05/19 | ePublished ahead of print: 2025/07/8

References
1. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health 2012;12:1-13 [DOI:10.1186/1471-2458-12-80]
2. Aghamolaei T, Hosseini Z, Hosseini F, Ghanbarnejad A. The Relationship between Health Literacy and Health Promoting Behaviors in Students. Preventive Medicine 2016;3:36-43
3. Dameworth JL, Weinberg JA, Goslar PW, Stout DJ, Israr S, Jacobs JV, et al. Health literacy and quality of physician-trauma patient communication: Opportunity for improvement. Journal of Trauma and Acute Care Surgery 2018;85:193-7 [DOI:10.1097/TA.0000000000001934]
4. Paasche-Orlow MK, Wolf MS. Promoting health literacy research to reduce health disparities. Journal of Health Communication 2010;15:34-41 [DOI:10.1080/10810730.2010.499994]
5. Zareban I, Izadirad H, Araban M. Psychometric evaluation of health literacy for adults (HELIA) in urban area of Balochistan. Payesh 2016;15:669-76 [Persian]
6. Embretson SE, Reise SP. Item response theory for psychologists multivariate. 1st Edition, Erlbaum Publishers: London, 2000
7. Vafaee-Najar A, Gholian-Aval M, Jamali J. Health Literacy among Rural Communities: A Large Cross-Sectional Study. Journal of Health Literacy 2023;8:74-83
8. Steinmetz H, Schmidt P, Tina-Booh A, Wieczorek S, Schwartz SH. Testing measurement invariance using multigroup CFA: Differences between educational groups in human values measurement. Quality & Quantity 2009;43:599-616 [DOI:10.1007/s11135-007-9143-x]
9. MacKenzie SB, Podsakoff PM, Podsakoff NP. Construct measurement and validation procedures in MIS and behavioral research: Integrating new and existing techniques. Management Information Systems Quarterly 2011;35:293-334 [DOI:10.2307/23044045]
10. Bagheri Z, Jafari P, Tashakor E, Kouhpayeh A, Riazi H. Assessing Whether Measurement Invariance of the KIDSCREEN-27 across Child-Parent Dyad Depends on the Child Gender: A Multiple Group Confirmatory Factor Analysis. Global Journal of Health Science 2014;6:p142 [DOI:10.5539/gjhs.v6n5p142]
11. Woods CM, Oltmanns TF, Turkheimer E. Illustration of MIMIC-model DIF testing with the Schedule for Nonadaptive and Adaptive Personality. Journal of Psychopathology and Behavioral Assessment 2009;31:320-30 [DOI:10.1007/s10862-008-9118-9]
12. Woods CM. Evaluation of MIMIC-model methods for DIF testing with comparison to two-group analysis. Multivariate Behavioral Research 2009;44:1-27 [DOI:10.1080/00273170802620121]
13. Magnani JW, Mujahid MS, Aronow HD, et al. Health literacy and cardiovascular disease: fundamental relevance to primary and secondary prevention. A Scientific Statement from the American Heart Association 2018; 138:48-74 [DOI:10.1161/CIR.0000000000000579]
14. Baccolini V, Rosso A, Di Paolo C, Isonne C, Salerno C, Migliara G, et al. What is the prevalence of low health literacy in European :union: member states? A systematic review and meta-analysis. Journal of General Internal Medicine 2021;36:753-61 [DOI:10.1007/s11606-020-06407-8]
15. Tehrani Banihashemi S-A, Amirkhani MA. Health literacy and the influencing factors: a study in five provinces of Iran. Strides in Development of Medical Education 2008;4:1-9
16. Ghanbari S, Ramezankhani A, Mehrabi Y, Montazeri A. The Health Literacy Measure for Adolescents(HELMA): Development and Psychometric Evaluation. Payesh 2016;4:388-402 [Persian] [DOI:10.1037/t52460-000]
17. Bagheri Z, Jafari P, Faghih M, Allahyari E, Dehesh T. Testing measurement equivalence of the SF-36 questionnaire across patients on hemodialysis and healthy people. International Urology and Nephrology 2015;47:2013-21 [DOI:10.1007/s11255-015-1092-z]
18. Jamali J, Ayatollahi SMT, Jafari P. The effect of small sample size on measurement equivalence of psychometric questionnaires in MIMIC model: A simulation study. BioMed Research International 2017;2017:1-12 [DOI:10.1155/2017/7596101]

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