The Assessment of Health Literacy in Cancer Screening (AHL-C): A Means to Assess Literacy Deficits in the Context of Cancer Screening

Monday, 30 July 2012: 10:45 AM

Hae-Ra Han, RN, PhD, FAAN
School of Nursing, The Johns Hopkins University, Baltimore, MD
Miyong T. Kim, PhD
Health Systems and Outcomes, Johns Hopkins University, Baltimore, MD


Despite considerable progress in U.S. cancer control over the past 20 years, certain ethnic minority groups continue to experience significant health disparities. Health literacy is emerging as a major barrier to effective cancer care. Persons with low health literacy, particularly those who are foreign-born, non-English-speaking immigrants and women, have been found to have disproportionately higher cancer incidence and mortality as well as decreased cancer screening. In order to appropriately intervene with low literate persons in the health care setting, it is first necessary to identify who may be in need of such intervention. While several measures exist to broadly assess health literacy within the clinical context, including the rapid estimate of adult literacy in medicine (REALM) and the test of functional health literacy in adults (TOFHLA), they fail to address particular health contexts in which health literacy needs to be screened. As a result, many terms included in the measures are irrelevant and deter clinicians from administering these tools for practice improvements. With these considerations in mind, we developed an instrument, the AHL-C, to measure health literacy in the context of breast and cervical cancer screening. The purpose of this paper is to describe the development and testing of the new instrument using baseline data from 560 non-English speaking immigrant women who participated in a large-scale community-based intervention trial to promote breast and cervical cancer screening.


Modeling on the structure of the REALM and TOFHLA, the AHL-C consists of a word recognition measure, a numeracy test, and functional literacy items.


Rigorous psychometric testing indicated that the AHL-C was reliable, valid, and significantly correlated with theoretically selected variables.


The AHL-C demonstrates evidence of validity and reliability. Future research is needed to test its utility for evaluating health literacy intervention in the context of cancer screening.