Research Article
BibTex RIS Cite

Development and psychometric evaluation of future physicians' approach to health literacy scale (F-PATHS)

Year 2025, Issue: Advanced Online Publication, 313 - 330

Abstract

Objective: Health literacy (HL) practices are a key element of effective communication between patients and healthcare professionals, enabling the delivery of better quality patient-centered care. The main purpose of this study is to develop a set of scales within the scope of an Erasmus + European Union Project in order to evaluate the knowledge and attitudes of clinical period students of the national partners about HL. Subsequently, the validity and reliability analyses of the set of scales (Future Physicians’ Approach to HL Scale, F-PATHS) are presented.
Methods: A total of 39 statements, to be analyzed for validity and reliability, were delivered to the participants by the convenience sampling method as a component of an online data collection form with a total of 62 questions prepared through Google Forms. Then, Exploratory Factor Analysis (EFA) was applied to evaluate the construct validity. Principal component analysis and the “direct oblimin” rotation method were used in EFA. The reliability was calculated with Cronbach’s Alpha and the item-total score correlation.
Results: Considering the factor loadings and theoretical framework, items 3, 4 and 26 were removed from the scale set. The total variance explained percentage of the final scale set was 63.96% and the number of factors was 7. The KMO value was 0.913, and the Bartlett test was statistically significant (p<0.001). Considering the theoretical structure and Likert format of the scale set, it was determined that it measured different characteristics and could be evaluated independently as three separate scales. According to the KMO value and Bartlett’s test, the data were suitable for factor analysis for all three scales and the factor structure was regular. Cronbach's Alpha values of the scales are 0.862, 0.858, and 0.909, respectively.
Conclusion: F-PATHS appears to be valid in terms of EFA and reliable for determining the approaches of faculty of medicine clinical term students regarding the HL of the society.

Ethical Statement

Participation in the research was carried out on a voluntary basis and informed consent was obtained from the participants. For the research, permission was received from Gazi University Ethics Commission (date: 23.3.2021; number: E-77082166- 604.01.02-59610) and faculty deans.

Supporting Institution

The study was conducted within the framework of an Erasmus+ European Union Project of Strategic Partnership.

References

  • 1. Ratzan SC, Parker RM. Introduction. In: Selden CR, Zorn M, Ratzan SC, Parker RM, editors. National Library of Medicine Current Bibliographies in Medicine: Health Literacy. NLM Pub. No. CBM 2000-1. Bethesda (MD): National Institutes of Health, U.S. Department of Health and Human Services; 2000.
  • 2. Okan O, Bauer U, Levin-Zamir D, Pinheiro P, Sørensen K. International Handbook of Health Literacy: Research, practice and policy across the lifespan. Bristol: Policy Press, 2019.
  • 3. WHO. Health literacy: The solid facts. In: Kickbusch I, Pelikan JM, Apfel F, Tsouros AD, editors. World Health Organization, Regional Office for Europe [online]. Available at: https://iris.who.int/bitstream/handle/10665/128703/e96854.pdf. Accessed March 22, 2025.
  • 4. Liu YB, Liu L, Li YF, Chen YL. Relationship between Health Literacy, Health-Related Behaviors and Health Status: A Survey of Elderly Chinese. Int J Environ Res Public Health 2015;12(8):9714-9725.
  • 5. Weiss BD. Health literacy research: Isn’t there something better we could be doing? Health Commun 2015;30(12):1173-1175.
  • 6. Adkins RN, Corus C. Health literacy for improved health outcomes: Effective capital in the marketplace. J Consum Aff 2009;43(2):199-222.
  • 7. Ülker İ, Aydın MA, Yıldız M, Coşkun H. Relationship between microbiota awareness, nutrition literacy, and health literacy among adolescents. Turk J Med Sci 2024;54(5):938-948.
  • 8. Sacks K, Kim B. Health Literacy in the United States: Enhancing Assessments and Reducing Disparities. In: Milken Institute [online]. Available at: https://milkeninstitute.org/content-hub/research-and-reports/reports/health-literacy-united-states-enhancing-assessments-and-reducing-disparities. Accessed March 22, 2025.
  • 9. McCaskill A, Gasch-Gallen A, Montero-Marco J. Measuring general health literacy using the HLS19-Q12 in specialty consultations in Spain. BMC Public Health 2024;24(1):3247.
  • 10. Soğanda SY, Öztop MB, Üner S, et al. Empowering health literacy: Turkiye’s Health Literacy Action Plan 2022-2026. Eur J Public Health 2024;34(Suppl 3):ckae144.2192.
  • 11. Tavakoly Sany SB, Peyman N, Behzhad F, Esmaeili H, Taghipour A, Ferns G. Health providers’ communication skills training affects hypertension outcomes. Med Teach 2018;40(2):154-163.
  • 12. Stone M, Bazaldua O, Morrow J. Developing Health Literacy Communication Practices for Medical Students. MedEdPORTAL 2021;17:11091.
  • 13. Allenbaugh J, Spagnoletti CL, Rack L, Rubio D, Corbelli J. Health literacy and clear bedside communication: a curricular intervention for internal medicine physicians and medicine nurses. MedEdPORTAL 2019;15:10795.
  • 14. Quigley DD, Elliott MN, Farley DO, Burkhart Q, Skootsky SA, Hays RD. Specialties differ in which aspects of doctor communication predict overall physician ratings. J Gen Intern Med 2014;29(3):447-454.
  • 15. Coleman CA, Peterson-Perry S, Bumsted T. Long-Term Effects of a Health Literacy Curriculum for Medical Students. Fam Med 2016;48(1):49-53.
  • 16. Hildenbrand GM, Perrault EK, Keller PE. Evaluating a Health Literacy Communication Training for Medical Students: Using Plain Language. J Health Commun 2020;25(8):624-631.
  • 17. Kripalani S, Weiss BD. Teaching about health literacy and clear communication. J Gen Intern Med 2006;21(8):888-890.
  • 18. Tavakoly Sany SB, Behzhad F, Ferns G, Peyman N. Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial. BMC Health Serv Res 2020;20(1):60.
  • 19. Tsai HY, Lee SD, Coleman C, et al. Health literacy competency requirements for health professionals: a Delphi consensus study in Taiwan. BMC Med Educ 2024;24(1):209.
  • 20. Ali NK, Ferguson RP, Mitha S, Hanlon A. Do medical trainees feel confident communicating with low health literacy patients? J Community Hosp Intern Med Perspect 2014;4(2):22893.
  • 21. Schillinger D, Bindman AB, Wang F, Stewart A, Piette J. Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Educ Couns 2004;52(3):315-323.
  • 22. Seligman HK, Wang FF, Palacios JL, et al. Physician notification of their diabetes patients’ limited health literacy. A randomized, controlled trial. J Gen Intern Med 2005;20(11):1001-1007.
  • 23. Saunders C, Palesy D, Lewis J. Systematic review and conceptual framework for health literacy training in health professions education. Health Prof Educ 2019;5(1):13-29.
  • 24. Yang Y. Effects of health literacy competencies on patient-centered care among nurses. BMC Health Serv Res 2022;22(1):1172.
  • 25. Kaper MS, Reijneveld SA, van Es FD, et al. Effectiveness of a comprehensive health literacy consultation skills training for undergraduate medical students: A randomized controlled trial. Int J Environ Res Public Health 2020;17(1):81.
  • 26. World Health Organization. Health Literacy. In: WHO [online]. Available at: https://www.who.int/news-room/fact-sheets/detail/health-literacy. Accessed March 25, 2025.
  • 27. Özkan S, Gershuni O, Şirin H, et al. Development and Integration of Health Literacy Education with Innovative Methods in Medical Curricula Across Europe. Turkish Journal of Health Literacy 2023;4(2):62-68.
  • 28. Teutsch C. Patient-doctor communication. Med Clin North Am 2003;87(5):1115-1145.
  • 29. Stewart M, Brown JB, Boon H, Galajda J, Meredith L, Sangster M. Evidence on patient-doctor communication. Cancer Prev Control 1999;3(1):25-30.
  • 30. Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J 2010;10(1):38-43.
  • 31. Tabachnick BG, Fidell LS. Using Multivariate Statistics. 6th ed. Boston: Pearson Education, Inc., 2013. 32. Thompson B. Exploratory and Confirmatory Factor Analysis: Understanding Concepts and Applications. Washington DC: American Psychological Association, 2004.
  • 33. Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ 2011;2:53-55.
  • 34. Costello AB, Osborne J. Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Pract Assess Res Eval 2005;10(7):1-9.
  • 35. Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ. Evaluating the use of exploratory factor analysis in psychological research. Psychol Methods 1999;4(3):272-299.
  • 36. Kühn L, Bachert P, Hildebrand C, et al. Health Literacy Among University Students: A Systematic Review of Cross-Sectional Studies. Front Public Health 2021;9:680999.
  • 37. Chang CC, Tseng PL, Liu CC, Ming JL, Fan SH, Tung CY. Development and validation of the Physician's Health Literacy Competence Scale: A step towards effective doctor-patient communication. Medicine (Baltimore) 2025;104(9):e41643.
There are 36 citations in total.

Details

Primary Language English
Subjects Health Literacy
Journal Section Research Article
Authors

Tülin Çoban 0000-0003-1665-129X

Sarp Üner 0000-0002-9880-8811

Sevgi Turan 0000-0001-9287-0641

L. Hilal Özcebe 0000-0002-0918-8519

Damla Özyürek 0000-0002-5413-5766

Fahriye Has Akdağ 0000-0001-5952-0463

Bürge Atılgan 0000-0002-2800-4957

Hülya Şirin 0000-0001-8489-5005

Seçil Özkan 0000-0003-1572-8777

Submission Date January 21, 2025
Acceptance Date November 3, 2025
Early Pub Date December 15, 2025
Published in Issue Year 2025 Issue: Advanced Online Publication

Cite

APA Çoban, T., Üner, S., Turan, S., … Özcebe, L. H. (2025). Development and psychometric evaluation of future physicians’ approach to health literacy scale (F-PATHS). Turkish Journal of Public Health(Advanced Online Publication), 313-330. https://doi.org/10.20518/tjph.1623065
AMA Çoban T, Üner S, Turan S, et al. Development and psychometric evaluation of future physicians’ approach to health literacy scale (F-PATHS). TJPH. December 2025;(Advanced Online Publication):313-330. doi:10.20518/tjph.1623065
Chicago Çoban, Tülin, Sarp Üner, Sevgi Turan, L. Hilal Özcebe, Damla Özyürek, Fahriye Has Akdağ, Bürge Atılgan, Hülya Şirin, and Seçil Özkan. “Development and Psychometric Evaluation of Future Physicians’ Approach to Health Literacy Scale (F-PATHS)”. Turkish Journal of Public Health, no. Advanced Online Publication (December 2025): 313-30. https://doi.org/10.20518/tjph.1623065.
EndNote Çoban T, Üner S, Turan S, Özcebe LH, Özyürek D, Has Akdağ F, Atılgan B, Şirin H, Özkan S (December 1, 2025) Development and psychometric evaluation of future physicians’ approach to health literacy scale (F-PATHS). Turkish Journal of Public Health Advanced Online Publication 313–330.
IEEE T. Çoban, S. Üner, S. Turan, L. H. Özcebe, D. Özyürek, F. Has Akdağ, B. Atılgan, H. Şirin, and S. Özkan, “Development and psychometric evaluation of future physicians’ approach to health literacy scale (F-PATHS)”, TJPH, no. Advanced Online Publication, pp. 313–330, December2025, doi: 10.20518/tjph.1623065.
ISNAD Çoban, Tülin et al. “Development and Psychometric Evaluation of Future Physicians’ Approach to Health Literacy Scale (F-PATHS)”. Turkish Journal of Public Health Advanced Online Publication (December2025), 313-330. https://doi.org/10.20518/tjph.1623065.
JAMA Çoban T, Üner S, Turan S, Özcebe LH, Özyürek D, Has Akdağ F, Atılgan B, Şirin H, Özkan S. Development and psychometric evaluation of future physicians’ approach to health literacy scale (F-PATHS). TJPH. 2025;:313–330.
MLA Çoban, Tülin et al. “Development and Psychometric Evaluation of Future Physicians’ Approach to Health Literacy Scale (F-PATHS)”. Turkish Journal of Public Health, no. Advanced Online Publication, 2025, pp. 313-30, doi:10.20518/tjph.1623065.
Vancouver Çoban T, Üner S, Turan S, Özcebe LH, Özyürek D, Has Akdağ F, et al. Development and psychometric evaluation of future physicians’ approach to health literacy scale (F-PATHS). TJPH. 2025(Advanced Online Publication):313-30.

                     13955                      13956                         13959                        28911                              13958

  

       

TURKISH JOURNAL OF PUBLIC HEALTH - TURK J PUBLIC HEALTH. online-ISSN: 1304-1096 

Copyright holder Turkish Journal of Public Health. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.