Psychometric evaluation of a 10-item health insurance knowledge scale


Background: College students are a priority population for health insurance literacy interventions. Yet, there are few psychometric studies on measuring health insurance knowledge-a core construct of health insurance literacy. Methods: We administered a health insurance survey to 2,250 college students. We applied Classical Test Theory and Item Response Theory methods to estimate psychometric properties of the Kaiser Family Foundation’s 10-item health insurance knowledge quiz. Results: The scale is unidimensional, and a two-parameter logistic model best fit the data. IRT estimates indicated varying item discriminations (a range: 0.717 to 2.578) and difficulties (b range: -0.913 to 1.790). Precision of measurement was maximized for students half a standard deviation below the mean (θ = -0.686) health insurance knowledge ability. Conclusions: This scale can be used to identify gaps in health insurance knowledge among college students and be applied in clinical and community health education practice.

Journal of Nursing Measurement

What is this paper about?

People who have health insurance still report difficulty affording healthcare. Healthcare in the U.S. is very complex: copays, deductibles, premiums, etc. Health insurance literacy describes a person’s ablity to choose, use, and understand their health insurance plan. A good understanding of health insurance can help people make better, more affordable, healthcare decisions. This paper focuses on how researchers measure health insurance knowledge. We collected data using a survey of college students to assess a 10-question quiz developed by the Kaiser Family Foundation.

Want to take the survey for yourself? Take it here at the Kaiser Family Foundation website.

How does this paper improve public health?

Health insurance literacy has recently become an important concept in research. However, we need survey tools to accurately measure health insurance knowledge. Our statistical analysis provides evidence that the 10-question quiz can be used to measure knowledge about health insurance among college students. This means that the questions can be used for future research, or creating health programs.


  • Is this paper peer reviewed? This paper is published in the Journal of Nursing Measurement. This journal uses double-blind peer review, where the authors and the reviewers do not know each other’s identities.

  • Who paid for this project? This work was not supported by a public or private grant. Data collection was supported by the Student Health Care Center at the University of Florida, which is funded partially by university student fees.

  • Was this study reviewed by an ethics board? Yes. This study received approval from the University of Florida’s Institutional Review Board.

  • Are there any conflicts of interest? There are no conflicts of interest.