Background

Immigrants from the former Soviet Union (FSU), most are Russian speaking, comprise large and important population groups in several host countries, e.g. Germany or the United States (US). However, there is a paucity of literature about the health literacy (HL) of Russian-speaking FSU immigrants.

Objective

The purpose of this work was to adapt the HLS₁₉ questionnaire developed within the WHO Measuring Population and Organizational Health Literacy Network into the Russian language to study the health literacy in Russian-speaking immigrants in Germany and the US.

Methods

First, the German version of the HLS₁₉ questionnaire was translated into Russian by two professional translators. Second, three native Russian speakers with HL expertise from different countries, including Russia, Kazakhstan, and the US performed four rounds of reviews. At first, two variants of translations made by professional translators from German into Russian were critically reviewed, compared to their local translations, and revised by the Russian-speaking experts. Each expert provided insights in English to the German research team, the questionnaire was then evaluated and edited until full concordance was reached and approved.

Results

The undertaken adaptation can be conditionally classified into 3 categories: linguistic, stylistic, and cultural. Out of 90 questions, 95% of questions were linguistically or stylistically adapted. In many cases, two translation variants were reviewed and a new variant was suggested. The most challenging was the cultural adaptation of questions about education, healthcare system, and health insurance.

Conclusion

Compared to native-born people of Germany and the US, FSU immigrants come from different cultural, educational as well as healthcare system backgrounds, which may affect their ability to find, understand, assess and use health information in the host country. A substantial adaptation of the HLS₁₉ questionnaire led to the development of a culturally and linguistically appropriate tool relevant to the context of their host countries. We also considered peculiarities of the FSU immigrant populations compared to FSU residents. The questionnaire adaptation study can serve as an example of collaborative international and multi-cultural work.