Development and Psychometric Testing of the Health Literate Cancer Hospital Scale
Keywords:
Cancer care, Delphi technique, Health literacy, Healthcare organization, Psychometric testing, Self-assessment scaleAbstract
People with low health literacy experience difficulty understanding health information and using cancer services.Healthcare organizations are increasingly working to enhance patient understanding and their literacy of health information.However,no validated tools were available to measure a health literate cancer hospital until we developed and tested a self-assessment scale for this purpose.
Two study phases were organized:Phase I aimed to identify the core components of a health literate cancer hospital scale using the three-round Delphi technique with 18 experts in the fields of health literacy,hospital accreditation and health education.Thematic content analysis and measure of central tendency and dispersion were performed for consensus, yielding 4 attributes with 42 items.Phase II tested the scale.A multicenter cross-sectional survey was conducted in six cancer hospitals in Thailand, and a total of 306 healthcare providers completed a questionnaire.Exploratory factor analysis with factor loading in excess of .63 reduced the items from 42 to 22, including leader’s vision(8items), healthcare provider’s competency(8items),health education materials(3items)and patient-friendly environment(3items).The scale demonstrated high internal consistency reliability(Cronbach’s alpha coefficient .94)and acceptable discrimination(corrected item-total correlation ranged from0.44 to0.74).
The final Health Literate Cancer Hospital Scale exhibited a reliable construct validity and internal consistency reliability.Nurses and other health professionals can use this scale as a guideline to provide care and improve their competencies.It can also be integrated in a hospital’s quality assurance system so as to self-assess and improve the process of establishing a health literate cancer organization.However, the scale should be tested in other types of hospitals where cancer care is provided for broader generalization.
References
Hsieh LY, Chou FJ, Guo SE. Information needs of patients with lung cancer from diagnosis until first treatment follow-up. PLoS One. 2018 13(6):1–13. doi: 10. 1371/journal.pone.0199515.eCollection2018.
Blodt S, Kaiser M, Adam Y, Adami S, Schultze M, Muller Jacqueline. Understanding the role of health in patients’ experiences: secondary analysis of qualitative narrative interviews with people diagnosed with cancer in Germany. BMJ Open. 2018 8:e019576. doi:10.1136/bmjopen2017-019576.
Okuhara T, Ishikawa H, Urakubo A, Hayakawa M, Yamaki C, Takayama T, et al. Cancer information needs according to cancer type: a content analysis of data from Japan’s largest cancer information website. Preventive Medicine Reports. 2018 12:245–52.
Thorne S, Oliffe JL, Stajduhar KI. Communicating shared decision-making: cancer patient perspectives. Patient Educ Couns. 2013 90(3):291–6. doi: 10.1016/j.pec.2012. 02.018.
Katz SJ, Belkora J, Elwyn G. Shared decision making for treatment of cancer: challenges and opportunities. J Oncol Pract. 2014 10(3):206–8.
McCorkle R, Ercolano E, Lazenby M, Schuman-Green D, Schilling LS, Lazenby M. Self-management: enabling
and empowering patients living with cancer as a chronic illness. CA Cancer J Clin. 2011 61(1):50–62.
Hammer MJ, Ercolano EA, Wright F, Dickson VV, Chyun D, Melkus GD, et al. Self-management for adult patients
with cancer: an integrative review. Cancer Nurs. 2015 38(2):e10–26.
World Health Organization. Shanghai Declaration on Promoting Health in the 2030 Agenda for Sustainable
Development. Health Promot Int. 2017 32(1):7–8.
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an
updated systematic review. Ann Intern Med. 2011 155(2):97–107.
Halverson JL, Martinez-Donate AP, Palta M, Leal T, Lubner S, Walsh MC, et al. Health literacy and health-related
quality of life among a population-bases sample of cancer patients. J Health Commun. 2015 20(11):1320–9.
Busch EL, Martin C, DeWalt DA, Sandler RS. Functional health literacy, chemotherapy decisions, and patient
outcomes within a cohort of colorectal cancer patients. Cancer Control. 2015 22(1):95–101.
Koay K, Schofield P, Jefford M. Importance of health literacy in oncology. Asia Pac J Clin Oncol. 2012 8(1):14–23.
Martinez-Donate AP, Halverson J, Simon NJ, Strickland JS, Trentham-Dietz A, Smith PD, et al. Identifying health
literacy and health system navigation needs among rural cancer patients: finding from the rural oncology literacy
enhancement study (ROLES). J Cancer Educ. 2013 28(3):573–81.
Castro EM, Regenmortel TV, VAnhaechet K, Sermeus W, Hecke AV. Patient empowerment, patient participation and patient-centeredness in hospital care: a concept analysis based on a literature review. Patient Educ Couns. 2016 99(12):1923–39. doi: 10.1016/j.pec.2016.07.026.
Hincapie A, Warholak T. The impact of health information exchange on health outcomes. Appl Clin Inform. 2011 2(4):499–507. doi:10.4338/ACI-2011-05-R-0027.
Australian Commission on Safety and Quality in Health Care. Consumers, the health system and health literacy:
taking action to improve safety and quality. Consultation Paper. Sydney: ACSQHC; 2014.
Brach C, Keller D, Hernandez LM, Baur C, Parker R, Dreyer B, et al. Ten attributes of health literate health care
organizations. Institute of Medicine of the National Academes; 2012, pp.1–27.
Rudd RE, Anderson GE. Health literacy environment of hospitals and health centers. Harvard School of Public Health Department of Society, Human Development, & Health; 2006, pp.1–152.
Ministry of Health. Health literacy review: A guide. Wellington, New Zealand; Ministry of Health; 2015.
Kowalski C, Lee SY, Schmidt A, Wesselmann S, Wirtz MA, Pfaff H, et al. The health literate health care organization 10-item questionnaire (HLHO-10): development and validation. BMC Health Serv Res. 2015 15:1–9.
Ernstmann N, Halbach S, Kowalski C, Pfaff H, Ansmann L. Measuring attributes of health literate health care
organizations from the patients’ perspective: development and validation of a questionnaire to assess health literacysensitive communication (HL-COM). Z. Evid. Fortbild. Qual. Gesundh. wesen (ZEFQ). 2017 121:58–63.
Ketefian S, Manojlovich M. Why do we need tools in nursing research. Pacific Rim Int J of Nurs Res. 2020; 24(1): 1–4.
Macmillan TT. The Delphi Technique. Paper presented at the Annual Meeting of the California Junior Colleges
Associations Committee on Research and Development, Monterey, California; 1971.
Coleman CA1, Hudson S, Maine LL. Health literacy practices and educational competencies for health professionals: a consensus study. J Health Commun. 2013 18 Suppl 1:82–102. doi: 10.1080/10810730.2013. 829538.
Chang LC1, Chen YC2, Wu FL1, Liao LL3.Exploring health literacy competencies towards patient education programme for Chinese-speaking healthcare professionals:a Delphi study. BMJ Open. 2017 7(1):e011772.
Skulmoski GJ, Hartman FT, Krahn J. The Delphi Method for graduate research. Journal of Information Technology Education. 2007 6:1–21.
Hsu CC. The Delphi Technique: making sense of consensus.Practical Assessment, Research, and Evaluation. 2007 12(10):1–8.
Ramos D, Arezes P, Afonso P. Application of the Delphi Method for the inclusion of externalities in occupational
safety and health analysis. DYNA. 2016 83(196):14–20.
Comrey A, Lee H. A first course in factor analysis. Hillsdale, NJ: Erlbaum; 1992.
Tabachnick BG, Fidell LS. Using multivariate statistics (5th ed.). New York: Harper Collins; 2007.
George D, Mallery P. SPSS for Windows step by step: A simple guide and reference. 11.0 update (4th ed.). Boston:Allyn & Bacon; 2003.
Kwszei AP, Novak M, Streiner DL. Introduction to health measurement scales. J Psychosom Res. 2010 68(4):319–
doi: 10.1016/j.jpsychores.2010.01.006.
The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care:A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission; 2010.
Stikes R, Arterberry K, Logsdon MC. A nurse leadership project to improve health literacy on a maternal-infant unit. J Obstet Gynecol Neonatal Nurs. 2015 44(5):665–76. doi:10.1111/1552-6909.12742.
Doak CC, Doak LG, Friedell GH, Meade CD. Improving comprehension for cancer patients with low literacy skills: strategies for clinicians. CA Cancer J Clin. 1998 48(3):151–62.
Kripalani S, Weiss BD. Teaching about health literacy and clear communication. J Gen Intern Med. 2006 21(8): 888–90.
Palumbo R, Annarumma C. The Importance of Being Health Literate: An Organizational Health Literacy Approach. 17th Toulon-Verona International Conference. Excellence in Services; 2014, pp. 247–62.
Mikhail D, Visscher KL, Chen N, Wang J, Emara BY, Hutnik CM. Patient-appropriate health literacy educational
materials in ophthalmology. Can J Ophthalmol. 2015 50(1):19–25. doi: 10.1016/j.jcjo.2014.08.002.
Imoisili O, Levinsohn E, Pan C, Howell BA, Streiler S, Rosenbaum R. Discrepancy between patient health literacy
levels and readability of patient education materials from an electronic health record. HLRP: Health Literacy
Research and Practice. 2017 1(4):e203–7.
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