ORIGINAL ARTICLE
Int. J. Public Health
Structural Validation and Measurement Invariance of the HLS-Q12 Health Literacy Instrument in Finnish Adults: Comparing Traditional and Alignment Methods
- JZ
Jing Zhou 1,2
- HR
Hanna Rekola 2
- MS
Marjorita Sormunen 3
- TM
Tomi Mäki-Opas 2,4
1. School of Law, Shanghai Lixin University of Accounting and Finance, Shanghai, China
2. Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
3. Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
4. Social, Wellbeing, and Rescue Research Centre, Wellbeing Services County of North Savo, Kuopio, Finland
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Abstract
Objectives: To examine the internal structure, internal consistency, and measurement invariance of the HLS-Q12 across sociodemographic groups in Finnish adults, using traditional multi-group confirmatory factor analysis (MGCFA) and alignment optimization. Methods: We analyzed data from 7,077 Finnish adults drawn from a nationally representative national sample (n=4,003) and a regional sample from North Savo (n=3,074). Analyses included confirmatory factor analysis, MGCFA, and alignment optimization with Monte Carlo evaluation. Invariance was examined across gender, age, education, and study samples. Results: Reliability was high (α = 0.905 & ω = 0.896) and unidimensional structure (CFI = 0.951, TLI = 0.935, RMSEA = 0.058). MGCFA supported scalar invariance for gender, education, and study samples. Alignment optimization exhibited acceptable non-invariance (2.8%-25% of parameters), primarily in intercepts. Women and individuals with higher education showed higher health literacy; young adults exhibited higher levels than older cohorts. Conclusions: The Finnish HLS-Q12 supported subgroup comparisons for population monitoring, with largely adequate measurement invariance across key sociodemographic groups. The evidence pertains primarily to internal structure and measurement invariance. Further studies should examine additional validity evidence using external criteria.
Summary
Keywords
alignment method, Health Literacy, HLS-Q12, measurement invariance, structural validation
Received
18 November 2025
Accepted
12 March 2026
Copyright
© 2026 Zhou, Rekola, Sormunen and Mäki-Opas. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jing Zhou, zhou@uef.fi
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