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Started with an existing operational definition of cancer literacy and sought patients' perspective on this concept via in-depth interviews.Translation and back-translation from Italian to English performed. Cognitive interviews were done to test the survey prior to fielding.

The framework of the C-HLS was based on Leavell and Clark's Levels of Prevention, and the scale items were developed according to Nutbeam's 3 levels of HL. First, the authors conducted 4 focus group interviews to obtain data as a basis for the subsequent development of scale items of C-HLS. The Delphi method was employed, and 13 experts were invited to evaluate the content validity of the C-HLS. The expert validity of each item was reviewed in terms of its appropriateness, necessity, and semantic clarity. The expert panel included oncologists, nurses, case managers, healthcare system managers and experts in the fields of HL and education. In addition, 10 newly diagnosed cancer patients were invited to assess the face validity of the items and rate them for semantic clarity and sentence fluency. Based on the first round of face validity and expert validity evaluations, the C-HLS was revised to have 39 items; that version was then put through the second round of expert validity evaluation. The final version of the C-HLS consisted of 35 items, with 14, 10, and 11 items, respectively, for the 3 levels of HL: functional, interactive, and critical literacy. A cross-sectional design was adopted for large-sample verification of reliability and validity and to assess the receiver operating characteristic (ROC) curve.

Used the Sentence Verification Technique to write items based on realistic health messages about cancer prevention and screening, including media messages, clinical encounters, and clinical print materials. Items were reviewed, revised, and pre-tested.

Development and evaluation of a new scale for assessing functional cervical cancer health literacy

Test the reliability and validity, in a culturally diverse sample of women, of a revised Breast Cancer Literacy Assessment Tool (Breast-CLAT) designed to measure functional understanding of breast cancer in English, Spanish, and Arabic

Used the Sentence Verification Technique to write items based on realistic health messages about cancer prevention and screening, including media messages, clinical encounters and clinical print materials. Items were reviewed, revised, and pre-tested.

Used a Delphi Panel to discuss domains of health literacy and evaluate various definitions of health literacy. Researchers also conducted and recorded 6 focus group sessions to elicit their understanding of cancer health literacy. For both groups, a qualitative content analysis was used to analyze the transcripts. Transcripts from both groups were supplemented with recent research reports and the research team examined the materials to each write 25 test items. The research team met and revised a list of 112 items that was pilot tested with cognitive interviews with 25 patients diagnosed with cancer. Items identified in the interviews as redudant, unclear, or slightly related to cancer health literacy were eliminated to result in 76 items.

Used a Delphi Panel to discuss domains of health literacy and evaluate various definitions of health literacy. Researchers also conducted and recorded 6 focus group sessions to elicit their understanding of cancer health literacy. For both groups, a qualitative content analysis was used to analyze the transcripts. Transcripts from both groups were supplemented with recent research reports and the research team examined the materials to each write 25 test items. The research team met and revised a list of 112 items that was pilot tested with cognitive interviews with 25 patients diagnosed with cancer. Items identified in the interviews as redudant, unclear, or slightly related to cancer health literacy were eliminated to result in 76 items.

Interviews with diverse women from the target populations, extraction of critical indicators, review by cancer health professionals, and pilot testing. A community based organization-initiated model was used for the Arabic translation.