Development and Psychometric Evaluation of the Cancer Health Literacy Scale in Newly Diagnosed Cancer Patients.

BACKGROUND: Health literacy (HL) influences a patient's comprehension and judgment of health-related information. A rigorous assessment tool is needed to screen for low HL in order to improve it.

OBJECTIVE: The aim of this study was to develop and validate the Cancer Health Literacy Scale (C-HLS).

METHODS: The framework of the C-HLS is based on the Levels of Prevention model. The scale items were developed according to Nutbeam's 3 constructs of HL. We employed several procedures to develop the C-HLS, including focus group interviews, item generation, the expert Delphi process, and face validity. Various types of analysis, including reliability and split-half reliability testing, confirmatory factor analysis, and criterion-related validity testing, were performed; receiver operating characteristic curve analysis was also performed to confirm sensitivity and specificity.

RESULTS: There were 33 items included in the C-HLS for validation; 360 newly diagnosed cancer patients completed the survey. The administration time is only 10 to 15 minutes. Results showed that C-HLS had good reliability, split-half reliability, and validity. All confirmatory factor analysis model fit indices reached acceptable thresholds. The receiver operating characteristic curve analyses suggested that the C-HLS had an adequate combination of sensitivity and specificity to distinguish between high and low HL.

CONCLUSIONS: The C-HLS is a reliable, valid tool capable of discriminating levels of HL in the assessment of cancer patients and does not have an excessive administration time.

IMPLICATIONS FOR PRACTICE: This scale can aid our understanding of HL in newly diagnosed cancer patients and can serve as a basis for providing individual care interventions.