Health literacy has emerged as an important construct because its four components, cultural and conceptual knowledge, listening and speaking (oral literacy), writing and reading (print literacy) and numeracy affect the health outcomes of individuals. Yet, there is no consensus about the most appropriate way to measure health literacy. The two most widely used health literacy measures, REALM and TOFHLA, have been in used with immigrant populations to measure print literacy (REALM and TOFHLA) and numeracy (TOFHLA), only two of the four health literacy components. Cultural and conceptual knowledge and oral literacy are not measured, limiting our ability to comprehensively assess health literacy across populations that are at most risk for low health literacy. Therefore, the current study is the first step in a long-term research agenda designed to address these methodological shortcomings. We propose to develop a comprehensive method for assessment of cultural and conceptual cancer knowledge that can be used with immigrant, older, and low SES, low literate populations. Moreover, we envision that this assessment will allow for the measurement of cultural and conceptual elements that are common and specific across immigrant populations. The two populations we will study are (a) immigrant Mexican women in the state of Illinois, and (b) immigrant Guamanian/Chamorro women in the state of Hawaii. Although we hope to extend this work to other health conditions, in this exploratory study we focus upon development and testing of health literacy assessment measures in the context of breast and cervical cancer knowledge and beliefs. We also propose to contribute to the larger literature by providing a model for the use of mixed methodologies to develop a sound health literacy assessment method. First, we will seek to understand the experiences of immigrant Mexican and Chamorro women with low health literacy. Second, with input from experts and community women, we will determine the adequacy of items to be included in a new measure. Third, we will obtain feedback from immigrant women to evaluate and revise the items, and narrow the set of items to create an empirically-based measure to assess cultural and conceptual knowledge for each group; this measure will incorporate common and specific knowledge elements for each population. Psychometrics will be obtained in a future R01.
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