Cancer Health Literacy Study Levent Dumenci 1 Robin K. Matsuyama 2 - - PowerPoint PPT Presentation

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Cancer Health Literacy Study Levent Dumenci 1 Robin K. Matsuyama 2 - - PowerPoint PPT Presentation

Jan 19, 2024 282 likes •515 views

Cancer Health Literacy Study Levent Dumenci 1 Robin K. Matsuyama 2 Laura Cartwright 2 Robert A. Perera 2 Laura A. Siminoff 1 College of Public Health, Temple University, USA 1 School of Medicine, Virginia Commonwealth University, USA 2 Funding:

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Cancer Health Literacy Study

Funding: NIH/NCI: R01 CA140151

Levent Dumenci1 Robin K. Matsuyama2 Laura Cartwright2 Robert A. Perera2 Laura A. Siminoff1

College of Public Health, Temple University, USA1 School of Medicine, Virginia Commonwealth University, USA2

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Cancer Health Literacy Study

OUTLINE

  • Introduce CHLT-30 and CHLT-6
  • Why two tests
  • Test properties
  • Supporting evidence
  • Conclusion and future directions
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Cancer Health Literacy Study

Why Two Tests: CHLT-30: To measure cancer health literacy along a continuum. CHLT-6: To identify individuals with limited cancer health literacy

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Cancer Health Literacy Study

Health Literacy

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Cancer Health Literacy Study

Health Literacy 6%

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Cancer Health Literacy Study

Health Literacy 6% Health Literacy 76%

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Cancer Health Literacy Study

Health Literacy 6% Health Literacy Health Literacy 76% 1.6%

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Cancer Health Literacy Study

Health Literacy 6% Health Literacy Health Literacy Health Literacy 76% 1.6% 36%

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Cancer Health Literacy Study

CHLT-30: Test Development Process

  • Item writing:
  • Transcripts from
  • Delphi Panel discussions
  • Focus groups
  • Actual patient education materials
  • Recent advances in health literacy
  • Item selection:
  • 6 item writes 128 items
  • 76 items following cognitive interviews
  • 30 items using exploratory methods
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CHLT-30

  • Measures a unidimensional construct
  • 1-factor model / 2-PL IRT
  • N = 1,306 persons with cancer

χ2 df p RMSEA 90% CI CFI TLI

542.57 405 .001 .016 .010 - .019 .990 .989

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CHLT-30

  • Invariant measurement (i.e., no test bias) between
  • Blacks and Whites
  • Males and females
  • Persons with (N=1,306) and without (N=512) cancer

Group Test Configural Scalar Difference

Blacks vs White Chi-Sq (df) 938.81 (810); p<.005 996.37 (838); p< .005 22.21 (28); p=.095 Males vs Females Chi-Sq (df) 933.96 (810); p<.005 1004.05 (838); p< .0001 62.52 (28); p<.005 Cancer vs Non- Cancer Chi-Sq (df) 1011.62 (810); p<.0001 1041.64 (838); p< .0001 37.44 (28); p>.10

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CHLT-30

Group Mean p

Males vs Females 23.97 – 24.26 = 0.247 Black vs Whites 20.04 – 26.61 <0.001 Cancer vs non-Cancer 24.13 – 21.58 <0.001

  • Whites score higher than Blacks
  • Persons with cancer score higher than persons without
  • No mean difference between gender groups
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CHLT-30

  • The CHLT-30 scores are most informative of CHL of

patients at the lower end of the distribution.

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CHLT-30

Internal Consistency (N = 1,306) Cronbach’s Alpha McDonald’s Omega

.88 .93

Test – Retest Two – Week (N = 98) Six – Month (N = 60)

Mean: Time - 1 23.92 24.87 Mean: Time - 2 23.97 25.45 r .90 .92

  • Test scores are highly reliable.
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CHLT-30

  • Taking into account important covariates and general

health literacy tests, the CHLT-30 is a strong predictor

  • f self-confidence in engaging in health decisions.

CHLT

Covariates: Education Income Gender Ethnicity Age

REALM

STOFHLA

Health Decisions .41***

n.s. n.s.

.68 .66 .88

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CHLT-6

  • 6 items selected from the 30 items containing the largest amount of

information about cancer health literacy

  • Measures a binary construct
  • Latent class model – 2 classes
  • Limited CHL
  • Adequate CHL
  • N = 1,306 persons with cancer

Test χ2 (df) p =

Pearson’s χ2 84.76 (50) 0.002 LRT χ2 82.22 (50) 0.003

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CHLT-6

0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 1 2 3 4 5 6 Probability Item Number Limited CHL (18%) Adequate CHL (82%)

  • Prevalence
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CHLT-6

Limited Adequate Limited .950 .050 Adequate .037 .963

  • Classification are highly accurate.
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CHLT-6

  • Invariant measurement (i.e., no test bias) between
  • Blacks and Whites
  • Males and females
  • Persons with and without cancer diagnosis

Group Pearson’s χ2 (df) p = LRT χ2 (df) p = Entropy

Blacks vs Whites 145.03 (100) 0.002 126.75 (100) 0.037 0.902 Males vs Females 122.97 (100) 0.059 123.11 (100) 0.058 0.915 Cancer vs No-Cancer 117.08 (100) 0.117 119.56 (100) 0.888 0.899 Blacks vs Whites 139.92 (112) 0.038 124.40 (112) 0.199 0.869 Males vs Females 104.75 (112) 0.674 125.03 (112) 0.189 0.875 Cancer vs No-Cancer 162.25 (112) 0.001 160.29 (112) 0.002 0.895

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CHLT-6

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Cancer Health Literacy Study

Expending the scope: Test standardization and validation in non-cancer population Translational: Implementing in clinics and pharmacies Next grant: Developing research protocols to test predictors and health outcomes of change in cancer health literacy during treatment

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