Psychometric evaluation of the Turkish version of the falls health literacy scale in older adults and determination of the factors affecting falls health literacy

This study was conducted in two phases—methodological and descriptive/correlational-to test the validity and reliability of the Turkish version of the Falls Health Literacy Scale (FHLS) in older adults and to identify the factors affecting Falls Health Literacy (FHL). Research data were collected from 12 Family Health Centers in the Nevşehir provincial center between March and December 2024. A proportional stratified sampling method was used in sample selection, with the first stage completed with 400 individuals and the second stage with 381 individuals. The data were collected using the Descriptive Information Form and FHLS. The data were evaluated using psychometric tests in the first stage and descriptive statistics and regression analysis in the second stage. In the first stage, a content validity index of over 80% was obtained for language equivalence. In the subjective section, exploratory factor analyses removed items with factor loadings below 0.50 or under more than one factor, resulting in a final structure of 16 items and 6 factors. The three subscales included in the developed scale were retained. In this form, the Kaiser-Meyer-Olkin value was 0.713; Bartlett's χ²=1879.165 (p<0.001) was obtained. The results of the Confirmatory Factor Analysis indicated that the proposed model demonstrated an acceptable level of fit to the data (CMIN/DF<3), that the standardized factor loadings of the items ranged between 0.45 and 0.90 and were statistically significant (p<0.001), and that a substantial proportion of the variance of the items was explained according to the R² values, thereby confirming the predefined factor structure of the scale. It was determined that 69.81% of the total variance was explained, and the Cronbach's alpha coefficients for the sub-dimensions ranged from 0.648 to 0.822. Hotelling's T² and Tukey tests indicated that the scale has a multidimensional but non-aggregable structure. For the objective section, item difficulty indices ranged from 0.76 to 0.97; discrimination indices ranged from 0.28 to 0.52, the Kuder–Richardson 20 (KR-20) reliability coefficient was determined as 0.576. Test-retest analysis results indicated that the scale had a high level of reliability. Test-retest analysis results indicated that the scale has a high level of temporal stability (ICC=0.953; p<0.001). In the second phase of the study, 34.9% of individuals with an average age of 67.22±2.76 reported experiencing fear of falling. The scale's subscale mean scores were 24.72±2.24 for fall prevention experience, 6.06±0.86 for general health and active living, and 21.83±2.16 for seeking health counseling and services. Regression analysis revealed that the FHLS score in the subscale for fall prevention experience was higher among high school (β1=1.887) and college (β1=3.219) graduates, those unable to care for themselves independently (β1=1.062), those who did not use assistive devices (β1=1.560), and those who were not informed about falls (β1=0.564). In the health and active living sub-dimension, scores were higher among high school graduates (β1=0.700), those with a fear of falling (β1=0.660), and those who had fallen 1-2 times in the past year (β1=0.246). In the health counseling and services sub-dimension, men (β1=0.393), high school (β1=2.125) and college (β1=2.706) graduates, workers (β1=0.827), those who do not use assistive devices (β1=0.982), and those who do not experience anxiety about falling during activities (β1=0.465) obtained higher scores. The descriptive factors explained 16% (Adj. R²=0.163), 18% (Adj. R²=0.182), and 27% (Adj. R²=0.271) of the subscales, respectively. In conclusion, the analyses conducted have demonstrated that the FHLS in Turkish is a valid and reliable measurement tool. Educational level, gender, physical independence, history of falls, and level of knowledge about falls are the key factors influencing the FHLS. Keywords: Falls, Health Literacy, Elderly, Nursing