Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses

Objective
Health literacy refers to an individual's ability to seek, understand, and use health information. A range of indices exist that purport to measure health literacy across individuals and populations. This study aimed to review the development and content of existing indices and to critically appraise their properties.

Study Design and Setting
Using standardized search terms, published generic health literacy indices (1990–2008) were identified. Using a methodological framework, each was evaluated for purpose, validity (face, content, construct), reliability, responsiveness, feasibility, and generalizability.

Results
Nineteen instruments were evaluated. Three measurement approaches were identified: direct testing of individual abilities, self-report of abilities, and population-based proxy measures. Composition of underlying constructs and content varied widely across instruments, and none appeared to fully measure a person's ability to seek, understand, and use health information. The content was focused primarily on reading comprehension and numeracy; scoring categories were poorly defined and may not be mutually exclusive, and few indices had been assessed for reliability.

Conclusion
Health literacy is not consistently measured, making it difficult to interpret and compare health literacy at individual and population levels. Empirical evidence demonstrating validity and reliability of existing indices is required, and more comprehensive health literacy instruments need to be developed.

A validity-driven approach to the understanding of the personal and societal burden of low back pain : development of a conceptual and measurement model

Introduction: While the importance and magnitude of the burden of low back pain upon the individual is well recognized, a systematic understanding of the impact of the condition on individuals is currently hampered by the lack of an organized understanding of what aspects of a person’s life are affected and the lack of comprehensive measures for these effects. The aim of the present study was to develop a conceptual and measurement model of the overall burden of low back pain from the individual’s perspective using a validity-driven approach.
Methods: To define the breadth of low back pain burden we conducted three concept-mapping workshops to generate an item pool. Two face-to-face workshops (Australia) were conducted with people with low back pain and clinicians and policy-makers, respectively. A third workshop (USA) was held with international multidisciplinary experts. Multidimensional scaling, cluster analysis, participant input and thematic analyses organized participants’ ideas into clusters of ideas that then informed the conceptual model.
Results: One hundred and ninety-nine statements were generated. Considerable overlap was observed between groups, and four major clusters were observed - Psychosocial, Physical, Treatment and Employment - each with between two and six subclusters. Content analysis revealed that elements of the Psychosocial cluster were sufficiently distinct to be split into Psychological and Social, and a further cluster of elements termed Positive Effects also emerged. Finally, a hypothesized structure was proposed with six domains and 16 subdomains. New domains not previously considered in the back pain field emerged for psychometric verification: loss of independence, worry about the future, and negative or discriminatory actions by others.
Conclusions: Using a grounded approach, an explicit a priori and testable model of the overall burden of low back pain has been proposed that captures the full breadth of the burden experienced by patients and observed by experts.

A content analysis of sponsor representation across professional sport websites : extension of attribute typology

The sport industry has identified the importance of using the internet as a tool that can benefit the organisation. Much like the purpose of entering into sponsorship of sporting events, corporate partners are also attracted to the opportunities that professional sport team websites offer to fulfil similar objectives. The major purpose of this research is to explore the various ways in which sponsor logos are represented across professional sport websites and to extend previous advertising research, specifically the work developing advertising attribute typologies. The subjects for this research are professional sport websites and a qualitative approach is adopted with a content analysis as the main method of analysis used. To ensure reliability and validity within the coding instruments used, percentage agreement and Cohen’s kappa were adopted as indexes to verify this. The findings show sponsors’ logos exist on most professional sport websites and are represented in a variety of ways. Furthermore, a typology for sponsor representation and location across sport websites has been established to present a reliable foundation for future research in the area of consumer attitudes, behaviour and response towards sponsors and their presence on sport websites.

Descriptive analysis of landings during international netball competition: enhancing ecological validity of laboratory testing environments

Non-contact landings have been identified as a common activity associated with injury in netball. Investigating injury risk factors during landing via laboratory-based analysis warrants the performance of sportspecific landing tasks with the inclusion of “game- like” factors to enhance ecological validity of testing protocols. Understanding how players perform landing tasks in a competitive environment is, therefore, essential.

The purpose of this study was to perform a descriptive analysis of in-game landings performed by netball players, with regard to the landing techniques used and game events surrounding these landings; with the intent of providing information to enhance the ecological validity of laboratory-based testing environments. Landings were categorised according to landing technique and game events surrounding the landing.