Objectives/purpose: Limited cancer health literacy (LCHL) is burdensome for cancer patients, family caregivers, and the nation. This study aimed to obtain model-based estimates of LCHL rates and explore rate differences in five groups stratified by diagnostic status: race/ethnicity, education, income, age, and sex.
Sample and setting: Patients with a confirmed cancer diagnosis were recruited from oncology clinics in the U.S. (n=1,306). Patients without a cancer diagnosis were recruited from primary care clinics, health fares, community centers, and churches in the Mid-Atlantic region (n=512).
Procedures: The Cancer Health Literacy Test-6 (CHLT-6) and demographic questionnaire were administered in-person using a hand-held device. Latent class analysis (LCA) with two classes [LCHL and adequate cancer health literacy (ACHL)] was used to test the measurement structure of CHLT-6. Scalar invariance model was used to test the measurement equivalence between groups and estimate LCHL rates.
Results: Scalar invariance was supported in all comparisons. Among cancer patients, approximately 10-fold rate differences in LCHL were found between Blacks (50%) and Whites (5%), patients with ≤high school (54%) and >high school (6%), as well as patients earning <$40K (50%) and ≥$40K (4%). Results were similar among persons without cancer, but LCHL rates were somewhat higher among persons without cancer than those with cancer across all groups.
Conclusion and clinical implications: LCHL is highly prevalent among Blacks, under-educated, and low-income persons with and without a diagnosis of cancer. To improve the health and wellbeing of patients and caregivers, clinicians are urged to be proactive to minimize adverse health and financial consequences of LCHL.