Validation of three health literacy screening questions compared with S-TOFHLA in a low-income diverse English- and Spanish-Speaking population.

BACKGROUND: Clinicians need a tool to gauge patients' ability to understand health conditions and treatment options. The Short-form Test of Functional Health Literacy in Adults (S-TOFHLA) is the gold standard for this, but its length is prohibitive for use in clinical settings. This study seeks to validate a novel three-item question set for predicting health literacy. METHODS: This cross-sectional study utilized an in-person questionnaire alongside the S-TOFHLA. The sample included 2027 English- and Spanish-speaking adults (≥18 years) recruited from primary care practices serving a low-income eastern Pennsylvania community. Most patients (57.7%) identified as Hispanic. Diagnostic accuracy of each question and aggregated scores were assessed against the validated survey by calculating the area under the receiver operating characteristic (AUROC) curve. RESULTS: Questions in the 'Problems Learning' and 'Help Reading' domains (AUROC 0.66 for each) performed better than the 'Confident Forms' question (AUROC 0.64). Summing all three scores resulted in an even higher AUROC curve (0.71). Cronbach's alpha of the combined items was 0.696. CONCLUSIONS: Study results suggest that any of the three questions are viable options for screening health literacy levels of diverse patients in primary care clinical settings. However, they perform better as a summed score than when used individually.

A Social Needs Assessment Tool for an Urban Latino Population.

Unmet social needs contribute significantly to health outcomes, yet they are not routinely assessed in health care settings. Identifying modifiable social needs and feasible tools to assess them may improve health and decrease costs. We conducted 18 focus groups with 115 participants, stratified by age (18-35, 36-64, and 65+), ethnicity (Hispanic, non-Hispanic), and language (English, Spanish) to explore priority social needs, images to depict social need categories, and acceptability of a computer-based program to identify these needs. The top three social need domains were access to care, health promoting behaviors, and family responsibilities. Participants voiced diverse social needs with notable differences across demographic groups. Both the 36-64 year old age groups and Spanish-speaking Hispanic patients were disproportionately impacted by unmet social needs. Perceptions regarding use of an interactive computer program to assess social needs varied by age. Most participants noted that a tablet computer was an acceptable venue to share social needs, though a tutorial may be needed for patients in the 65 and older group. Lastly, participants' ranking of icons were compiled to identify recognizable images of social need categories for those with literacy challenges. Unmet social needs were identified across all groups. This composite of information (priority social needs and images to represent them) will allow for creation of a tailored social need screening tool within an urban Hispanic population.

Qualitative assessment of local distribution of Screen for Life mass media materials in Appalachia.

INTRODUCTION: Screen for Life: National Colorectal Cancer Action Campaign is a multimedia campaign that informs men and women aged 50 and older about the importance of colorectal cancer screening. The Appalachia Cancer Network undertook a qualitative research study to help determine whether Screen for Life materials are being used and distributed by organizations serving Appalachian residents and to help assess key informants' perceived acceptability of the materials. METHODS: Semistructured telephone interviews were conducted with 13 state and local informants in three Appalachian states to assess the diversity of community organizations that received the materials, the level of material use, and receptivity to Screen for Life. RESULTS: Regional cancer control programs were more active in promoting Screen for Life at local levels than state health departments. Although state health departments are the primary route for distributing Screen for Life materials, they did not report the breadth of activities noted by regional cancer control programs. Several local interview respondents were unfamiliar with Screen for Life, and respondents who were familiar with Screen for Life used the materials in a general, unplanned way. Although some respondents were unfamiliar with the campaign materials, they were interested in Screen for Life. No formal evaluations on the effectiveness of the materials were reported. CONCLUSION: More guidance on how to implement the Screen for Life campaign as a targeted health communication media campaign would be helpful.

Social and cultural factors influencing health in southern West Virginia: a qualitative study.

INTRODUCTION: Social, cultural, and economic environments are associated with high rates of disease incidence and mortality in poor Appalachian regions of the United States. Although many historical studies suggest that aspects of Appalachian culture (e.g., fatalism, patriarchy) include values and beliefs that may put Appalachians at risk for poor health, other cultural aspects may be protective (e.g., strong social ties). Few recent studies have explored regional cultural issues qualitatively. The purpose of this study was to examine social and cultural factors that may be associated with health and illness in an Appalachian region. METHODS: Ten focus groups were conducted in southern West Virginia and included five groups of men and five groups of women. Cultural norms associated with residents of rural Appalachia, such as faith, family values, and patriarchy, were examined. RESULTS: Both men and women in the focus groups have a sense of place, strong family ties, and a strong spiritual belief or faith in God. Patriarchy as a cultural value was not a strong factor. CONCLUSION: There are limits to how qualitative data may be used, but findings from this study help increase understanding of the social and cultural environments of people living in rural Appalachia and how these environments may affect health.

Randomized, controlled trial of an easy-to-read informed consent statement for clinical trial participation: a study of the Eastern Cooperative Oncology Group.

PURPOSE: Studies have documented that the majority of consent documents for medical diagnosis and treatment are written at a reading level above that of the majority of the U.S. population. This study hypothesized that use of an easy-to-read consent statement, when compared with a standard consent statement, will result in higher patient comprehension of the clinical treatment protocol, lower patient anxiety, higher patient satisfaction, and higher patient accrual. METHODS: A randomized controlled trial was conducted in 44 institutions that were members or affiliates of three cooperative oncology groups. Institutions were randomly assigned to administer either an easy-to-read consent statement or the standard consent statement to patients being recruited to participate in selected cancer treatment trials. Telephone interviews were conducted with a total of 207 patients to assess study outcomes. RESULTS: Patients in the intervention arm demonstrated significantly lower consent anxiety and higher satisfaction compared with patients in the control arm. Patient comprehension and state anxiety were not affected by the intervention. Accrual rates into the parent studies also did not differ significantly between the two study groups. CONCLUSION: Clinical trial informed consent statements can be modified to be easier to read without omitting critical information. Patient anxiety and satisfaction can be affected by the consent document. The generalizability of these study results is limited by the characteristics of the patient sample. Ninety percent of the sample were white women, and the mean Rapid Estimate of Adult Literacy in Medicine score was approximately 64, indicating a literacy level at or above the ninth grade.

The Appalachia Cancer Network: cancer control research among a rural, medically underserved population.

Residents of Appalachia, especially those in rural Appalachia, are generally considered to be medically underserved. In fact, cancer mortality in Appalachia, especially in rural Appalachia, is higher than it is in the remainder of the United States. Developing from the Appalachia Leadership Initiative on Cancer, the Appalachia Cancer Network (ACN) is a network of academic and community organizations that seek to conduct surveillance, intervention, and dissemination research to reduce this excess cancer burden in Appalachia. The purpose of this report is to (1) describe the approach to cancer control research in ACN, a Special Population Network, among the medically underserved of Appalachia, and (2) to put forward observations from this experience to enhance the research of other academic and community networks among underserved populations. ACN has instituted a conceptual model, organizational structure, and other methods to foster this research and to develop junior and community-based investigators. Important issues and questions related to the effectiveness of such research networks have also been articulated.

Rural cancer patients' perspectives on clinical trials: a qualitative study.

BACKGROUND: To increase the participation of low-income, rural cancer patients in clinical trials, a better understanding of patients' attitudes, knowledge, and beliefs is needed. METHODS: In-depth interviews were conducted with 17 cancer patients living in rural West Virginia. RESULTS: Patients had limited knowledge regarding clinical trials. Factors that might influence their decisions to participate include location of the treatment facility, physician recommendation, disease status, side effects of the treatment, and the perceived effectiveness of treatment. CONCLUSIONS: Rural, low-income cancer patients should be better informed about clinical trials, when applicable. Physician trust may enhance willingness to participate if clinical trials are close to home.

Community-based cancer screening programs in older populations: making progress but can we do better?

BACKGROUND: Older individuals have higher rates of most types of cancer. Community-based cancer screening programs offer one avenue for addressing the need to prevent or detect cancers in early stages in this population. Identifying characteristics of successful interventions can assist researchers in the development of future studies. METHODS: A comprehensive literature review of community-based cancer screening interventions was undertaken and 114 behavioral interventions for breast, cervical and colorectal cancer screening published prior to 2000 and 42 studies published during 2000-2003 were identified. From these, 17 studies were identified as model interventions that were effective in significantly increasing screening rates among older populations. RESULTS: Effective interventions employed a variety of strategies including the use of social networks and lay health care workers, mass media, community-based education, reminder notices/behavioral cues, and health care provider assistance. CONCLUSION: Although subgroups of individuals still have lower rates of screening, the results indicate that older populations can be encouraged to engage in appropriate cancer screening behaviors through community-based interventions. The next round of interventions could be strengthened by evaluating intervention components, integrating theory and community participation into designs, focusing on those most at need, and considering program sustainability and costs.