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The objective of this study was to validate the HLS19-NAV measurement scale applied in the European Health Literacy Population Survey 2019\u20132021 (HLS19). From December 2019 to January 2021, data on NAV-HL was collected in eight European countries. The HLS19-NAV was translated into seven languages and successfully applied in and validated for eight countries, where language and survey method differed. The psychometric properties of the scale were assessed using confirmatory factor analysis (CFA) and Rasch modelling. The tested CFA models sufficiently well described the observed correlation structures. In most countries, the NAV-HL data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). For some countries, some items showed poor data\u2013model fit when tested against the PCM, and some items displayed differential item functioning for selected person factors. The HLS19-NAV demonstrated high internal consistency. To ensure content validity, the HLS19-NAV was developed based on a conceptual framework. As an estimate of discriminant validity, the Pearson correlations between the NAV-HL and general health literacy (GEN-HL) scales were computed. Concurrent predictive validity was estimated by testing whether the HLS19-NAV, like general HL measures, follows a social gradient and whether it forms a predictor of general health status as a health-related outcome of general HL. In some countries, adjustments at the item level may be beneficial.<\/jats:p>","DOI":"10.3390\/ijerph192113863","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T21:58:06Z","timestamp":1666735086000},"page":"13863","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["HLS19-NAV\u2014Validation of a New Instrument Measuring Navigational Health Literacy in Eight European Countries"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9900-2967","authenticated-orcid":false,"given":"Lennert","family":"Griese","sequence":"first","affiliation":[{"name":"School of Public Health, Bielefeld University, 33615 Bielefeld, Germany"}]},{"given":"Hanne S.","family":"Finbr\u00e5ten","sequence":"additional","affiliation":[{"name":"Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, 2418 Elverum, Norway"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9101-523X","authenticated-orcid":false,"given":"Rita","family":"Francisco","sequence":"additional","affiliation":[{"name":"Cat\u00f3lica Research Centre for Psychological, Family and Social Well-Being, Universidade Cat\u00f3lica Portuguesa, 1649-023 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7992-7209","authenticated-orcid":false,"given":"Saskia M.","family":"De Gani","sequence":"additional","affiliation":[{"name":"Careum Foundation, Careum Center for Health Literacy, 8032 Zurich, Switzerland"},{"name":"Careum School of Health, Kalaidos University of Applied Sciences, 8006 Zurich, Switzerland"}]},{"given":"Robert","family":"Griebler","sequence":"additional","affiliation":[{"name":"Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria"}]},{"given":"\u00d8ystein","family":"Guttersrud","sequence":"additional","affiliation":[{"name":"Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway"}]},{"given":"Rebecca","family":"Jaks","sequence":"additional","affiliation":[{"name":"Careum Foundation, Careum Center for Health Literacy, 8032 Zurich, Switzerland"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6150-0629","authenticated-orcid":false,"given":"Christopher","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, 2418 Elverum, Norway"},{"name":"Department of Social Determinants of Health, Division of Prevention and Public Health, Norwegian Directorate of Health, 0213 Oslo, Norway"}]},{"given":"Thomas","family":"Link","sequence":"additional","affiliation":[{"name":"Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, A-1010 Vienna, Austria"}]},{"given":"Andreia","family":"Silva da Costa","sequence":"additional","affiliation":[{"name":"Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1049-005 Lisboa, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9183-9121","authenticated-orcid":false,"given":"Miguel","family":"Telo de Arriaga","sequence":"additional","affiliation":[{"name":"Cat\u00f3lica Research Centre for Psychological, Family and Social Well-Being, Universidade Cat\u00f3lica Portuguesa, 1649-023 Lisboa, Portugal"},{"name":"Dire\u00e7\u00e3o-Geral da Sa\u00fade, 1049-005 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2713-0943","authenticated-orcid":false,"given":"Rajae","family":"Touzani","sequence":"additional","affiliation":[{"name":"Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Sant\u00e9 & Traitement de l\u2019Information M\u00e9dicale, Equipe CANBIOS Labellis\u00e9e Ligue 2019, 13009 Marseille, France"},{"name":"Institut Paoli-Calmettes, SESSTIM U1252, 13009 Marseille, France"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2486-9053","authenticated-orcid":false,"given":"Mitja","family":"Vrdelja","sequence":"additional","affiliation":[{"name":"Communication Unit, National Institute of Public Health, 1000 Ljubljana, Slovenia"}]},{"given":"J\u00fcrgen M.","family":"Pelikan","sequence":"additional","affiliation":[{"name":"WHO-CC Health Promotion in Hospitals and Health Care, Austrian National Public Health Institute, A-1010 Vienna, Austria"}]},{"given":"Doris","family":"Schaeffer","sequence":"additional","affiliation":[{"name":"School of Public Health, Bielefeld University, 33615 Bielefeld, Germany"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.15256\/joc.2017.7.97","article-title":"Patients with multimorbidity and their experiences with the healthcare process: A scoping review","volume":"7","author":"Stronks","year":"2017","journal-title":"J. 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