Cross-cultural adaptation of cancer health literacy instruments in Arabic: the CHLT-30-Arabic and CHLT-6-Arabic

Abstract

Background Health literacy plays a crucial role in physical and mental health outcomes. Patients with chronic diseases, cancer patients in particular, shoulder a disproportionate burden due to limited health literacy. Limited cancer health literacy (LCHL) is a risk factor for disease prevention, treatment adherence, and management, leading to poor health.Aims Currently, there are no standardized instruments to measure cancer health literacy in Arabic and identify Arabic-speaking cancer patients with LCHL. This study aimed to test the psychometric properties of the Arabic translation of Cancer Health Literacy Test (CHLT-30-Arabic and CHLT-6-Arabic) for use among cancer patients.Methods Data collected from a sample of cancer patients (N = 260) from a comprehensive medical center in Riyadh, Saudi Arabia were used to test the measurement structures and estimate item statistics using classical test theory, factor analysis and Item Response Theory driven two-parameter logistic model (2PL). Additionally, an independent sample of 19 patients was used to estimate one-month stability of CHLT-30-Arabic scores.Results A one-factor model was confirmed as the measurement structure of CHLT-30-Arabic (RMSEA = 0.04; CFI = 0.92; TLI = 0.91). Test scores were highly reliable (Cronbach’s α = 0.86; McDonald’s ω = 0.92; one-month test-retest r = 0.93). The CHLT-6-Arabic measurement structure, latent class analysis with two classes (adequate vs. limited), was consistent with the observed response patterns of six items (LR χ2(50) = 59.95, p = 0.16) with high class separation (entropy = 0.81). The model estimated LCHL rate was 22% (accuracy = 93%). Both instruments had invariant measurement properties across age, gender, educational attainment, and income groups.Discussion The CHLT-30-Arabic and CHLT-6-Arabic offer valuable standardized instruments for measuring cancer health literacy needs among Arabic-speaking patients with cancer and help to improve care management and healthcare services for this population. These instruments can identify cancer patients with LCHL and inform targeted interventions to potentially minimize adverse health and financial consequences of LCHL.