1. Introduction
FHL
DISEASE, CHRONIC DISEASES
Healthcare systems all over the world are developing in a way that compels patients to become more active in the management of their own health and disease–a development that changes the role of modern patients and the skills needed to navigate the healthcare system. Demographic changes resulting in more elderly people have led to increases in the burden of chronic diseases and put pressure on increasingly scarce healthcare resources [The core elements in HL are obtaining, understanding, and applying health-related information. Don Nutbeam has described these three elements as functional (accessing health-related information), interactive (the ability to understand health-related information) and critical HL (the ability to actively use health-related information) [A recent review [A full-length Danish version of the full-length American TOFHLA (D-TOFHLA; D denoting Danish) was developed according to acknowledged guidelines with assessment of face validity (refers to the extent to which a measure appears to accurately assess the variable it is intended to measure, based on its face value or appearance. It is a subjective judgment made by the observer or user of the measure and is often based on common sense and intuition) content validity (assesses the extent to which a measurement instrument, such as a questionnaire or test, comprehensively and accurately covers the domain it is intended to measure. It involves ensuring that the items on the instrument represent all the important aspects of the construct being measured), internal consistency (a reliability measure that assesses the consistency or stability of the results obtained from a measurement instrument across multiple items that are intended to measure the same construct. It involves calculating the correlation coefficient, such as Cronbach’s alpha, between the individual items on the instrument to determine whether they are measuring the same underlying construct) etc. and has proven accurate in assessing functional health literacy (FHL) in previous studies [This paper aims to use machine learning to develop a short version of the D-TOFHLA (DS-TOFHLA; DS denoting Danish Short) that is easily applicable in the Danish clinical context and that does not require the involvement of an interviewer (healthcare personnel). This paper seeks to describe a generic model-based approach applied in the development of the short version of the D-TOFHLA that can also be used in the development of short versions of the TOFHLA in other languages or, in general, to develop short versions of full-length screening instruments.