Psychometric properties and factorial structure of the Spanish version of the HLS-EU-Q16 questionary in Venezuelan adults

Judith Francisco-Pérez; Víctor López-Guerra; Gabriel Ortíz; Angélica Rojas; Carmen Martínez; Ronald Serrano

doi:10.1371/journal.pone.0324782

Peer Review History

Original SubmissionSeptember 11, 2024
Decision Letter - Oriana Rivera-Lozada de Bonilla, Editor Dear Dr. López-Guerra, 1. Strengthen the introduction, including more background on other similar studies. 2. Specify how the population and sample were selected Please submit your revised manuscript by Mar 22 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. 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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: This is an interesting review of a Health literacy scale that has been adapted to the local language. Here are a few comments: Add more literature in the introduction, cite more than one research for the factors thought to be associated with Health literacy (if possible include various socioeconomic locations and global and regional data.) Line 132 Find a better term for 'Accidental sampling', additionally it's not clear where exactly the sample population was gotten from (at their homes, public areas, schools?) Generally, can you further explain the difference between assessing the psychometric qualities of the scale VS validating the tool in local context Reviewer #2: This paper aims to evaluate the psychometric validity of the HLS-EU-Q16 in the Venezuelan context, offering valuable insights into health literacy levels among Venezuelan adults. A few comments for author's consideration: 1. the adaptation of the HLS-EU-Q16 is mentioned briefly, and many researcher are unaware of this tool. Please expand on its items. 2. Could you provide more details about the informed consent process and how privacy and confidentiality were ensured? 3. Why a factor of 1.5 was used? a reference would be useful. 4. On what basis did you use these thresholds in the scoring system to determine the categories (inadequate, problematic, and adequate)? 5. Why two statistical softwares has been used? please elaborate. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org https://doi.org/10.1371/journal.pone.0324782.r001
Revision 1
21 Feb 2025 Author Response Revisor 1 1)Add more literature in the introduction, cite more than one research for the factors thought to be associated with Health literacy (if possible include various socioeconomic locations and global and regional data.) R: References were added that relate LH to chronic disease management, the role of caregivers in diabetes, the influence of education and financial deprivation on LH levels, as well as its impact on prevention and health promotion in cancer patients, adolescents and in the context of COVID-19. Studies linking LH to self-care, perioperative risk reduction and cognitive impairment were also included. 2)Line 132 Find a better term for 'Accidental sampling', additionally it's not clear where exactly the sample population was gotten from (at their homes, public areas, schools?) R: The term “Accidental sampling” was replaced by “Convenience sampling”, as this term is more accurate and widely accepted in the methodological literature to describe a non-probability sampling based on the accessibility and willingness of the participants. In addition, it was specified in the manuscript that the data was collected through electronic surveys (Google Forms) and face-to-face interviews in public institutions, parks or shopping malls. These locations were strategically selected to ensure a diverse representation of the population, covering different socioeconomic and educational levels. 3)Generally, can you further explain the difference between assessing the psychometric qualities of the scale VS validating the tool in local context R:The distinction between the assessment of psychometric properties (reliability, validity and factor structure analysis) and the validation of the tool in the local context (linguistic and cultural adaptation) has been added to the manuscript. This improves the methodological clarity of the study. Revisor 2 4)The adaptation of the HLS-EU-Q16 is mentioned briefly, and many researcher are unaware of this tool. Please expand on its items. R:In response to the reviewer’s comment, we have expanded the introduction to detail the linguistic and cultural adaptation of the HLS-EU-Q16. We incorporated references to previous adaptations in different cultural contexts (Gústafsdóttir et al., 2020; Storms et al., 2017) to emphasize the importance of maintaining the instrument’s validity. Additionally, we explicitly describe our process, including translation, back-translation, and cognitive interviews with 30 participants to ensure its comprehension and relevance in the Venezuelan context. Examples of some items that make up the questionnaire were also provided. 5)Could you provide more details about the informed consent process and how privacy and confidentiality were ensured? The description of the informed consent process has been expanded to clarify that participants provided written consent, were informed about the study objectives, and assured confidentiality. It is now explicitly stated that data collection was anonymous, and no personally identifiable information was recorded." 6)Why a factor of 1.5 was used? a reference would be useful R:The use of a factor of 1.5 to account for potential data inaccuracies is not a commonly documented practice in standard psychometric analyses. Therefore, we have removed it from the manuscript to ensure methodological rigor and adherence to established psychometric principles. 7)On what basis did you use these thresholds in the scoring system to determine the categories (inadequate, problematic, and adequate)? R:The justification for the categorization thresholds has been expanded in the manuscript by incorporating references to previous studies that have used different classification approaches for health literacy. �Sørensen et al. (2015) proposed a four-level classification, combining the ‘inadequate’ and ‘problematic’ levels into a single “limited” literacy category for some analyses. �Nolasco et al. (2020) used a simplified two-level classification, distinguishing between ‘inadequate or problematic’ (0-12 points) and ‘sufficient’ (13-16 points). �Other studies, such as García-Vera et al. (2023), Poza Méndez et al. (2023), and Kampouroglou et al. (2021), adopted a three-level categorization, similar to the one used in this study. Following these methodological precedents, the present study establishes three levels of health literacy: inadequate (16-40 points), problematic (41-60 points), and adequate (61-80 points). The existence of multiple categorization models across different studies demonstrates that classifications are adapted based on research objectives and target populations. The three-level approach chosen for this study provides a more precise differentiation of health literacy levels within the Venezuelan context, facilitating the identification of groups that require greater intervention in terms of access to and comprehension of health information. 8)Why two statistical softwares has been used? please elaborate. R:All analyses were performed using Jeffrey’s Amazing Statistics Program (JASP) version 0.18.3.0. Therefore, references to IBM Statistical Package for the Social Sciences (SPSS) version 24 (IBM Inc., Chicago, IL, USA) have been removed to ensure consistency in the description of the statistical software used Editor 9)Please review your reference list to ensure that it is complete and correct. R:All references have been carefully reviewed. Attachments Attachment Submitted filename: Response to Reviewers (17feb).docx https://doi.org/10.1371/journal.pone.0324782.r002
Decision Letter - Oriana Rivera-Lozada de Bonilla, Editor Psychometric properties and factorial structure of the Spanish version of the HLS-EU-Q16 questionary in Venezuelan adults PONE-D-24-37744R1 Dear Dr. Victor López-Guerra, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Oriana Rivera-Lozada de Bonilla Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0324782.r003
Formally Accepted
Acceptance Letter - Oriana Rivera-Lozada de Bonilla, Editor PONE-D-24-37744R1 PLOS ONE Dear Dr. López-Guerra, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Oriana Rivera-Lozada de Bonilla Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0324782.r004

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