The Chinese version of the HLS-EU-Q47 for assessing health literacy among older adults: Cultural adaptation, validation, and exploratory international contextualization.

OBJECTIVES: To culturally adapt and validate the Chinese HLS-EU-Q47 for assessing health literacy (HL) among community-dwelling older adults in Mainland China, and to contextualize limited HL rates internationally. METHODS: A cross-sectional survey was conducted among 957 adults aged ≥60 years from three community health centers in Nanjing, China. The HLS-EU-Q47 was adapted through forward-back translation, expert review, and linguistic refinement. Psychometric properties were evaluated using exploratory and confirmatory factor analyses, reliability and convergent validity testing, and floor and ceiling effect analyses. Published studies on older adults were reviewed for exploratory international contextualization. RESULTS: The adapted Chinese HLS-EU-Q47 showed acceptable internal consistency (Cronbach's alpha > 0.70; Spearman-Brown coefficient and split-half reliability both > 0.90), good structural validity (RMSEA = 0.032, GFI = 0.989, CFI = 0.968, IFI = 0.968, and TLI = 0.966), and satisfactory convergent validity (AVE > 0.50; CR > 0.80). No substantial floor or ceiling effects were observed. The mean general HL score was 29.35 ± 8.83, with the lowest score in the disease prevention domain. Overall, 66.0% of participants had limited HL, including 51.2% with problematic HL. In exploratory international contextualization, limited HL appeared common among older adults across studies, and the estimate in this sample was relatively high within the broad international range. CONCLUSION: The Chinese HLS-EU-Q47 is a reliable and valid instrument for assessing HL among community-dwelling older adults in Mainland China. The high prevalence of limited HL, particularly in the disease prevention domain, highlights the need for age-sensitive assessment and targeted nursing interventions.