PROJECT 4 - HEALTH LITERACY AND CANCER PREVENTION; DO PEOPLE UNDERSTAND WHAT THEY

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This application proposes to develop a test to assess comprehension of oral (i.e., spoken) messages about cancer prevention and screening, to examine the relationship between health literacy and cancer prevention, and to test whether modifications to oral messages can improve comprehension. Findings will lay the foundation for future research into the prevalence of inadequate health literacy-oral; identification of groups and individuals with inadequate comprehension skills, identification of risk factors and causes of limited comprehension; and development and evaluation of interventions to improve comprehension of orally transmitted messages. .The specific aims are: 1) to develop and validate a psychometrically sound test of Health Literacy-Oral, 2) to investigate the relationship between health literacy-oral and cancer prevention behaviors and 3) to develop and test recommendations for improving oral communication about cancer prevention and screening. Test development will include identification of authentic health messages about cancer and cancer prevention. Item development will be iterative, with items generated and reviewed by a team of experts in psychometrics, physician-patient communication, health communication, language comprehension and cancer. An award-winning medical writer/producer will create high quality video- and audio-tapes of typical cancer prevention messages simulating actual messages encountered in the media and in health care settings. Comprehension questions will be written using the Sentence Verification Technique. To avoid potential contamination with print literacy, absolutely no reading will be required; all text will have accompanying voiceover. After extensive pretesting and piloting, items will be administered to a diverse sample of 900 health plan members, recruited from 3 health plans across the United States (from Massachusetts, Georgia, and Hawaii). Classical and modern test theory procedures will be used to examine item and test characteristics, and to estimate reliability. Validity studies will include assessment of dimensionality and differential item functioning, and correlations with external measures. The relationship between health literacy-oral and cancer prevention will be investigated through models predicting cancer prevention practices (self-reported) and participation in cancer screening utilization (self reported and documented in health plan records). Multivariate models will test for the relative contributions of health Jiteracy-print, demographic variables, physician recommendations, perceived risk/worry, and perceived costs and benefits of screening. Both quantitative and qualitative methods will be used to identify the factors that affect comprehensibility of oral messages about cancer prevention and screening. Recommendations for modifying oral messages so that they are easily comprehensible will be developed, and the impact of specific enhancements will be tested in a randomized experiment.