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

Chou, Hsiu-Ling, PhD; Lo, Yu-Ling, MS; Liu, Chieh-Yu, PhD; Lin, Shih-Chiang, MD; Chen, Yu-Chi, PhD

doi: 10.1097/NCC.0000000000000711
Article: PDF Only

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.

Author Affiliations: Nursing Department, Far Eastern Memorial Hospital, New Taipei City, and School of Nursing, National Yang-Ming University, Taipei (Dr Chou and Ms Lo); Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei (Dr Liu); Department of Oncology and Hematology, Far Eastern Memorial Hospital, New Taipei City (Dr Lin); and Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei (Dr Chen), Taiwan, Republic of China.

This work was supported by NYMU-FEMH Joint Research Program, Taiwan (NYMU-FEMH 105-FN-17).

The authors have no conflicts of interest to disclose.

Correspondence: Yu-Chi Chen, PhD, Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St, Beitou Dist, Taipei City 112, Taiwan, Republic of China (

Accepted for publication January 24, 2019.

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