Assessing Cancer Health Literacy among Spanish-Speaking Latinos
Health literacy is a dynamic construct that changes with specific health conditions; thus, new disease-specific health literacy tools are needed. Since cancer is the leading cause of death among Latinos, the largest and fastest-growing minority population in the nation, there is a need to develop tools to assess cancer health literacy (CHL) among the Spanish-speaking population. The Cancer Health Literacy Test, Spanish version (CHLT-30-DKspa) was applied to identify Spanish-speaking individuals with low CHL and ascertain which items in the tool best discriminate between CHL level groups. Cross-sectional field test of the CHLT-30-DKspa among Spanish-speaking Latinos. Latent class analysis (LCA) identified participants with varying CHL levels. Probability of correct answers, odds ratios, and standardized errors were used to identify the items that allow the classification of individuals among the latent classes. LCA resulted in a three-latent-class model predicting 39.4% of participants to be in the HIGH class, 43.3% in the MEDIUM class, and 17.3% in the LOW class. Eleven items (the CHLT-11-DKspa) meet the criteria to clearly separate participants with HIGH and LOW classes of CHL. Although the best model fit was a three-class solution, results showed a clear separation of individuals from HIGH versus LOW levels of CHL, but separation of those in the MEDIUM level was not as clear. The CHLT-11-DKspa is a shorter measure that may be relatively easy to use in a clinical encounter to identify Spanish-speaking patients with the poorest levels of CHL who may require additional support to understand medical instructions and care plans.
KeywordsCancer health literacy Latinos Hispanics Assessment Psychometric evaluation Spanish Assessment tools Cancer literacy levels
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Dr. Magarita Echeverri’s contribution was supported in part by the Research Centers in Minority Institutions Program (RCMI) of the National Institute on Minority Health and Health Disparities (NIMHD) grant number 2G12MD007595, the NIMHD grant number 5S21MD0000100, and the grant number 1U54GM104940 from the National Institute of General Medical Sciences of the National Institutes of Health which funds the Louisiana Clinical and Translational Science Center (LA CaTS). Dr. Anna María Nápoles’ contribution was supported by the Resource Centers for Minority Aging Research program of the National Institute on Aging grant number P30 AG15272 and the National Cancer Institute grant number 1U54CA153511.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the Xavier University of Louisiana’s Institutional Review Board (study no. 511) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- 1.Kutner M, Greenberg E, Jin Y, Paulsen C (2006). The health literacy of America’s adults: results from the 2003 National Assessment of Adult Literacy (NCES 2006–483). U.S. Department of Education. Washington, DC: National Center for Education Statistics (NCES)Google Scholar
- 2.Zarcadoolas C, Greer DS, Pleasant A (2006) Advancing health literacy: a framework for understanding and action. Wiley, San FranciscoGoogle Scholar
- 3.Institute of Medicine (2004) Health literacy: a prescription to end confusion. National Academies Press, Washington, DCGoogle Scholar
- 7.U.S. Census Bureau (2015) Facts for features: Hispanic Heritage Month. Release Number CB15-FF.18, September 14, 2015. From http://www.census.gov/newsroom/facts-for-features/2015/cb15-ff18.html. Accessed 19 July 2017
- 9.American Cancer Society (2012) Cancer facts & figures for Hispanics/Latinos 2012–2014. American Cancer Society, Atlanta, 40 pGoogle Scholar
- 11.Betancourt H, Flynn PM, Riggs M, Garberoglio C (2010) A cultural research approach to instrument development: the case of breast and cervical cancer screening among Latino and Anglo women. Adv Access Publ 25(6):991–1007Google Scholar
- 15.Collins LM, Lanza ST (2010) Latent class and latent transition analysis: with applications in the social, behavioral, and health sciences. Wiley, New York, 330 pGoogle Scholar
- 16.McCutcheone AL (1987) Latent class analysis, Sage University paper series on quantitative applications in the social sciences, no 07–064. Sage, Newbury ParkGoogle Scholar
- 19.Linzer DA, Lewis JB (2011) poLCA: an R package for polytomous variable latent class analysis. J Stat Soft 42(10):1–29Google Scholar
- 20.Muthén LK, Muthén BO (2012) Mplus user’s guide, 7th edn. Muthén & Muthén, Los AngelesGoogle Scholar
- 22.Masyn K (2013). Applied Latent Class Analysis: A Workshop. Texas Tech University 2013. From http://www.depts.ttu.edu/immap/Masyn_LCAWorkshop_Dec2013_TTU.pdf. Accessed 19 July 2017
- 23.R Development Core Team (2011) R: a language and environment for statistical computing. Vienna, Austria: The R Foundation for Statistical Computing, 2011Google Scholar
- 25.Echeverri M, Anderson D, Nápoles AM (2016) Cancer Health Literacy Test-30-Spanish (CHLT-30-DKspa), a new Spanish-language version of the Cancer Health Literacy Test (CHLT-30) for Spanish-speaking Latinos. J Health Commun Int Perspect 21(1):69–78. doi: 10.1080/10810730.2015.1131777
- 26.Center for Health Care Strategies (2013) Health Literacy Fact Sheets. From http://www.chcs.org/media/CHCS_Health_Literacy_Fact_Sheets_2013.pdf. Accessed 19 July 2017