Psychometric properties of an Arabic-language health literacy assessment scale for adolescents (HAS-A-AR) in Palestine

ObjectivesHealth literacy research in Palestine is limited, and a locally validated tool for use among adolescents has been unavailable until now. Therefore, this study aimed to adapt health literacy assessment scale for adolescents (HAS-A) into Arabic language (HAS-A-AR) and Palestinian context and to investigate its psychometric properties.DesignWe conducted a cross-sectional household survey using a stratified random sample and household face-to-face interviews.Setting and participantsWe conducted 1200 interviews with sixth to ninth graders in the Ramallah and al-Bireh district of the West Bank, Palestine in 2017.MethodsWe translated and adapted HAS-A to be sensitive to the Palestinian context and tested its psychometric properties. We evaluated face and content validity during the back-translation process and checked for construct validity through exploratory factor analysis (EFA). We tested for internal consistency using Cronbach’s alpha, MacDonald’s omega test and the greatest lower bound (GLB). Furthermore, we calculated the scale’s average inter-item correlation.ResultsEFA revealed that HAS-A-AR has a similar structure to the original HAS-A. It extracted three factors (communication, confusion and functional health literacy) whose eigenvalues were >1. Together they explained 57% of the total variance. The proportions of adolescents with high levels of communication, confusion and functional health literacy were 45%, 68% and 80%, respectively. Cronbach’s alpha, MacDonald’s omega and the GLB values for communication subscale were 0.87, 0.88 and 0.90, and they were 0.78, 0.77 and 0.79 for confusion subscale, while they were 0.77, 0.77 and 0.80, respectively, for functional healthy literacy subscale. The average inter-item correlation for the subscales ranged between 0.36 and 0.59.ConclusionHAS-A-AR is a valid and reliable health literacy measuring instrument with appropriate psychometric properties. HAS-A-AR is currently available for use among adolescents in Palestine and the surrounding Arab countries with similar characteristics as Palestine, including language, culture and political instability.

Download Full-text

Comprehension of the education handout and health literacy of pacemaker users

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2016-0336 ◽

2017 ◽

Vol 70 (3) ◽

pp. 633-639 ◽

Cited By ~ 2

Author(s):

Jackelline Evellin Moreira dos Santos ◽

Virginia Visconde Brasil ◽

Katarinne Lima Moraes ◽

Jacqueline Andréia Bernardes Leão Cordeiro ◽

Gabriela Ferreira de Oliveira ◽

...

Keyword(s):

Health Literacy ◽

Pearson Correlation ◽

Cardiac Pacemaker ◽

Cross Sectional Study ◽

Functional Health ◽

Care Process ◽

Functional Health Literacy ◽

Literacy Assessment ◽

Cognitive Changes ◽

Cross Sectional

ABSTRACT Objective: To verify the comprehension of the education handout and the level of Functional Health Literacy of individuals with cardiac pacemaker (PM) and whether there is correlation between the comprehension and Functional Health Literacy (FHL). Method: Cross-sectional study with 63 individuals with PM who answered to comprehension tests of the handout, literacy assessment (SAHLPA-50) and cognition (MMSE). Measurements of dispersion, Pearson correlation and multiple linear regression were calculated. Results: Most women, study time ≤ 9 years, 66.21 (average age) presented no cognitive changes. An adequate literacy level was evidenced in 50.8% individuals with PM and satisfactory comprehension of the handout. No correlation was identified between FHL, handout comprehension, age, years of study and cognition. Conclusion: The handout comprehension assessed by individuals with appropriate FHL indicated that it can be a printed material suitable for use, aiming to improve care process and knowledge of individuals with PM.

Download Full-text

Translation, cultural adaptation and psychometric properties of the Ghanaian language (Akan; Asante Twi) version of the Health Literacy Questionnaire

BMC Health Services Research ◽

10.1186/s12913-020-05932-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Millicent Addai Boateng ◽

Peter Agyei-Baffour ◽

Sanne Angel ◽

Ulrika Enemark

Keyword(s):

Health Literacy ◽

Psychometric Properties ◽

Cognitive Testing ◽

Sub Saharan Africa ◽

Difficulty Level ◽

Measurement Tool ◽

Cronbach’S Alpha ◽

Cronbach's Alpha ◽

Health Literacy Questionnaire ◽

Composite Reliability

Abstract Background Patients’ competencies and resources to manage their own health, which is termed health literacy, is a necessity for better health outcomes. Thus, it is relevant to have a comprehensive health literacy measurement tool suitable for populations of interest. The Health Literacy Questionnaire (HLQ) is a tool useful for health literacy assessment covering nine dimensions/scales of health literacy. The HLQ has been translated and validated in diverse contexts but has so far not been assessed in any country in sub-Saharan Africa. We sought to translate this tool into the most common language used in Ghana and assess its validity. Methods We carried out a cross-sectional study using the HLQ concurrently with an assessment of a malaria programme for caregivers with children under 5 years. The HLQ was translated using a systematic translation procedure. We analysed the psychometric properties of the HLQ based on data collected by face-to-face interview of 1234 caregivers. The analysis covered tests on difficulty level of scales, composite reliability, Cronbach’s alpha and confirmatory factor analysis (CFA). Results Cognitive testing showed that some words were ambiguous, which led to minor rewording of the questionnaire. A nine-factor CFA model was fitted to the 44 question items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ2 DWLS (866 df) = 17,177.58, p < 0.000, CFI = 0.971, TLI = 0.969, RMSEA = 0.126 and SRMR = 0.107. Composite reliability and Cronbach’s alpha were > 0.65 for all scales except Cronbach’s alpha for scale 9, ‘Understanding health information well enough to know what to do’ (0.57). The mean differences between most demographic groups among health literacy scales were statistically significant. Conclusion The Akan-Twi version of HLQ proved relevant in our description of the health literacy levels among the caregivers in our study. This validated tool will be useful to conduct health literacy needs assessments to guide policies addressing such needs. Further work is needed to validate this tool for use in Ghana and similar contexts.

Download Full-text

Cultural Adaptation and Validation of the Ghanaian Language (Akan; Asante Twi) Version of the Health Literacy Questionnaire.

10.21203/rs.3.rs-39715/v1 ◽

2020 ◽

Author(s):

Millicent Addai Boateng ◽

Sanne Angel ◽

Peter Agyei-Baffour ◽

Ulrika Enemark

Keyword(s):

Health Literacy ◽

Psychometric Properties ◽

Cognitive Testing ◽

Sub Saharan Africa ◽

Difficulty Level ◽

Measurement Tool ◽

Cronbach’S Alpha ◽

Cronbach's Alpha ◽

Health Literacy Questionnaire ◽

Composite Reliability

Abstract Background In under-resourced settings, patient competences to manage their own health is sometimes a necessity and high health literacy is needed to obtain a good health outcome. Thus, it is relevant to have a comprehensive measurement tool suitable for populations in such settings. The Health Literacy Questionnaire (HLQ) is a tool useful for health literacy assessment covering nine dimensions/scales of health literacy. The HLQ has been translated and validated in diverse contexts but has so far not been assessed in any country in sub-Saharan Africa. We sought to translate this tool into the most common language used in Ghana and assess its validity. Methods We carried out a cross-sectional study using the HLQ concurrently with an assessment of a malaria programme for caregivers with children under five years. The HLQ was translated using a systematic translation procedure. We analysed the psychometric properties of the HLQ based on data collected by face-to-face interview of 1234 caregivers. The analysis covered tests on difficulty level of scales, composite reliability, Cronbach’s alpha and confirmatory factor analysis (CFA). Results Cognitive testing showed that some words were ambiguous, which led to minor rewording of the questionnaire. A nine-factor CFA model was fitted to the 44 question items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ2 DWLS (866 df) = 17177.58, p < 0.000, CFI = 0.929, TLI = 0.922, RMSEA = 0.116 and SRMR = 0.099. Composite reliability and Cronbach’s alpha were >0.7 for all scales except Cronbach’s alpha for scale 9, ‘Understanding health information well enough to know what to do’ (0.6). The mean differences between most demographic groups among health literacy scales were statistically significant. Conclusion The Akan-Twi version of HLQ proved relevant in our description of the health literacy levels among the caregivers in our study. This validated tool will be useful to conduct health literacy needs assessments to guide policies addressing such needs. Further work is needed to assess its psychometric properties among other population groups.

Download Full-text

Translation, Cultural Adaptation and Psychometric Properties of the Ghanaian language (Akan; Asante Twi) version of the Health Literacy Questionnaire

10.21203/rs.3.rs-39715/v2 ◽

2020 ◽

Author(s):

Millicent Addai Boateng ◽

Peter Agyei-Baffour ◽

Sanne Angel ◽

Ulrika Enemark

Keyword(s):

Health Literacy ◽

Psychometric Properties ◽

Cognitive Testing ◽

Sub Saharan Africa ◽

Difficulty Level ◽

Measurement Tool ◽

Cronbach’S Alpha ◽

Cronbach's Alpha ◽

Health Literacy Questionnaire ◽

Composite Reliability

Abstract BackgroundPatients’ competencies to manage their own health, which is termed health literacy, is a necessity for better health outcomes. Thus, it is relevant to have a comprehensive health literacy measurement tool suitable for populations of interest. The Health Literacy Questionnaire (HLQ) is a tool useful for health literacy assessment covering nine dimensions/scales of health literacy. The HLQ has been translated and validated in diverse contexts but has so far not been assessed in any country in sub-Saharan Africa. We sought to translate this tool into the most common language used in Ghana and assess its validity.Methods:We carried out a cross-sectional study using the HLQ concurrently with an assessment of a malaria programme for caregivers with children under five years. The HLQ was translated using a systematic translation procedure. We analysed the psychometric properties of the HLQ based on data collected by face-to-face interview of 1234 caregivers. The analysis covered tests on difficulty level of scales, composite reliability, Cronbach’s alpha and confirmatory factor analysis (CFA).Results:Cognitive testing showed that some words were ambiguous, which led to minor rewording of the questionnaire. A nine-factor CFA model was fitted to the 44 question items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ2 DWLS (866 df) = 17177.58, p < 0.000, CFI = 0.971, TLI = 0.969, RMSEA = 0.126 and SRMR = 0.107. Composite reliability and Cronbach’s alpha were >0.65 for all scales except Cronbach’s alpha for scale 9, ‘Understanding health information well enough to know what to do’ (0.57). The mean differences between most demographic groups among health literacy scales were statistically significant.Conclusion:The Akan-Twi version of HLQ proved relevant in our description of the health literacy levels among the caregivers in our study. This validated tool will be useful to conduct health literacy needs assessments to guide policies addressing such needs. Further work is needed to validate this tool for use in Ghana and similar contexts.

Download Full-text

Development of a health literacy hypertension test in Thailand

Journal of Health Research ◽

10.1108/jhr-05-2019-0096 ◽

2020 ◽

Vol 34 (6) ◽

pp. 475-483

Author(s):

Potchara Chinnasee ◽

Suchitra Sukonthasab ◽

Nattaporn Lawthong

Keyword(s):

Health Literacy ◽

Latent Variables ◽

Assessment Tool ◽

Literacy Assessment ◽

Validity And Reliability ◽

Alpha Coefficient ◽

Cronbach’S Alpha ◽

Chi Square ◽

Content Type ◽

Cronbach's Alpha

PurposeThe purpose of this study is to develop a reliable test metric that can ascertain health literacy as it relates to hypertension in the population of Thailand.Design/methodology/approachOne thousand five hundred patients from hypertension clinics in hospitals under the Ministry of Public Health, Thailand were recruited to this study. The test was developed and divided into three latent variables and four observed variables for health literacy concepts. Indexes of Item-Objective Congruence (IOC) from seven experts and Cronbach’s alpha coefficient of the entire questionnaire were evaluated for content validity and reliability. The Confirmatory Factor Analysis with LISREL also analyzed for construct validity.FindingsThe result illustrates that the Item-Objective Congruence was 0.68, and Cronbach’s alpha coefficient was 0.87. The result also shows that Barlett’s Test of Sphericity was 3129.31 (p < 0.01), and the Kaiser-Meyer-Olkin measure of sampling adequacy was 0.83. The model was fit to empirical data (Chi-square = 0.02).Originality/valueThis study concludes that the Thai Hypertension Health Literacy Assessment Tool (THHLA) created as a result of the study is valid and reliable. The test can be used to evaluate health literacy for hypertension patients in Thailand.

Download Full-text

Arabic validation and cross-cultural adaptation of the 5C scale for assessment of COVID-19 vaccines psychological antecedents

PLoS ONE ◽

10.1371/journal.pone.0254595 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0254595

Author(s):

Samar Abd ElHafeez ◽

Iffat Elbarazi ◽

Ramy Shaaban ◽

Rony ElMakhzangy ◽

Maged Ossama Aly ◽

...

Keyword(s):

Factor Analysis ◽

Internal Consistency ◽

Convergent Validity ◽

Discriminant Validity ◽

Five Factor Model ◽

Arabic Language ◽

Arab Countries ◽

Cronbach’S Alpha ◽

Cronbach's Alpha ◽

Confirmatory Factor

Background In the Arab countries, there has not been yet a specific validated Arabic questionnaire that can assess the psychological antecedents of COVID-19 vaccine among the general population. This study, therefore, aimed to translate, culturally adapt, and validate the 5C scale into the Arabic language. Methods The 5C scale was translated into Arabic by two independent bilingual co-authors, and then translated back into English. After reconciling translation disparities, the final Arabic questionnaire was disseminated into four randomly selected Arabic countries (Egypt, Libya, United Arab Emirates (UAE), and Saudi Arabia). Data from 350 Arabic speaking adults (aged ≥18 years) were included in the final analysis. Internal consistency was assessed by Cronbach’s alpha. Construct validity was determined by concurrent, convergent, discriminant, exploratory and confirmatory factor analyses. Results Age of participants ranged between 18 to 73 years; 57.14% were females, 37.43% from Egypt, 36.86%, from UAE, 30% were healthcare workers, and 42.8% had the intention to get COVID-19 vaccines. The 5 sub-scales of the questionnaire met the criterion of internal consistency (Cronbach’s alpha ≥0.7). The predictors of intention to get COVID-19 vaccines (concurrent validity) were young age and the 5C sub-scales. Convergent validity was identified by the significant inter-item and item-mean score of the sub-scale correlation (P<0.001). Discriminant validity was reported as inter-factor correlation matrix (<0.7). Kaiser-Meyer-Olkin sampling adequacy measure was 0.80 and Bartlett’s sphericity test was highly significant (P<0.001). Exploratory factor analysis indicated that the 15 items of the questionnaire could be summarized into five factors. Confirmatory factor analysis confirmed that the hypothesized five-factor model of the 15-item questionnaire was satisfied with adequate psychometric properties and fit with observed data (RMSEA = 0.060, GFI = 0.924, CFI = 0.957, TLI = 0.937, SRMR = 0.076 & NFI = 906). Conclusion The Arabic version of the 5C scale is a valid and reliable tool to assess the psychological antecedents of COVID-19 vaccine among Arab population.

Download Full-text

Cross-Cultural Adaptation and Validation of the Arabic Version of Musculoskeletal Health Questionnaire (MSK-HQ-Ar)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17145168 ◽

2020 ◽

Vol 17 (14) ◽

pp. 5168

Author(s):

Fahad Saad Algarni ◽

Abdulmajeed Nasser Alotaibi ◽

Abdulrahman Mohammed Altowaijri ◽

Hana Al-Sobayel

Keyword(s):

Psychometric Properties ◽

Internal Consistency ◽

Strong Association ◽

Intraclass Correlation ◽

Arabic Language ◽

Arabic Version ◽

Health Questionnaire ◽

Musculoskeletal Health ◽

Cronbach’S Alpha ◽

Cronbach's Alpha

Background: Musculoskeletal disorders (MSD) affect millions of people worldwide. Musculoskeletal Health Questionnaire (MSK-HQ) is a valid and reliable tool to assess the health of patients with MSD. However, this scale is not available in the Arabic language. The purpose of this study was to translate and cross-culturally adapt the Musculoskeletal Health Questionnaire (MSK-HQ) into Arabic (MSK-HQ-Ar) and evaluate its validity and reliability among participants with MSD. Methods: This cross-sectional study used guidelines from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) to translate as well as validate the psychometric properties of MSK-HQ-Ar. Patients with MSD (n = 149) living in Taif participated in the study. Cronbach’s alpha and the intraclass correlation coefficient (ICC) were used to assess internal consistency and test-retest reliability of MSK-HQ-Ar respectively. Spearman’s correlation was used to assess the correlation between MSK-HQ-Ar and the European quality of life five-dimension, five-level scale (EQ-5D-5L). Results: Out of 149 participants, 119 completed the MSK-HQ-Ar twice. The scale showed good internal consistency, Cronbach’s alpha (0.88), and reliability (ICC 0.92–0.95). A strong association was found with the EQ-5D-5L scores. Conclusion: The adapted MSK-HQ-Arabic version revealed acceptable psychometric properties and is a valid and reliable outcome measure to assess MSK health among Arabic speaking patients with MSD.

Download Full-text

Translation, Cultural Adaptation and Psychometric Properties of the Ghanaian language (Akan; AsanteTwi) version of the Health Literacy Questionnaire.

10.21203/rs.3.rs-39715/v3 ◽

2020 ◽

Author(s):

Millicent Addai Boateng ◽

Sanne Angel ◽

Peter Agyei-Baffour ◽

Ulrika Enemark

Keyword(s):

Health Literacy ◽

Psychometric Properties ◽

Cognitive Testing ◽

Sub Saharan Africa ◽

Difficulty Level ◽

Measurement Tool ◽

Cronbach’S Alpha ◽

Cronbach's Alpha ◽

Health Literacy Questionnaire ◽

Composite Reliability

Abstract Background: Patients’ competencies and resources to manage their own health, which is termed health literacy, is a necessity for better health outcomes. Thus, it is relevant to have a comprehensive health literacy measurement tool suitable for populations of interest. The Health Literacy Questionnaire (HLQ) is a tool useful for health literacy assessment covering nine dimensions/scales of health literacy. The HLQ has been translated and validated in diverse contexts but has so far not been assessed in any country in sub-Saharan Africa. We sought to translate this tool into the most common language used in Ghana and assess its validity. Methods: We carried out a cross-sectional study using the HLQ concurrently with an assessment of a malaria programme for caregivers with children under five years. The HLQ was translated using a systematic translation procedure. We analysed the psychometric properties of the HLQ based on data collected by face-to-face interview of 1234 caregivers. The analysis covered tests on difficulty level of scales, composite reliability, Cronbach’s alpha and confirmatory factor analysis (CFA). Results: Cognitive testing showed that some words were ambiguous, which led to minor rewording of the questionnaire. A nine-factor CFA model was fitted to the 44 question items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ2 DWLS (866 df) = 17177.58, p < 0.000, CFI = 0.971, TLI = 0.969, RMSEA = 0.126 and SRMR = 0.107. Composite reliability and Cronbach’s alpha were >0.65 for all scales except Cronbach’s alpha for scale 9, ‘Understanding health information well enough to know what to do’ (0.57). The mean differences between most demographic groups among health literacy scales were statistically significant. Conclusion: The Akan-Twi version of HLQ proved relevant in our description of the health literacy levels among the caregivers in our study. This validated tool will be useful to conduct health literacy needs assessments to guide policies addressing such needs. Further work is needed to validate this tool for use in Ghana and similar contexts.

Download Full-text

Functional Health Literacy: Psychometric Properties of the Newest Vital Sign for Portuguese Adolescents (NVS-PTeen)

Nutrients ◽

10.3390/nu13030790 ◽

2021 ◽

Vol 13 (3) ◽

pp. 790

Author(s):

Osvaldo Santos ◽

Miodraga Stefanovska-Petkovska ◽

Ana Virgolino ◽

Ana Cristina Miranda ◽

Joana Costa ◽

...

Keyword(s):

Health Literacy ◽

Psychometric Properties ◽

Vital Sign ◽

Two Dimensions ◽

Functional Health ◽

Functional Health Literacy ◽

Cross Sectional Survey ◽

Internal Reliability ◽

Newest Vital Sign ◽

Portuguese Adolescents

Self-management of health requires skills to obtain, process, understand, and use health-related information. Assessment of adolescents’ functional health literacy requires valid, reliable, and low-burden tools. The main objective of this study was to adapt and study the psychometric properties of the Newest Vital Sign for the Portuguese adolescents’ population (NVS-PTeen). Classic psychometric indicators of reliability and validity were combined with item response theory (IRT) analyses in a cross-sectional survey, complemented with a 3-month test-retest assessment. The NVS-PTeen was self-administered to students enrolled in grades 8 to 12 (12 to 17 years old) in a school setting. Overall, 386 students (191 girls) from 16 classes of the same school participated in the study (mean age = 14.5; SD = 1.5). Internal reliability of the NVS-PTeen was α = 0.60. The NVS-PTeen total score was positively and significantly correlated with Portuguese (r = 0.28) and mathematics scores (r = 0.31), school years (r = 0.31), and age (r = 0.19). Similar to the original scale (for the U.S.), the NVS-PTeen is composed of two dimensions, reading-related literacy and numeracy. Temporal reliability is adequate, though with a learning effect. IRT analyses revealed differences in difficulty and discriminative capacity among items, all with adequate outfit and infit values. Results showed that the NVS-PTeen is valid and reliable, sensible to inter-individual educational differences, and adequate for regular screening of functional health literacy in adolescents.

Download Full-text

The 8-item Morisky medication adherence scale: validation of a Portuguese version in HIV patients

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.669 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Aguiar ◽

C Piñeiro ◽

R Serrão ◽

R Duarte

Keyword(s):

Medication Adherence ◽

Psychometric Properties ◽

Reliability Analysis ◽

Cronbach’S Alpha ◽

Portuguese Version ◽

Cronbach's Alpha ◽

Adherence To Medication ◽

Morisky Medication Adherence Scale ◽

Adherence Scale ◽

The Mean

Abstract Background Antiretroviral therapy (ART) has the most effective treatment for people with HIV, but its effectiveness depends on the individual medication adherence. Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used scales to assess patient adherence. Thus, we aimed to validate a Portuguese version of MMAS-8 and determine its psychometric properties in HIV positive patients. Methods A cross-sectional survey was conducted in Centro Hospitalar Universitário São João (Porto, northern Portugal) at the infectious diseases department. After authorization to use the scale - granted by the author - and, a standard forward-backwards procedure to translate MMAS-8 to Portuguese, the questionnaire was applied to 233 patients with HIV doing ART. Reliability was assessed using Cronbach's alpha and test-retest reliability. Three levels of adherence were considered: 0 to < 6 (low), 6 to < 8 (medium), 8 (high). Results In the studied sample, the mean age was 45.03 years (SD = 11.63), 80.3% men, 19.3% women and 1 transgender, and 53.8% had ≤9 years of education. The mean number of prescribed ART per patient was 1.76. The mean score for the medication adherence scale was 7.29 (SD = 6.74). For the reliability analysis, 12 patients were excluded due to missing data (n = 221). Regarding the level of adherence, 22.5% were low adhering, 71.6% medium and 5.9% high. Corrected item-total correlations showed that 1 item does not correlate very well with the overall scale and was dropped. Scale reliability analysis for the remaining 7 items revealed an overall Cronbach's alpha of 0.661. Women had a protective effect on adherence (OR = 0.31;95%CI:0.15-0.66). Number of years doing ART, age of participants, and type of residence didn't show to be correlated with adherence. Conclusions MMAS-8 is a reliable and valid measure to detect patients at risk of non-adherence. A satisfactory Cronbach's alfa (0.661) was obtained. In general, adherence to medication was medium or high. Key messages This scale can be applied nationwide in other different hospitals, as it could serve as a tool for measuring adherence to ART that can allow for better health care to the ones that are low adhering. A Portuguese version of the MMAS-8 was created for measuring adherence to ART that maintained a similar structure to the original MMAS-8 and good psychometric properties.

Download Full-text