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

Hsiu Ling Chou, Yu Ling Lo, Chieh Yu Liu, Shih Chiang Lin, Yu Chi Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)E291-E303
JournalCancer Nursing
Issue number5
StatePublished - 1 Sep 2020


  • Health literacy
  • Newly diagnosed cancer patients
  • Scale development


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