Cancer Health Literacy Research Articles

Cognition of the warning symptoms and risk factors for cancer among Chinese college students: a cross-sectional study based on a summer social practice activity

Background To investigate the cognition of cancer warning symptoms and cancer risk factors among Chinese college students, analyze the influencing factors, and explain the correlations between cancer cognition and cancer symptom discrimination, cancer fear and psychological distress. Methods Chinese college students were recruited in this cross-sectional study funded by a summer social practice activity in Yunnan Province, China. Cognition rates of cancer warning symptoms and cancer risk factors were evaluated using Cancer Warning symptoms Cognition Questionnaire (CWSCQ) and Cancer Risk Factors Cognition Questionnaire (CRFCQ), respectively. Factors associated with cognition of cancer warning symptoms, and factors associated with cognition of cancer risk factors were evaluated using multiple linear regression analysis. Interactions between cancer cognition, cancer symptom discrimination, psychological distress, and cancer fear were evaluated by structural equation modeling. Results There were 846 effective samples, with an effective rate of 80.9%. The cognition rates of cancer warning symptoms were from 47.9% to 84.4%, which were affected by cancer symptom discrimination, education, attitudes towards cancer screening, living expenses, drinking history, and ways to obtain cancer knowledge (p < 0.05). The cognition rates of cancer risk factors were from 46.3% to 91.3% in participants, which were affected by education, cancer symptom discrimination, psychological distress, attitudes towards cancer screening, life satisfaction, cancer history in relatives and friends, ways to obtain cancer knowledge, smoking history, and nursing history for cancer patients (p < 0.05). Cancer cognition and cancer symptom discrimination showed intermediary effects on psychological distress and cancer fear (p < 0.001). Conclusions The overall cancer cognition situation among Chinese college students is not optimistic, which highlights the necessity of improving the cancer health literacy among Chinese college students. With the increasing morbidity and mortality rates of cancer, it is necessary to raise awareness of early detection, and early treatment of cancer among the general public. Health education interventions are helpful to improve cancer health literacy.

Gynaecological cancer resources for Aboriginal and Torres Strait Islander women: A resource audit.

Aboriginal and Torres Strait Islander women experience considerable disparities in gynaecological cancer outcomes. Accessible and culturally appropriate health promotion resources about gynaecological cancers may support health literacy in this area. This study aimed to determine the understandability, actionability, readability, and cultural relevance of gynaecological cancer health literacy resources for Aboriginal and Torres Strait Islander consumers, families, and caregivers. We conducted a general Google search and targeted searches of Australian gynaecological cancer organisation websites in January and February 2022. Resources were assessed for understandability, actionability and cultural relevance to Aboriginal and Torres Strait Islander audiences. We found 16 resources. The resources were generally understandable, actionable, readable, and culturally relevant, however, most resources were focused on cervical cancer prevention through vaccination and screening. Few resources focused other gynaecological cancer types or aspects of the cancer care continuum. While many resources contained elements that made them culturally relevant, areas for improvement were identified. These included: greater transparency relating to the Aboriginal and Torres Strait Islander leadership, governance, and involvement in the development of the resources as well as availability of different resource formats with an emphasis on visual aids. This study highlighted a need for the development of resources relating to a wider range of gynaecological cancer types and different stages of the cancer care continuum for Aboriginal and Torres Strait Islander women. SO WHAT?: The development of a broader range of culturally appropriate gynaecological cancer health literacy resources, ideally developed through co-design with Aboriginal and Torres Strait Islander peoples, may contribute to addressing the disparities in gynaecological cancer outcomes for Aboriginal and Torres Strait Islander women.

Cross-cultural comparisons of limited cancer health literacy rates

Abstract Purpose This study aims to compare the limited cancer health literacy (LCHL) rates among White (U.S.), Black (U.S.) and Chinese (H.K.) cancer patients using the Cancer Health Literacy Test - 6 (CHLT-6) and its recent adaptation in Chinese. Rationale Arbitrary nature of determining LCHL using the cut-score method is a major obstacle to scientifically investigate racial/ethnic differences in LCHL rates. To overcome, we used the multi-group latent class analysis (LCA) to test invariant measurement properties of the CHLT-6, a necessary condition to claim that the differences in LCHL rates reflect true group differences. Results Data included 1,899 cancer patients: White (N = 806) and Black (N = 491) and Chinese (N = 602). Measurement invariance test between the unconstrained and conditional probability constrained multi-group LCA favored the latter using the Bayesian Information Criterion (BIC: 10,388 vs.10,334) indicating that the LCHL label has the same meaning between three groups. The CHLT-6 determines cancer patients with LCHL with high accuracy (&amp;gt;90%) in all three groups. The model-based estimates of LCHL rates varied across groups: White (4%), Black (50%), and Chinese (25%). Conclusions This study provides a strong construct validity evidence for the CHLT-6 by showing that it has invariant measurement properties between racial/ethnic groups and that it assigns cancer patients into LCHL group with high accuracy. Causal mechanisms underlying a wide range of LCHL rates need further explorations. Key messages • A substantial difference in limited cancer health literacy rates among White (U.S), Black (U.S.), and Chinese (Hong Kong) cancer patients. • The CHLT-6 accurately captures the limited cancer health literacy in diverse racial/ethnic groups.

Developing an evaluation indicators of health literacy for cervical cancer among Chinese women: a modified Delphi method study

BackgroundIncreasing women’s health literacy is the key to preventing cervical cancer, and various tools have been developed to assess women’s cancer health literacy. However, many of these tools come from other countries and have not been adapted to Chinese requirements. Furthermore, a system for evaluating cervical cancer health literacy among Chinese women has not been developed. Therefore, we sought to establish an evaluation index system for cervical cancer health literacy among Chinese women and to provide an effective evaluation tool for tertiary prevention of cervical cancer in China.MethodsWe invited 20 recognized experts to participate in two rounds of Delphi expert consultation, and the modified Delphi process with percentage weighting and multiplication was used. A literature review identified 67 potential indicators. Subsequent discussions within our research team led to the retention of 48 indicators following a rigorous screening process. On this basis, two rounds of Delphi expert consultation were conducted to rate and screen the indexes. Percentage weighting and multiplication were used to determine index weights.ResultsTwenty experts participated in the first-round Delphi consultations (95.23% recovery rate). In the second-round Delphi consultations, 20 questionnaires were returned (100%), and the expert authority coefficient was 0.93 ± 0.02. After both rounds of Delphi consultation, 4 first-level indicators, 9 second-level indicators, and 32 third-level indicators were identified for cervical cancer literacy among Chinese women. On a five-point scale, importance ratings ranged from 3.76 to 4.95 points, with variation coefficients ranging from 0.06 to 0.25, while sensitivity ratings ranged from 3.71 to 4.83 points, with variation coefficients ranging from 0.08 to 0.24. Across both rounds, Kendall’s W coefficients ranged from 0.168 to 0.248. The weights of first-level indicators of basic knowledge and attitudes about cervical cancer, primary prevention of cervical cancer literacy, secondary prevention of cervical cancer literacy, and tertiary prevention of cervical cancer literacy were 0.257, 0.249, 0.251, and 0.243, respectively.ConclusionsWe have developed the first tertiary prevention-based, comprehensive evaluation index system for cervical cancer literacy among Chinese women, which will provide theoretical support for cervical cancer prevention and health education programs.

Cancer health literacy: Are all patients equitably equipped with the tools to make informed health care decisions? (154)

Cancer health literacy: Are all patients equitably equipped with the tools to make informed health care decisions? (154)

Factors Associated With Limited Cancer Health Literacy Among Chinese People: Cross-sectional Survey Study.

Limited cancer health literacy may be attributed to various factors. Although these factors play decisive roles in identifying individuals with limited cancer health literacy, they have not been sufficiently investigated, especially in China. There is a pressing need to ascertain the factors that effectively identify Chinese people with poor cancer health literacy. This study aimed to identify the factor associated with limited cancer health literacy among Chinese people based on the 6-Item Cancer Health Literacy Test (CHLT-6). We first categorized Chinese study participants according to the answers provided for cancer health literacy as follows: people who provided ≤3 correct answers were labeled as having limited cancer health literacy, whereas those who provided between 4 and 6 correct answers were labeled as having adequate cancer health literacy. We then adopted logistic regression to analyze the factors that were closely related to limited cancer health literacy among at-risk study participants. The logistic regression analysis identified the following factors that effectively predicted limited cancer health literacy: (1) male gender, (2) low education attainment, (3) age, (4) high levels of self-assessed general disease knowledge, (5) low levels of digital health literacy, (6) limited communicative health literacy, (7) low general health numeracy, and (8) high levels of mistrust in health authorities. Using regression analysis, we successfully identified 8 factors that could be used as predictors of limited cancer health literacy among Chinese populations. These findings have important clinical implications for supporting Chinese people with limited cancer health literacy through the development of more targeted health educational programs and resources that better align with their actual skill levels.

The Chinese Version of the Breast Cancer Literacy Assessment Tool: Translation, Adaptation, and Validation Study.

Breast cancer is the most common cancer among Chinese women, with an age-standardized prevalence of 21.6 cases per 100,000 women. Limited cancer health literacy reduces females' ability to engage in cancer prevention and detection. It is necessary to assess Chinese women's breast cancer literacy to deliver targeted interventions and effective education. However, there is no Breast Cancer Literacy Assessment Tool (B-CLAT) available in China currently. This study aimed to translate and linguistically and culturally adapt the B-CLAT into a simplified-Chinese version (C-B-CLAT), and then validate its psychometric properties by administering it to Chinese college students. First, we translated the B-CLAT into a simplified-Chinese version and verified its validity and reliability using rigorous translation and validation guidelines proposed in previous studies. We then evaluated the psychometric properties among 50 female participants with a mean age of 19.62 (SD 1.31) years recruited from Nantong University, China. Items 1, 6, 8, 9, 10, 16, 17, 20, 21, 22, 23, 24, 25, 26, 29, and 30 were deleted to increase the relevant subscale internal consistency. Items 3, 12, 13, 14, 18, 20, 27, and 31 were deleted due to their Cronbach α being lower than .5 in the test-retest analysis. After deletion, the internal consistency of the entire scale was fair with α=.607. The prevention and control subscale had the highest internal consistency with α=.730, followed by the screening and knowledge subscale with α=.509, while the awareness subscale had the lowest internal consistency with α=.224. The intraclass correlation coefficient for the C-B-CLAT (items 2, 4, 5, 7, 11, 15, 28, 32, 33, and 34) was fair to excellent (odds ratio [OR] 0.88, 95% CI 0.503-0.808). The values of Cronbach α for items 2, 4, 5, 7, 11, 15, 28, 32, 33, and 34 ranged from .499 to .806, and the α value for the C-B-CLAT was .607. This indicates fair test-retest reliability. The mean difference in the C-B-CLAT scores between stage 1 and stage 2 was 0.47 (OR 0.67, 95% CI -0.53 to 1.47), which was not significantly different from zero (t48=0.945; P=.35). This result implies that the C-B-CLAT produced the same scores at stage 1 and stage 2 on average, thus showing good agreement in the C-B-CLAT scores between stage 1 and stage 2. The SD of the difference was 3.48. The 95% limits of agreement were -6.34 to 7.28. We developed a simplified-Chinese version of the B-CLAT through translation and adaptation. Psychometric properties testing has proven this version valid and reliable for assessing breast cancer literacy among Chinese college students.

Does Health Literacy Affect Colorectal Cancer Screening Rates?

ABSTRACT This study aims to determine the relationship between adult colorectal cancer screening behaviors and health literacy levels. This cross-sectional study aims to determine the relationship between adult colorectal cancer screening behaviors and health literacy levels. Of the participants, only a small proportion had undergone this screening (9.3%). Having an intestinal disease (OR = 23) and having a relative with colorectal cancer (OR = 8) had the highest effect on colorectal screening. There were significant differences between the colorectal screening groups concerning most THLS-32 subgroup scores, including the THLS-32 total score. Health literacy affects colorectal cancer screening rates. Primary care workers, especially community health nurses, are in an ideal position to increase health literacy and thereby increase cancer screening rates.

The Role of Cognitive Dysfunction and Health Literacy on the Quality of Life in Cancer Survivors

Background: Cancer disease is considered one of the basic health problems in the world, which threatens the health of human life. It causes numerous personal, family and social damages in physical, psychological, and social dimensions. Objectives: The present study aimed at investigating health literacy and cognitive dysfunction on the quality of life of cancer survivors to make better decisions for the daily functioning, quality of life, and work capacity of cancer survivors so that their lives can be spent with more peace and less stress. Methods: With a descriptive correlational design, 350 cancer survivors of the Cancer Research Cancer, Shahid Beheshti University of Madical Sciences (Shohaday Tajrish Hospital) from September 2021 to November 2021, who had been treated for at least one year, volunteered online and in person. In this study, a Cognitive Failure Questionnaire, Cancer Health Literacy Test, and the Quality of Life in Adult Cancer Survivors were used. Results: Pearson correlation showed a negative relationship between cognitive dysfunction and quality of life; so, path analysis showed that 25% of the quality of life is predicted by cognitive dysfunction, but cancer health literacy was not correlated with the quality of life of cancer survivors. Conclusions: According to the findings, the optimization of cognitive functions after treatment was emphasized to increase the quality of life of cancer survivors.

Adapting an Advance Care Planning Intervention Delivered via Telehealth for Older Patients With Acute Myeloid Leukemia and Myelodysplastic Syndromes

Background Older patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) experience high-intensity care (eg, chemotherapy, hospitalization, and life-sustaining treatments) during the end of life. Early advance care planning (ACP) may promote end-of-life care that is more consistent with patients’ values and goals. As the COVID-19 pandemic has resulted in a rapid shift to telehealth, the use of such methods may improve access to ACP among this vulnerable population. Objective In this qualitative study, we aimed to adapt an evidence-based ACP intervention, the Serious Illness Care Program (SICP), to be delivered via telehealth for older adults with AML and MDS. Methods We conducted semistructured interviews with 14 oncology clinicians and 10 palliative care clinicians (physicians, advanced practitioners, and nurses), as well as 15 patients and 4 caregivers. Oncology and palliative care clinicians were recruited if they had cared for at least one patient with AML or MDS in the past year. Eligible patients were aged ≥60 years and had a diagnosis of AML or MDS, and their caregivers, if available, were recruited. Interviews were transcribed and qualitatively coded by 2 independent coders using MAXQDA (VERBI GmbH). We used directed content analyses focused on the content and delivery (telehealth vs in-person ACP) of the SICP. Results The mean ages of clinicians, patients, and caregivers were 48, 71, and 66 years, respectively. Health literacy, which was measured using the 6-item Cancer Health Literacy Test, was high in both patients (score: mean 6; range 0-6) and caregivers (score: mean 6). The majority of participants liked the intent and content of the SICP, with suggestions mainly on wording changes. One patient stated, “I wish I’d had a little of this back in the beginning, it would’ve eased my way through….” Oncologists expressed positive feedback for the SICP language “planting the seeds” of the ACP conversation, emphasizing that “it doesn’t mean that it’s going to happen.” Oncology and palliative care clinicians were comfortable with conducting ACP discussions via telehealth. Providers felt that the use of telehealth in ACP conversations would allow them to “deliver care with less burden.” Most patients and caregivers however were comfortable with conducting ACP conversations via telehealth “after the first couple of appointments [being] in-person” to first establish care. Lastly, providers felt that including a geriatric assessment summary prior to ACP conversations “helps to ground and anchor the discussion,” as it provides a “sense of baseline functionality…[and] quality of life.” Conclusions Overall, the SICP was well received by clinicians, patients, and caregivers. This stakeholder feedback will help us to better understand current barriers to ACP conversations and gauge whether telehealth may be utilized to help improve access to ACP. This feedback will be used to further refine the SICP intervention for a future single-arm pilot study. Trial Registration ClinicalTrials.gov NCT04745676; https://clinicaltrials.gov/ct2/show/NCT04745676 Acknowledgements Funding: R00CA237744, 5UG1CA189961, and R33AG059206. Conflicts of Interest None declared.

Cancer health literacy: Central to informed care seeking and service delivery

Cancer health literacy: Central to informed care seeking and service delivery

Exploring cancer care needs for Latinx adults: a qualitative evaluation

Latinx adults with cancer, as compared with non-Latinx White adults, are diagnosed with more advanced stages and experience worse quality of life. Identifying barriers in cancer care among low-income Latinx adults is crucial to designing and implementing culturally appropriate interventions. The objective of this study was to explore the specific barriers encountered by Latinx adults after a cancer diagnosis and perspectives on the use of community health workers (CHWs) to address these barriers. We conducted semi-structured qualitative interviews with low-income Latinx adults with a past or current history of cancer and/or their caregivers in a community oncology clinic located in an agricultural community in California. Analysis was based in grounded theory and performed using the constant comparative method. Sixteen interviews were conducted with patients alone (n = 11), a caregiver alone (n = 1), and patient-caregiver pairs (n = 4 patients; n = 4 caregivers). Four major themes emerged: (1) low cancer health literacy including cancer diagnosis and treatment, cancer fatalism, navigating next steps after diagnosis, advance directives, and precision medicine; (2) challenges in communicating and receiving supportive services due to language barriers; (3) stress and anxiety regarding financial hardships related to job loss, insurance barriers, and the COVID-19 pandemic; (4) the need for supportive, bilingual, and bicultural personnel to assist in overcoming these challenges. Low-income Latinx adults with cancer and their caregivers experience health literacy, communication, and financial barriers that impede quality cancer care delivery. Embedding CHWs in the care team could be one way to address these barriers to culturally concordant, accessible care.

Adaptation of the Serious Illness Care Program for Older Patients with Acute Myeloid Leukemia and Myelodysplastic Syndromes

Introduction: Compared to patients with solid tumors, patients with hematologic malignancies such as acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), experience more intense inpatient care at end of life. Older patients with AML and MDS are more likely to have rapid clinical decline and worse survival compared to younger patients. The Serious Illness Care Program (SICP) is a multicomponent, structured communication intervention developed to improve conversations about values for patients with serious illnesses. A previous randomized trial found that, compared to the control arm, patients who participated in the SICP were more likely to have a serious illness conversation (96% vs 79%) and these conversations occurred 2.4 months earlier and were more patient-centered. However, fewer than 10% of patients in this trial had a hematologic malignancy. The purpose of this study was to adapt the SICP to be delivered via telehealth for older patients with AML and MDS. Methods: We conducted a single center qualitative study of oncology and palliative care clinicians, patients with AML or MDS (age 60 years and older), and their caregivers (if available). Semi-structured interviews were audio recorded and transcribed. Interview questions focused on telehealth and feedback on the SICP. Two investigators independently coded all transcripts using MAXQDA and resolved discrepancies through iteration. Data were organized into feedback on telehealth and the components of the SICP. Results: There were 45 participants in this study: 16 oncology clinicians, 9 palliative care clinicians, 15 patients with AML or MDS, and 5 caregivers with mean ages of 46, 49, 70, and 69 years, respectively. Participants in this study had high health literacy with an average patient score of 5.7 (SD 0.6) and an average caregiver score of 6.0 (SD 0.0) on the 6-item cancer health literacy test (possible range 0-6). Four qualitative themes emerged: 1) Serious illness conversations can be conducted via telehealth, 2) Older patients have limited experience using technology but are willing to learn, 3) Patients want to understand their AML or MDS diagnosis better, and 4) Serious illness conversations should be good care, not special care (Table 1). Participants felt that telehealth-based serious illness conversations may provide patients with the comfort of being in a familiar environment but may make interpretation of body language challenging. Older patients were concerned that their lack of experience with technology may limit their ability to successfully use telehealth. Despite this, patients reported they would be willing to learn how to use telehealth, and that the SICP would be helpful and allow them to better understand their diagnosis. Patients shared that the serious illness conversation would be most effective if discussed with hope and positivity. Finally, palliative care clinicians emphasized that serious illness conversations should not fall solely on their specialty. Rather, the field of oncology would benefit from having these conversations regularly, since these patients are often facing diagnoses that have a poor prognosis. The SICP were adapted as follow: 1) Patient preparation letter: Oncology clinicians suggested providing patients with examples of questions for their clinician, and patients felt that the visual layout of the letter was overwhelming. We changed the visual layout from letter to pamphlet. 2) Serious Illness Conversation Guide (SICG): Oncology clinicians suggested simplifying the language of the conversation guide and offered alternative wording to better gauge the patient's understanding of their diagnosis. Oncology clinicians and patients suggested that the word "worried” be removed from the SICG. Patients also suggested removing the word "goals.” 3) Family guide: Oncology clinicians and patients liked the family guide and felt it would have a positive impact on the patient's ability to communicate with loved ones. Some patients felt that the language on the family guide accurately reflected conversations that they have had with their loved ones about their illness. No changes were made to the family guide. Conclusion: We adapted the SICP to meet the unique needs of older patients with AML and MDS. The adapted SICP is being tested in an ongoing single arm pilot study at the Wilmot Cancer Institute. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Improving cancer caregiver communication and health literacy with a brief online training module.

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Prevalence of Low Cost-Related Health Literacy Among Colorectal Cancer Survivors: Findings From the Kentucky Cancer Registry.

The lack of research on cost-related health literacy among colorectal cancer (CRC) survivors warrants further evaluation. The objective of this study was to examine prevalence of low literacy (health, cancer, and insurance literacy), and numeracy and their association with sociodemographic factors in a group of Kentucky CRC survivors. Based on data from the Kentucky Cancer Registry, this cross-sectional study evaluated survey results from January 2019 to November 2019 for the prevalence of low cost-related health literacy. Overall, 104 participants had adequate health literacy (77%) and cancer health literacy (71%). However, fewer CRC survivors had high numeracy (16%) and confidence in choosing and using health insurance (18%). Thirty-one percent reported competence in their ability to select a health insurance plan and use it to access timely and appropriate healthcare services. Those with lower levels of education or those enrolled in a public health insurance plan were more likely to have lower health literacy, insurance literacy, and numeracy.

Urban-rural kidney cancer disparities: The role of health literacy, cancer literacy, smoking status, and urinary bother.

e16513 Background: Kidney cancer (KCa) does not currently have efficacious screening methods, therefore targeting modifiable risk factors is a strong approach to primary prevention. Prior research from our group identified a significant difference in KCa incidence and mortality between the urban and rural populations in Illinois, but the reason(s) for this geographic variation were unclear. The objective of this pilot study was to investigate KCa-relevant knowledge and health behaviors in order to explain our observed urban-rural differences in KCa incidence and mortality, and to inform approaches to KCa prevention. Methods: A convenience sample was surveyed from five study sites between June 2016 and February 2018. These included 207 urban and 53 rural patients presenting at urology and primary care clinics. Four outcome measures related to KCa were assessed using validated measures: 1) health literacy, 2) cancer health literacy, 3) smoking status and knowledge of its association with KCa, and 4) degree of bother caused by urologic symptoms. Multivariate logistic regression models were used to examine these outcome measures between the two populations. Smoking history, personal and family history of cancer, and socio-demographic characteristics were controlled for in the analysis. Results: The overall model for predicting health literacy was significant (Wald Pvalue = 0.0269). When accounting for all covariates, rural versus urban residence was not a significant predictor of adequate health literacy (p = 0.4871). However, participants with higher levels of education (p = 0.0005), higher household income (p = 0.0395), and participants who were female (p = 0.0104) were all more likely to have adequate vs. low health literacy. We did not identify a statistically significant difference in cancer health literacy, knowledge of smoking as a KCa risk factor, or measurement of urinary bother between urban and rural residents in this population. Conclusions: The analyses revealed significant differences in health literacy by education, income, and gender, but not by geographic location. While there were no statistically significant geographical differences found in three of our four domains, this may have been attributed to the low proportion of rural-residing clinic patients recruited in this study. With potential limitations of using RUCA as a measure of rurality, future work is needed to better reach this population and validate results to understand the disparity of improving KCa outcomes in rural areas.

Translation and Cross-Cultural Adaptation of the Cancer Health Literacy Test for Portuguese Cancer Patients: A Pre-Test.

Assuming the multidimensionality of health literacy, new complex and comprehensive approaches are more adequate to specific disease contexts, such as cancer. Assessing cancer literacy levels is a priority, since it entails potential serious implications for disease outcomes and patient’s quality of life. This article reports on the translation and cultural adaptation of the Cancer Health Literacy Test to measure cancer literacy in Portuguese cancer patients. A multidisciplinary team of experts ensured the translation and cultural adaptation of the CHLT-30. A pre-test was conducted in two stages to evaluate the Portuguese version (CHLT-30 PT) in a sample of cancer patients (n = 71). Descriptive statistics were used to characterize the sample. Reliability (test–retest and internal consistency) and construct validity of CHLT-30 PT were assessed. The results obtained show a good internal consistency of the tool, respectively (Cronbach’s alpha = 0.86 in the test and 0.80 in the retest). Patients’ raw score mean in both test (23.96) and retest (25.97) and the distribution of scores categories are not statistically different. A suggestive association between higher education level and better total score was found compared to the results reported in CHLT-30-DKspa. The results obtained in the pre-test are favorable, and the instrument is now suitable for the next steps of the validation process. A Portuguese version of this tool will allow outlining patients’ cancer literacy along the cancer care continuum, enabling the identification and implementation of adequate socio-educational strategies with highly positive impacts on health outcomes.

General versus disease-specific health literacy in patients with breast cancer: a cross-sectional study.

Health literacy is recognized as a critical factor affecting communication across the continuum of cancer care and plays a key role in patients' ability to meaningfully discuss their condition with healthcare providers. However, there is no consensus on the best approach to measure health literacy in clinical practice. The aims of this study were to compare general and disease-specific measurements of health literacy in patients with breast cancer as well as examine their relationships with patient-provider communication. During office visits, patients with HER-2 + breast cancer who received care at oncology clinics with value-based models of care completed a survey including the 6-item cancer health literacy tool (CHLT-6), 6-item newest vital sign (NVS), 2 items measuring difficulty of patient-provider communication, and 11 demographic/clinical items. The mean age of 146 participants was 57.1 ± 10.8years. Most participants had adequate general health literacy as measured by the NVS (79%) and a high probability of adequate cancer health literacy (≥ 0.7) as measured by the CHLT-6 (92%). Most patients easily communicated with healthcare providers (90.2%) and understood information they provided (83.5%). However, there was no significant relationship between patient-provider communication and health literacy. Both the CHLT-6 and NVS may be useful tools to assess the health literacy of patients with cancer in clinical practice. Study findings of adequate health literacy and ease of communication might have been influenced by the value-based care models adopted by participating clinics. Further research in more diverse samples of patients with cancer and different types of oncology practice settings is warranted.

SMART Oncology Nursing: Literacy, Goals, Coaching, and Empowerment.

This study assesses the effect of a nurse-designed SMART educational intervention on goal attainment, patient empowerment, and satisfaction. A mixed-methods study design was used. 68 adults with cancer were recruited from an oncology research center and randomized to the immediate or waitlist control group. Empowerment was measured using the Patient Empowerment Scale, and health literacy was measured using the Cancer Health Literacy Test. Measures were completed by the immediate group at enrollment and by the waitlist control group after an eight-week waiting period to establish an updated baseline. Participants received four learning modules on goal setting and coaching to facilitate learning and activation of knowledge. Visit data were collected by nurses based on participants' written and oral responses. Goal attainment ranged from 67% to 100%. Patient empowerment scores were high at baseline and throughout. No significant differences were noted among the groups on goal attainment, empowerment, or satisfaction. RNs can deliver a SMART educational intervention using a universal health literacy approach to support adults with cancer in creating symptom management strategies and attaining self-care goals.

Abstract PO-038: Assessing Spanish health literacy and cervical cancer knowledge, attitudes, and behaviors in a student-run free clinic

Abstract It is well-established that Hispanic populations in the United States have a higher incidence of invasive cervical cancer compared to non-Hispanic populations. Variations in cancer screening utilization and socioeconomic status are thought to account for much of this observed difference, and examination of health literacy has the potential to illuminate further aspects of this disparity. In addition to an association between English health literacy and Papanicolau (Pap) test knowledge, research has shown that in the setting of Spanish health materials low Spanish health literacy is strongly associated with never having a Pap test. This indicates that even when health information is provided in Spanish, low functional health literacy limits adequate care. The objective of this project is to examine Spanish health literacy and cervical cancer screening knowledge, attitudes, and behaviors in the patient population of the BRIDGE Healthcare Clinic; a student-run free clinic that serves primarily Spanish-speaking populations in the Tampa area. Spanish health literacy will be measured by the Short Assessment of Health Literacy–Spanish (SAHL-S), a validated health literacy questionnaire. A short questionnaire examining functional cervical cancer health literacy will measure the knowledge and attitudes of BRIDGE patients. Cervical cancer screening behaviors will be measured via the electronic medical record. Patients will be approached for recruitment as they wait for their appointments. Eligibility criteria include having a cervix, speaking Spanish as a primary language, and being over 21. Spanish health literacy will be assessed using the SAHL-S followed by a Spanish questionnaire assessing cervical cancer screening knowledge and attitudes. This questionnaire will consist of simple words and short sentences, with question structure based on previous studies of cancer health literacy. Patients will be asked to agree or disagree with knowledge statements such as “HPV causes cervical cancer” as well as attitude statements such as “I think it is important to get regular Pap smears.” Data quality will be monitored as the questionnaires are completed and manually transcribed into an Excel file. All data will be managed and analyzed using SPSS. This project is not powered to test hypotheses, but to robustly describe Spanish health literacy and cervical cancer screening knowledge, attitudes, and behaviors using descriptive statistics. Results will be used to generate information on how Spanish health literacy may mediate adequacy of cervical cancer screening. Additionally, quality improvement will be pursued by creating targeted cervical cancer educational materials for BRIDGE patients. There is also potential for future projects, such as re-administering the knowledge and attitudes questionnaire after an educational intervention. Ultimately, this project will illuminate understudied aspects of the widening disparity in Hispanic cervical cancer incidence and identify future directions for addressing this disparity from a health literacy perspective. Citation Format: Anna Ulyanenkova Fusani, Nat Jones, Sage Hewitt, Valeria Pereira Martinez, Lucy Guerra, Eduardo Gonzalez. Assessing Spanish health literacy and cervical cancer knowledge, attitudes, and behaviors in a student-run free clinic [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-038.