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Background: Measurement error might lead to biased estimates, causing ineffective interventions and service delivery. Identifying measurement error of health-related instruments helps develop accurate assessment of health-related constructs., Objective: We compared the internal consistency of eight psychological scales used in health research in groups with adequate versus limited health literacy and in groups with higher versus lower education., Methods: Participants ( N = 1,005) from a nationally representative internet panel completed eight self-report scales: (1) information avoidance, (2) cognitive causation, (3) unpredictability, (4) perceived severity, (5) time orientation, (6) internal health locus of control, (7) need for cognition, and (8) social desirability. The first four assess beliefs about diabetes and colon cancer. We used the Newest Vital Sign to categorize participants' health literacy (limited vs. adequate). We also categorized participants' education (high school or less vs. more than high school). We compared the Cronbach's alpha for each psychological scale between groups with different health literacy and education levels using the Feldt test., Key Results: Among all the 13 subscales, scale internal consistency was significantly lower among people with limited health literacy than those with adequate health literacy for five subscales: information avoidance for colon cancer (0.80 vs. 0.88), unpredictability of diabetes (0.84 vs. 0.88), perceived severity for diabetes (0.66 vs. 0.75), need for cognition (0.63 vs. 0.82), and social desirability (0.52 vs. 0.68). Internal consistency was significantly lower among people who had a high school education or less than among those with more than a high school education for four scales: perceived severity of diabetes (0.70 vs. 0.75), present orientation (0.60 vs. 0.66), need for cognition (0.73 vs. 0.80), and social desirability (0.61 vs. 0.70)., Conclusions: Several psychological instruments demonstrated significantly lower internal consistency when used in a sample with limited health literacy or education. To advance health disparities research, we need to develop new scales with alternative conceptualizations of the constructs to produce a measure that is reliable among multiple populations. [ HLRP: Health Literacy Research and Practice . 2021;5(3):e244-e255.] Plain Language Summary: We compared the internal consistency of several psychological scales in groups with adequate versus limited health literacy and higher versus lower education. For several scales, internal consistency was significantly lower among (1) people with limited health literacy compared those who have adequate health literacy and/or (2) people who had a high school education or less compared to those with more than a high school education.

Lay illness risk beliefs are commonly held philosophies about how risk works. These include beliefs that one's personal illness risk is unknowable and beliefs that thinking about one's risk can actually increase that risk. Beliefs about risk may impact risk behaviors and thereby subsequent health status. However, limited research examines the relation between lay risk beliefs and health behavior. This paper explores this possible relation. A nationally representative sample of adults (N = 1005) recruited from an internet panel were surveyed about lay risk beliefs and risk perceptions regarding diabetes and colorectal cancer, psychosocial factors (i.e., health literacy, need for cognition, locus of control), demographics, and current health behaviors (i.e., cigarette smoking, red meat intake, physical activity). In separate sets of regressions controlling for either demographics, psychosocial factors, or risk perceptions, lay risk beliefs remained significantly related to health behaviors. It may be important to consider how to address lay risk beliefs in intervention content and targeting in order to increase adaptive health behaviors and thereby prevent chronic disease.

Background: People who say they don't know (DK) their disease risk are less likely to engage in protective behavior., Purpose: This study examined possible mechanisms underlying not knowing one's risk for common diseases., Methods: Participants were a nationally representative sample of 1005 members of a standing probability-based survey panel who answered questions about their comparative and absolute perceived risk for diabetes and colon cancer, health literacy, risk factor knowledge and health information avoidance, and beliefs about illness unpredictability. Survey satisficing was a composite assessment of not following survey instructions, nondifferentiation of responses, haphazard responding, and speeding. The primary outcomes were whether a person selected DK when asked absolute and comparative risk perception questions about diabetes or colon cancer. Base structural equation modeling path models with pathways from information avoidance and health literacy/knowledge to DK responding for each DK outcome were compared to models that also included pathways from satisficing or unpredictability beliefs., Results: Base models contained significant indirect effects of health literacy (odds ratios [ORs] = 0.94 to 0.97, all P < 0.02) and avoidance (ORs = 1.05 to 1.15, all P < 0.01) on DK responding through risk factor knowledge and a direct effect of avoidance (ORs = 1.21 to 1.28, all P < 0.02). Adding the direct effect for satisficing to models resulted in poor fit (for all outcomes, residual mean square error estimates >0.17, all weighted root mean square residuals >3.2, all Comparative Fit Index <0.47, all Tucker-Lewis Index <0.49), indicating that satisficing was not associated with DK responding. Unpredictability was associated with not knowing one's diabetes risk (OR = 1.01, P < 0.01)., Limitations: The data were cross-sectional; therefore, directionality of the pathways cannot be assumed., Conclusions: DK responders may need more health information, but it needs to be delivered differently. Interventions might include targeting messages for lower health literacy audiences and disrupting defensive avoidance of threatening health information.

Background: Health literacy and numeracy influence many health-related behaviors and outcomes. Health literacy and numeracy have been assessed objectively and subjectively, but interrelationships among the measures and the consistency of their association with health knowledge have not been examined., Objective: To increase understanding of the structure and interrelations among objective and subjective health literacy and numeracy and how these constructs relate to knowledge of risk factors of two major diseases., Design: Secondary analysis of cross-sectional survey data, weighted to be representative of the general US population of non-institutionalized adults., Participants: Participants (N = 1005, 55.2% response rate) were recruited from GfK KnowledgePanel. The unweighted sample included 52% women, 26% racial/ethnic minorities, and 37% with no college experience., Main Measures: Objective health literacy, subjective health literacy, objective numeracy, subjective numeracy. Objective and perceived knowledge of diabetes and colon cancer risk factors were also assessed., Key Results: Confirmatory factor analyses indicated that a model with correlated (r = 0.16-0.56) but separate factors for each of the four literacy/numeracy constructs best fit the data (RMSEA = 0.055 (95% CI 0.049-0.061), CFI = 0.94). Consistency between measures in classifying people as having adequate or limited health literacy or numeracy was 60.9-77.1%, depending on the combination of measures. All four literacy/numeracy constructs were independently associated with objective diabetes knowledge and objective colon cancer knowledge (all ps < .04). Subjective (but not objective) literacy and numeracy measures were associated with diabetes perceived knowledge (all ps < .02). No literacy/numeracy measures were associated with perceived colon cancer knowledge., Conclusions: We identified objective and subjective health literacy and numeracy as four distinct but related concepts. We also found that each construct accounts for unique variance in objective (but not subjective) disease knowledge. Until research uncovers what psychological processes drive subjective measures (e.g., motivation, self-efficacy), research investigating the relationship between health literacy and health outcomes should consider assessing all four measures.

There is a need to investigate which health information sources are used and trusted by people with limited health literacy to help identify strategies for addressing knowledge gaps that can contribute to preventable illness. We examined whether health literacy was associated with people's use of and trust in a range of potential health information sources. Six hundred participants from a GfK Internet survey panel completed an online survey. We assessed health literacy using the Newest Vital Sign, the sources participants used to get health information, and the extent to which participants trusted health information from these sources. We performed multivariable regressions, controlling for demographic characteristics. Lower health literacy was associated with lower odds of using medical websites for health information and with higher odds of using television, social media, and blogs or celebrity webpages. People with lower health literacy were less likely to trust health information from specialist doctors and dentists, but more likely to trust television, social media, blogs/celebrity webpages, friends, and pharmaceutical companies. People with limited health literacy had higher rates of using and trusting sources such as social media and blogs, which might contain lower quality health information compared to information from healthcare professionals. Thus, it might be necessary to enhance the public's ability to evaluate the quality of health information sources. The results of this study could be used to improve the reach of high-quality health information among people with limited health literacy and thereby increase the effectiveness of health communication programs and campaigns.

Individuals with different cultural worldviews conceptualise risks in distinct ways, yet this work has not extended to personal illness risk perception. The purpose of this study was to 1) examine the relationships between two types of cultural worldviews (Hierarchy-Egalitarian; Individualism-Communitarianism) and perceived risk (perceived severity and susceptibility) for diabetes and colon cancer, 2) test whether health literacy modifies the above relationships, and 3) investigate whether trust in government health information functions as a putative mediator of the relations between cultural worldviews and disease perceived risk. We recruited (N = 600) participants from a nationally-representative Internet survey panel. Results were weighted so the findings are representative of the general United States population. People with a more hierarchical worldview expressed lower perceived susceptibility to developing both diabetes and colon cancer, and perceived these diseases to be less severe, relative to those with a less hierarchical (more egalitarian) worldview. There was no significant association between individualistic worldview and perceived risk. Health literacy modified the relationships between hierarchical worldview and perceived risk; the associations between hierarchical worldview and lower perceived severity were stronger for those with limited health literacy. We did not observe indirect effects of cultural worldviews on perceived risk through trust in health information from government sources. It may be useful to identify specifically tailored risk communication strategies for people with hierarchical and individualistic worldviews, especially those with limited health literacy, that emphasise their important cultural values. Further research examining cultural components of illness risk perceptions may enhance our understanding of risk-protective behaviours. [ABSTRACT FROM AUTHOR]

We identified determinants of uncertainty about perceived risk judgments and demonstrated that uncertainty is associated with lower engagement in risk-reducing behavior. We found that people likely have metacognitive awareness of when their judgments are overly pessimistic, resulting in uncertainty and that question context (more constraints) and people's time orientation (future orientation) are associated with lower uncertainty. Uncertainty about conditioned risk judgments was associated with lower engagement in exercising and eating a healthy diet in order to reduce risk for heart disease. As a potential determinant of behavior, uncertainty about risk judgments merits further consideration for integration into theories of health behavior. [ABSTRACT FROM AUTHOR]

Individuals sometimes report that they don't know their risk for a health problem, but many studies of illness risk perception do not provide a 'don't know' (DK) response option. We examined how providing versus not providing a DK option affected responding – either the number of DK responses when the option was provided or the number of skips when a DK option was not provided. We also examined whether it systematically affected perceived risk estimates. Participants (N = 960) reported perceived absolute and comparative risk for four health issues. They were randomly assigned to receive risk questions with or without a DK response option. In the DK Option condition, 'don't know' answers ranged from 3.5% to 12.7% of responses. For all absolute risk questions, perceived risk was significantly higher in the DK Option condition; all Fs (1, 932) < 3.79, all ps <.05. DK responding was issue-specific; more than 25% of the sample answered DK to at least once, but only 2.7% answered DK to more than half of the items. Substantial use of the DK response option and higher perceived absolute risk estimates were seen when a DK response was provided. These findings have implications for assessing the validity of measured risk estimates, of relations between constructs, and for survey design best practices. In addition, they suggest that DK responses are primarily knowledge-based – that individuals answer DK largely because of lacking sufficient knowledge or health literacy to form a risk perception rather than due to satisficing. [ABSTRACT FROM AUTHOR]

Purpose: Rural residents may have lower access to and use of certain health information sources relative to urban residents. We investigated differences in information source access and use between rural and urban US adults and whether having low health literacy might exacerbate rural disparities in access to and use of health information. Methods: Six hundred participants (50% rural) completed an online survey about access and use of 25 health information sources. We used logistic regression models to test associations between rurality and access to and use of health information sources and whether rurality interacted with health literacy to predict the access and use. Findings: Compared to urban residents, rural residents had lower access to health information from sources including primary care providers, specialist doctors, blogs, and magazines, and less use of search engines. After accounting for sociodemographics, rural residents only had lower access to specialist doctors than urban residents. Rural residents with limited health literacy had lower access to mass media and scientific literature but higher use of corporations/companies than rural residents with adequate health literacy and urban residents regardless of health literacy level. Conclusions: Some differences in access to and use of health information sources may be accounted for by sociodemographic differences between rural and urban populations. There may be structural barriers such as shortage of specialist doctors and limited media exposure that make it harder for rural residents to access health information, especially those with limited health literacy. [ABSTRACT FROM AUTHOR]

Background: Health literacy and numeracy influence many health-related behaviors and outcomes. Health literacy and numeracy have been assessed objectively and subjectively, but interrelationships among the measures and the consistency of their association with health knowledge have not been examined.Objective: To increase understanding of the structure and interrelations among objective and subjective health literacy and numeracy and how these constructs relate to knowledge of risk factors of two major diseases.Design: Secondary analysis of cross-sectional survey data, weighted to be representative of the general US population of non-institutionalized adults.Participants: Participants (N = 1005, 55.2% response rate) were recruited from GfK KnowledgePanel. The unweighted sample included 52% women, 26% racial/ethnic minorities, and 37% with no college experience.Main Measures: Objective health literacy, subjective health literacy, objective numeracy, subjective numeracy. Objective and perceived knowledge of diabetes and colon cancer risk factors were also assessed.Key Results: Confirmatory factor analyses indicated that a model with correlated (r = 0.16-0.56) but separate factors for each of the four literacy/numeracy constructs best fit the data (RMSEA = 0.055 (95% CI 0.049-0.061), CFI = 0.94). Consistency between measures in classifying people as having adequate or limited health literacy or numeracy was 60.9-77.1%, depending on the combination of measures. All four literacy/numeracy constructs were independently associated with objective diabetes knowledge and objective colon cancer knowledge (all ps < .04). Subjective (but not objective) literacy and numeracy measures were associated with diabetes perceived knowledge (all ps < .02). No literacy/numeracy measures were associated with perceived colon cancer knowledge.Conclusions: We identified objective and subjective health literacy and numeracy as four distinct but related concepts. We also found that each construct accounts for unique variance in objective (but not subjective) disease knowledge. Until research uncovers what psychological processes drive subjective measures (e.g., motivation, self-efficacy), research investigating the relationship between health literacy and health outcomes should consider assessing all four measures. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the influence of demographic characteristics, breast cancer knowledge, fatalistic beliefs, health beliefs, and subjective norms on Jordanian women's intention to participate in mammography screening. Design: A cross-sectional survey was used to collect data at 14 comprehensive healthcare centers in Amman and Zarqa, Jordan. A convenience sample of 142 Jordanian women 40 years of age or older with no history of breast cancer and able to read and write in Arabic participated. Methods: Self-report surveys included a combination of researcher-designed and existing instruments to measure the study variables. Data were analyzed using descriptive statistics, Pearson's correlation, t tests, and multiple logistic regression. Findings: Jordanian women surveyed lacked knowledge about breast cancer. Social norms and self-efficacy highly influenced these women's intention to engage in mammography screening. Younger women were more willing to indicate intention to engage in mammographic screening. Conclusions: Self-efficacy and the social connectedness of Jordanian society, but not religious beliefs or perceived barriers to screening, influence Jordanian women's intention to undergo mammography. Future research should examine cultural influences, rather than religious beliefs, and investigate Jordanian women's potentially unique perspectives on barriers to actual mammography screening behavior. Clinical Relevance: The prevalence of mammography screening may be enhanced by focusing interventions on Jordanian women's support systems and empowering women by providing knowledge and skills needed to engage in the procedure. Journal of Nursing Scholarship, 2012; 44:1, XXX-XXX. ©2011 Sigma Theta Tau International. [ABSTRACT FROM AUTHOR]