Validating the Functional, Communicative, and Critical Health Literacy Scale Using Rasch Modeling and Confirmatory Factor Analysis

Background and Purpose: The functional, communicative, and critical health literacy (FCCHL) scale is widely used for assessing health literacy (HL) in people with chronic diseases, such as type 2 diabetes (T2DM). Despite related subscales, researchers continue to apply a consecutive modeling approach, treating the three subscales as independent. This article studies the psychometric characteristics of the FCCHL by applying multidimensional modeling approaches. Methods: Rasch modeling and confirmatory factor analyses were applied to responses (paper-and-pencil) from 386 adults with T2DM. Results: Using a six-point rating scale and a three-dimensional Rasch model, this study found that a 12-item version of the FCCHL reduced within-item bias and improved subscale reliability indexes. Conclusion: This study suggests a parsimonious 12-item version of the FCCHL. The data fit a three-dimensional Rasch model best.