Development and Validation of the Assessment of Health Literacy in Breast and Cervical Cancer Screening

Abstract

For many people limited health literacy is a major barrier to effective preventive health behavior such as cancer screening, yet a comprehensive health literacy measure that is specific to breast and cervical cancer screening is not readily available. The purpose of this paper is to describe the development and testing of a new instrument to measure health literacy in the context of breast and cervical cancer screening, the Assessment of Health Literacy in Cancer Screening (AHL-C). The AHL-C is based on Baker’s conceptualization of health literacy and modeled from the two most popular health literacy tests, the Rapid Estimate of Adult Literacy in Medicine and the Test of Functional Health Literacy in Adults. The AHL-C consists of four subscales; print literacy, numeracy, comprehension, and familiarity. We used baseline data from 560 Korean American immigrant women who participated in a community-based randomized trial designed to test the effect of a health literacy-focused intervention to promote breast and cervical cancer screening. Rigorous psychometric testing supports that the AHL-C is reliable, valid, and significantly correlated with theoretically selected variables. Future research is needed to test the utility of the AHL-C in predicting cancer screening outcomes.

Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California

“…However, we measured health literacy through a subjective assessment across one health literacy dimension. It is possible that more comprehensive measures of health literacy may be a fruitful area for future research to help explain Asian cancer screening disparities (Han et al 2014 ; Haun et al 2014 ).…”

Analyzing Factors of Breast Cancer Screening Adherence among Korean American Women Using Andersen’s Behavioral Model of Healthcare Services Utilization

“…We assessed the BC screening knowledge by a total composite score of the following two scales: a fiveitem BC knowledge scale adopted from the ACS's BC screening guideline 16 and a five-item BC screening familiarity scale adopted from Han et al 17 The ACS's BC knowledge scale items included "Women at age of 40 are recommended to have a mammography annually," with response options of 'true' and 'false.' Also, the BC screening familiarity scale items measured participants' familiarity (scale from 0 for 'not familiar' to 4 for 'very much familiar') with the most commonly used terms related to mammography, including "hyperplasia," "lump," "lymph," "metastasis," and "nipple."…”

Decisional balance and self-efficacy mediate the association among provider advice, health literacy and cervical cancer screening

“…The staff then obtained written informed consent and administered the study questionnaire. Procedures to assess HL among KAW are reported elsewhere (Han et al, 2014). In brief, the survey was a paper-pencil questionnaire including HL, psychosocial determinants (e.g., breast and cervical cancer knowledge, decisional balance, and self-efficacy) and self-reported mammogram and Pap test use at baseline.…”

“…Any discrepancy was discussed until consensus was reached. In the case of HL scale, while all instructions were written in Korean, all items were written in English (Han et al, 2014) because the previous validation study reported that the Korean-translated version of the Rapid Estimate Adult Literacy in Medicine (REALM) and the Test of Functional Health Literacy in Adults did not capture the concept of HL in KAW whose primary language is phonetic (individuals can pronounce a word as long as they can recognize the Korean alphabet; Han et al, 2011). This violates the logic behind the development of popular literacy tests such as the REALM, which presupposes a high correlation between decoding skills and comprehension (Han et al, 2011).…”