Development and validation of a tool for assessing breast cancer health literacy among Chinese women

Abstract Background Breast cancer (BC) is a major malignancy that seriously threatens women’s health. No unified, evidence-based, standardized assessment tools for BC literacy are available in China yet. Objectives We sought to develop an assessment tool to measure BC health literacy among Chinese women and to test the tool’s reliability, validity, and feasibility. Methods Group discussion, expert consultation, and small-sample pilot investigation were conducted to develop an initial assessment tool. A multi-stage stratified random-sampling process was used to select women aged 18-64 years in Yichang City, Hubei Province, China, for an onsite survey. Project analysis and exploratory factor analysis were used to screen the questions to create a formal assessment tool, which was further evaluated by feasibility analysis and the measurement of reliability and validity. Results The official version of the assessment tool for Chinese female BC health literacy includes 32 items. Nine common factors (policy knowledge, uncorrectable risk factors, modifiable risk factors, identification of early warning signs #1 and #2, screening methods, breast self-awareness and examination behaviors, timely seeking of medical help and standardized treatment, and rehabilitation) were extracted through exploratory factor analysis with factor loadings of 0.511-0.873 and a cumulative explained variance of 65.989%. Confirmatory factor analysis revealed χ2/df = 1.61, CFI = 0.91, TLI = 0.90, RMSEA = 0.04, and SRMR = 0.06. The overall Cronbach’s α coefficient was 0.875, and the split-half reliability was 0.770 (both >0.700). Conclusions An assessment tool for Chinese female BC health literacy was developed with acceptable feasibility, reliability, and validity. The application of this tool can help to promote BC prevention and control in China and may also benefit other countries. Key messages • An assessment tool for Chinese female BC health literacy was developed with acceptable feasibility, reliability, and validity. • The application of this tool can help to promote BC prevention and control in China and may also benefit other countries.