Skip to main content

Advertisement

SpringerLink
Log in

Development and Assessment of a Brief Tool to Measure Melanoma-Related Health Literacy and Attitude Among Adolescents

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript

Abstract

The aim of this study is to develop a tool to measure health literacy and attitude towards melanoma and to assess the tool in a group of adolescents through a multicenter cross-sectional survey. The concept, dimensionality, and item pool of the tool were developed by a focus group. The Delphi method was applied to determine the content validity. Newly enrolled students in five universities were invited to an online questionnaire survey. Items were selected according to correlation, factor loading, and item response parameters. Psychometric properties (reliability, construct validity, and measurement invariance) were assessed using McDonald’s ω and confirmatory factor analysis (CFA), respectively. A total of 21,086 valid questionnaires were collected. The focus group drafted two subscales and 13 items. Content validity was good for all items (Kappa > 0.7). One item was removed from the tool owing to low factor loading and discrimination parameter. McDonald’s ω of the subscales were 0.84 (health literacy) and 0.86 (attitude). Local dependencies were identified in CFA; after modification, the goodness-of-fit was satisfactory (comparative fit index, CFI > 0.98). The tool showed measurement invariance across subgroups of gender, ethnicity, and university (CFI change < 0.01 across models). The brief tool to measure health literacy and attitude towards nevus and melanoma shows good psychometric properties and measurement invariance. It can be used in further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. National Cancer Institute Seer Proram. Cancer stat facts: melanoma of the skin. 2018. https://seer.cancer.gov/statfacts/html/melan.html

  2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127(12):2893–2917

    CAS  Google Scholar 

  3. Parkin DM, Pisani P, Ferlay J (1999) Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 80(6):827–841

    Article  CAS  Google Scholar 

  4. Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, Buzaid AC, Cochran AJ, Coit DG, Ding S, Eggermont AM, Flaherty KT, Gimotty PA, Kirkwood JM, McMasters KM, Mihm MC Jr, Morton DL, Ross MI, Sober AJ, Sondak VK (2009) Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 27(36):6199–6206

    Article  Google Scholar 

  5. Chinese Society of Clinical Oncology (2017) Melanoma diagnosis and treatment guideline: 2017.V1. People's Medical Publishing House, Beijing

    Google Scholar 

  6. Grange F, Mohr P, Harries M, Ehness R, Benjamin L, Siakpere O, Barth J, Stapelkamp C, Pfersch S, McLeod LD, Kaye JA, Wolowacz S, Kontoudis I (2017) Economic burden of advanced melanoma in France, Germany and the UK: a retrospective observational study (melanoma burden-of-illness study). Melanoma Res 27(6):607–618

    Article  Google Scholar 

  7. Krensel M, Schafer I, Augustin M (2018) Cost-of-illness of melanoma in Europe - a systematic review of the published literature. J Eur Acad Dermatol Venereol

  8. Berwick M, Armstrong BK, Ben-Porat L, Fine J, Kricker A, Eberle C, Barnhill R (2005) Sun exposure and mortality from melanoma. J Natl Cancer Inst 97(3):195–199

    Article  Google Scholar 

  9. Swetter SM, Pollitt RA, Johnson TM, Brooks DR, Geller AC (2012) Behavioral determinants of successful early melanoma detection: role of self and physician skin examination. Cancer 118(15):3725–3734

    Article  Google Scholar 

  10. Berwick M, Begg CB, Fine JA, Roush GC, Barnhill RL (1996) Screening for cutaneous melanoma by skin self-examination. J Natl Cancer Inst 88(1):17–23

    Article  CAS  Google Scholar 

  11. Schneider JS, Moore DH, Mendelsohn ML (2008) Screening program reduced melanoma mortality at the Lawrence Livermore National Laboratory, 1984 to 1996. J Am Acad Dermatol 58(5):741–749

    Article  Google Scholar 

  12. Tripp MK, Watson M, Balk SJ, Swetter SM, Gershenwald JE (2016) State of the science on prevention and screening to reduce melanoma incidence and mortality: the time is now. Ca Cancer J Clin 66(6):461–480

    Article  Google Scholar 

  13. World Health Organization (1998) Health promotion glossary. WHO, Geneva

    Google Scholar 

  14. Huang X, Zhang J, Li J, Zhao S, Xiao Y, Huang Y, Jing D, Chen L, Zhang X, Su J, Kuang Y, Zhu W, Chen M, Chen X, Shen M (2019) Daily intake of soft drinks and moderate-to-severe acne vulgaris in Chinese adolescents. J Pediatr 204:256–262

    Article  Google Scholar 

  15. Xiao Y, Huang X, Jing D, Huang Y, Chen L, Zhang X, Zhao S, Zhang M, Luo Z, Su J, Kuang Y, Li J, Zhu W, Zhang J, Chen X, Shen M (2019) The prevalence of atopic dermatitis and chronic spontaneous urticaria are associated with parental socioeconomic status in adolescents in China. Acta Derm Venereol 99(3):321–326

    Article  Google Scholar 

  16. Shi J, Mo X, Sun Z (2012) Content validity index in scale development. J Cent South Univ (Med Sci) 37(2):152–155

    Google Scholar 

  17. Rizopoulos D (2006) LTM: an R package for latent variable modeling and item response theory analyses. J Stat Softw 17(5)

  18. Shen M, Hu M, Liu S, Chang Y, Sun Z (2015) Assessment of the Chinese resident health literacy scale in a population-based sample in South China. BMC Public Health 15:637

    Article  Google Scholar 

  19. Hambleton RK, Swaminathan H, Algina J (1978) Criterion-referenced testing and measurement :review of technical issues and developments. Rev Educ Res 48(1):11–22

    Article  Google Scholar 

  20. Polit DF, Beek CT, Owen SV (2007) Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health 30(4):459–467

    Article  Google Scholar 

  21. Reise SP, Waller NG (2009) Item response theory and clinical measurement. Annu Rev Clin Psychol 5:27–48

    Article  Google Scholar 

  22. Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334

    Article  Google Scholar 

  23. Mcdonald R. P. Test theory: a unified treatment. Mahwah: L. Erlbaum Associates; 1999

    Google Scholar 

  24. Zhang ZY, Yuan KH (2016) Robust coefficients alpha and omega and confidence intervals with outlying observations and missing data: methods and software. Educ Psychol Meas 76(3):387–411

    Article  Google Scholar 

  25. Brown TA (2006) Confirmatory factor analysis for applied research. The Guilford Press, New York

    Google Scholar 

  26. Shen M, Hu M, Sun Z (2017) Development and validation of brief scales to measure emotional and behavioural problems among Chinese adolescents. BMJ Open 7(1):e012961

    Article  Google Scholar 

  27. Shen M, Cui Y, Hu M, Xu L (2017) Quantifying traditional Chinese medicine patterns using modern test theory: an example of functional constipation. Bmc Complement Altern Med 17:44

    Article  Google Scholar 

  28. Leung WF (2015) Product placement with 'Chinese characteristics': Feng Xiaogang's films and go Lala go! J Chinese Cinemas 9(2):125–140

    Article  Google Scholar 

  29. Zhu B, Chen S, Wang H, Yin C, Han C, Peng C, Liu Z, Wan L, Zhang X, Zhang J, Lian CG, Ma P, Xu ZX, Prince S, Wang T, Gao X, Shi Y, Liu D, Liu M, Wei W, Wei Z, Pan J, Wang Y, Xuan Z, Hess J, Hayward NK, Goding CR, Chen X, Zhou J, Cui R (2018) The protective role of DOT1L in UV-induced melanomagenesis. Nat Commun 9(1):259

    Article  Google Scholar 

  30. Wada M, Ito T, Tsuji G, Nakahara T, Hagihara A, Furue M, Uchi H (2017) Acral lentiginous melanoma versus other melanoma: a single-center analysis in Japan. J Dermatol 44(8):932–938

    Article  CAS  Google Scholar 

  31. Asgari MM, Shen L, Sokil MM, Yeh I, Jorgenson E (2017) Prognostic factors and survival in acral lentiginous melanoma. Br J Dermatol 177(2):428–435

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors acknowledge the following investigators from the departments of student affairs of the universities: Central South University (Jianghua Zhang, Yan Xiong), Huazhong University of Science and Technology (Yuanxiang Yi, Peng Li), Xiamen University (Jianbing Xiahou, Xiaozhu Fu), Xinjiang Medical University (Jianguang Li), Inner Mongolia Medical University (Chao Tian). The authors also acknowledge the following experts that participated in the Delphi consultation: Xiangya Hospital of Central South University (Mingliang Chen, Jianglin Zhang, Mei Yi, Bin Li, Pingping Gan).

Funding

This work was financially supported by the Ministry of Science and Technology of the People’s Republic of China (2016YFC0900802, 2015FY111100, 81472882) and the Department of Science and Technology of Hunan Province (2018SK2086, 2018SK2092).

Author information

Authors and Affiliations

  1. Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China

    Tianhao Wu, Juan Su, Shuang Zhao, Xiang Chen & Minxue Shen

  2. Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China

    Tianhao Wu, Juan Su, Shuang Zhao, Xiang Chen & Minxue Shen

  3. Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China

    Tianhao Wu, Juan Su, Shuang Zhao, Xiang Chen & Minxue Shen

Authors
  1. Tianhao Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shuang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Minxue Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors participated in data collection. J.S. and T.W. drafted the manuscript. M.S. analyzed the data. J.S. and S.Z. designed the item pool. J.S., M.S., and X.C. designed the study, critically reviewed and revised the manuscript, and obtained the funding. All authors gave their final approval to the version submitted for publication.

Corresponding authors

Correspondence to Juan Su or Minxue Shen.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Page S1

The original (simplified Chinese) and translated (English) versions of the tool. (PDF 351 kb)

Table S1

Distribution of item score. (DOCX 16 kb)

Table S2

Reliability of the tool. (DOCX 14 kb)

Table S3

Goodness-of-fit in confirmative factor analysis. (DOCX 14 kb)

Figure S1

Distribution of ability estimates in IRT model, using the Bayesian method. (A) Health literacy subscale; (B) Attitude subscale. (C) General health literacy in a previous study. (PDF 13.3 kb)

Figure S2

Item characteristics curves of the health literacy subscale. (PDF 78 kb)

Figure S3

Item characteristics curves of the attitude subscale. (PDF 63 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, T., Su, J., Zhao, S. et al. Development and Assessment of a Brief Tool to Measure Melanoma-Related Health Literacy and Attitude Among Adolescents. J Canc Educ 35, 905–911 (2020). https://doi.org/10.1007/s13187-019-01541-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-019-01541-2

Keywords

Search

Navigation