Cross-cultural Adaptation and Psychometric Validation of 3 Health Literacy Instruments (SAHL-E, AAHLS, and HLS-EU-Q47) in Hindi Among Rural Adults in North India

Objectives: Health literacy (HL) is a key determinant of health behaviors and health outcomes. However, the lack of validated Hindi-language instruments limits its assessment in India. This study aimed to translate, culturally adapt, and psychometrically validate 3 internationally recognized tools—the Short Assessment of Health Literacy in English (SAHL-E), the All Aspects of Health Literacy Scale (AAHLS), and the European Health Literacy Survey Questionnaire (HLS-EU-Q47)—for Hindi-speaking adults in rural North India.Methods: A community-based cross-sectional study enrolled 250 adults from 5 villages in Uttar Pradesh. Translation followed forward–backward procedures with expert review and pretesting. Psychometric evaluation included internal consistency (Cronbach α), test–retest reliability (intraclass correlation coefficients, ICC), construct validity (exploratory factor analysis), convergent and known-groups validity, and feasibility indicators (completion rates and interview duration).Results: All instruments demonstrated strong psychometric performance. Cronbach α values were 0.84 (SAHL-E), 0.87 (AAHLS), and 0.93 (HLS-EU-Q47), and ICCs ranged from 0.86 to 0.94. Factor structures aligned with theoretical expectations. Convergent correlations ranged from 0.42 to 0.61 (p<0.001), and known-groups validity analyses showed significant differences according to education and occupation. Completion rates exceeded 98%, and the mean interview duration was approximately 32 minutes.Conclusions: The Hindi-adapted SAHL-E, AAHLS, and HLS-EU-Q47 demonstrated strong reliability, validity, and feasibility for assessing HL among rural adults in India.