PMID- 36698106
OWN - NLM
STAT- MEDLINE
DCOM- 20230127
LR  - 20230202
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 23
IP  - 1
DP  - 2023 Jan 26
TI  - The Swiss Health Insurance Literacy Measure (HILM-CH): Measurement Properties and 
      Cross-Cultural Validation.
PG  - 85
LID - 10.1186/s12913-022-08986-0 [doi]
LID - 85
AB  - BACKGROUND: Most consumers face difficulties when choosing and navigating health 
      insurance plans. Health insurance literacy (HIL) has been discussed as a critical 
      lever to ensure efficient choices and navigation in choice-based health insurance 
      systems. Still, existing evidence about HIL mainly comes from the US, and the 
      only validated scale, the Health Insurance Literacy Measure (HILM), may not be 
      adequate to measure HIL outside US samples. This paper describes the measurement 
      properties of the Swiss Health Insurance Literacy Measure (HILM-CH), the first 
      scale to measure HIL in Switzerland. METHODS: The items of the HILM-CH were 
      adapted from the HILM in German, French, and Italian. A panel of experts refined 
      it to ensure its suitability for the Swiss context. The final version of the 
      HILM-CH contains 21 items, and other relevant measures were administered in the 
      Swiss Health Insurance Literacy Survey to a sample of 6036 insurees. Measurement 
      properties were investigated overall and per linguistic group. Internal 
      reliability was determined using Cronbach's alphas. Criterion validity was 
      examined through convergent and concurrent validity of the HILM-CH. The construct 
      validity was assessed using factor analysis. Measurement invariance of the 
      HILM-CH between linguistic regions was further evaluated using multiple-group 
      confirmatory factor analyses. RESULTS: The HILM-CH had acceptable to good 
      reliability (alphas between 0.70 and 0.91). Concurrent and convergent validity 
      showed that HILM-CH is a good measurement of HIL. Factor analysis revealed a 
      four-factor model and showed an acceptable fit to the data (CFI= 0.977; TLI = 
      0.974; RMSEA = 0.061; SRMR = 0.032). Using the established four-factor model, 
      measurement invariance was established across Switzerland's German, French, and 
      Italian-speaking regions. CONCLUSIONS: The HILM-CH is a reliable and valid 
      measure of HIL across Switzerland's German, French, and Italian-speaking regions. 
      It can be used in future research to find associations between HIL and individual 
      characteristics.
CI  - (c) 2023. The Author(s).
FAU - Bardy, Tess L C
AU  - Bardy TLC
AD  - Department of Health Sciences and Medicine & Center for Health, Policy and 
      Economics, University of Lucerne, Frohburgstrasse 3, CH-6002, Lucerne, 
      Switzerland. tess.bardy@unilu.ch.
LA  - eng
PT  - Journal Article
DEP - 20230126
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
SB  - IM
MH  - Humans
MH  - Reproducibility of Results
MH  - Switzerland
MH  - *Cross-Cultural Comparison
MH  - *Health Literacy
MH  - Insurance, Health
MH  - Surveys and Questionnaires
MH  - Psychometrics
PMC - PMC9876756
OTO - NOTNLM
OT  - Construct validity
OT  - Factor analysis
OT  - Health insurance literacy
OT  - Measurement invariance/equivalence
OT  - Multidimensional instrument
OT  - Psychometric properties
OT  - Reliability and validity
COIS- The author declares that she has no competing interests.
EDAT- 2023/01/26 06:00
MHDA- 2023/01/28 06:00
PMCR- 2023/01/26
CRDT- 2023/01/25 23:56
PHST- 2022/04/22 00:00 [received]
PHST- 2022/12/19 00:00 [accepted]
PHST- 2023/01/25 23:56 [entrez]
PHST- 2023/01/26 06:00 [pubmed]
PHST- 2023/01/28 06:00 [medline]
PHST- 2023/01/26 00:00 [pmc-release]
AID - 10.1186/s12913-022-08986-0 [pii]
AID - 8986 [pii]
AID - 10.1186/s12913-022-08986-0 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2023 Jan 26;23(1):85. doi: 10.1186/s12913-022-08986-0.