Bringing the Real World to Psychometric Evaluation of Cervical Cancer Literacy Assessments with Black, Latina, and Arab Women in Real-World Settings

This research describes the development and evaluation of a new scale for assessing functional cervical cancer health literacy, the Cervical Cancer Literacy Assessment Tool (C-CLAT). In phase 1, 35 items in English, Spanish, and Arabic for C-CLAT were generated, taking into account three content domains—Awareness, Knowledge, and Prevention/Control. After content validation, 24 items were retained for psychometric evaluation. In phase 2, the 24-item C-CLAT was evaluated in three racial/ethnic populations of urban women (N = 543). Psychometric methods included item analysis, multifactor item response theory modeling, and concurrent correlations. The final C-CLAT consisted of 16 items, with an internal consistency reliability of 0.72. C-CLAT reliabilities in Black, Latina, and Arab women were 0.73, 0.76, and 0.60, respectively. The rank order correlations of item difficulties across racial/ethnic groups was high (r's = 0.97 to 0.98). The C-CLAT was positively related to educational level, and Arab women scored significantly higher than the Black and Latina participants. This study presents a psychometrically sound instrument that measures health literacy related to cervical cancer. The C-CLAT is a tool that can be orally administered by a lay person and used in a community-based health promotion intervention.