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Elbarazi I, Aziz F, Ahmed LA, Abdullahi AS, Al-Maskari F. Cancer Health Literacy and Its Correlated Factors in the United Arab Emirates-A Cross Sectional Study. Cancer Control 2024; 31:10732748241248032. [PMID: 38717601 PMCID: PMC11146015 DOI: 10.1177/10732748241248032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/15/2024] [Accepted: 04/01/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Cancer Health literacy (CHL) is the health literacy related to cancer knowledge, prevention, treatment, screening, and access to services. It is an important indicator of people's adherence to screening and preventive measures, which helps to reduce the incidence and prevalence of cancer. The study assessed the CHL level and its association with relevant socio-demographic characteristics and sources of information among primary health care patients and visitors in the United Arab Emirates (UAE). METHODS A cross-sectional study recruited survey participants who consented to respond to an interviewer-administered questionnaire. The assessment of CHL was done by using 15 questions. CHL level was measured as a median score and also categorized as poor/inadequate, moderate, good/excellent. Nominal logistic regression was used to analyze the relationship between CHL categories and participants' sociodemographic characteristics and CHL sources of information. RESULTS Of the total 492 participants, 45.5% were young adults (30-39 years old), 32.9% were males, and 70.8% were UAE nationals. The overall median CHL score was 8.0 (IQR = 5.0-10). 33.7% of the participants had a poor/inadequate level of CHL, 49.6% had a moderate level and 16.7% had a good to excellent level of CHL. 76.9% of the participants knew the importance of early cancer screening tests, 72.7% acknowledged the metastatic capacity of cancer, and the protective factors of cancer, especially, in colon cancer (71.7%). A high proportion of participants received health information about cancer via the internet (50.7%), television (45.3%), social media (40.2%), and doctors (43.6%). Nationality other than UAE (aOR = 1.62, 95% CI = 1.03-2.56, P = .038), having university education (aOR = 2.20, 95% CI = 1.21-3.99, P = .010) compared to those with lower than high school, and having a family history of cancer (aOR = 2.42, 95% CI = 1.33-4.41, P = .004) were positively associated with CHL. Older age (aOR = .36, 95% CI = .17-.75, P = .007 for 50-59 years, and aOR = .29, 95% CI = .11-.82, P = .019) for 60-69 years, higher-income (aOR = .57, 95% CI = .33-.99, P = .047 for 10,000-19,999 AED; aOR = .53, 95% CI = .33-.88, P = .013 for ≥20,000) compared with those earning <10,000 AED were negatively associated with CHL. CONCLUSIONS CHL among the resident UAE population was moderately adequate, therefore implementation of awareness campaigns seems to be warranted. Moreover, evaluation research targeting the CHL impact on cancer prevention practices and screening is also advocated.
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Affiliation(s)
- Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Luai A. Ahmed
- Institute of Public Health, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Aminu S. Abdullahi
- Institute of Public Health, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fatima Al-Maskari
- Institute of Public Health, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Liu T, Xiao X. A Framework of AI-Based Approaches to Improving eHealth Literacy and Combating Infodemic. Front Public Health 2021; 9:755808. [PMID: 34917575 PMCID: PMC8669242 DOI: 10.3389/fpubh.2021.755808] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
The global COVID-19 pandemic has put everyone in an urgent need of accessing and comprehending health information online. Meanwhile, there has been vast amount of information/misinformation/disinformation generated over the Internet, particularly social media platforms, resulting in an infodemic. This public health crisis of COVID-19 pandemic has put each individual and the entire society in a test: what is the level of eHealth literacy is needed to seek accurate health information from online resources and to combat infodemic during a pandemic? This article aims to summarize the significances and challenges of improving eHealth literacy in both communicable (e.g., COVID-19) and non-communicable diseases [e.g., cancer, Alzheimer's disease, and cardiovascular diseases (CVDs)]. Also, this article will make our recommendations of a general framework of AI-based approaches to improving eHealth literacy and combating infodemic, including AI-augmented lifelong learning, AI-assisted translation, simplification, and summarization, and AI-based content filtering. This general framework of AI-based approaches to improving eHealth literacy and combating infodemic has the general advantage of matching the right online health information to the right people.
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Affiliation(s)
- Tianming Liu
- Department of Computer Science, University of Georgia, Athens, GA, United States
| | - Xiang Xiao
- Department of Network and New Media, College of Humanities and Arts, Hunan International Economics University, Changsha, China
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Koirala R, Gurung N, Dhakal S, Karki S. Role of cancer literacy in cancer screening behaviour among adults of Kaski district, Nepal. PLoS One 2021; 16:e0254565. [PMID: 34255769 PMCID: PMC8277024 DOI: 10.1371/journal.pone.0254565] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 06/24/2021] [Indexed: 12/03/2022] Open
Abstract
Cancer Screening is a key approach to detect cancer at an early stage and help reduce cancer mortality globally. Inadequate Cancer Literacy may pose a barrier to patient engagement in getting screened for cancer. This study assessed Cancer Screening behavior and its association with Cancer Literacy and other factors among adults of Kaski district, Nepal. A cross-sectional study was carried out among 180 adults from March to August 2019, selected using a multi-stage random sampling method. Data on demographics, history of cancer, use of naturopathy, fatalism, family support, cancer literacy and cancer screening behaviour were collected using a semi-structured questionnaire, with the aid of face-to-face interviews. Cancer Literacy was measured using a cancer health literacy tool (CHLT-6), and Cancer Screening behaviour was assessed on the basis of the self reported information about having gone through any type of cancer screening in the past. Odds ratio (OR) with 95% Confidence Interval (CI) was calculated to determine the strength of association using Multivariate Logistic Regression analysis. Only 43.4% of the respondents had Cancer Literacy scores more than the median and only 11.7% had ever gone through any Cancer Screening test in the past. In this study, Cancer Screening behaviour was significantly associated with Cancer Literacy [OR = 1.43, 95% CI (1.01–2.02)]. Similarly, significant association was found between Cancer Screening behaviour and other exposure variables such as age [OR = 1.06, 95% CI (1.02–1.11)] and gender [OR = 0.06, 95% CI (0.01–0.35)]. This study showed low cancer screening and cancer literacy scores amongst the respondents. This suggests that to tackle the ever increasing burden of cancer and hence, to increase cancer screening, we need to focus on improving knowledge and awareness about cancer, as well as, on targeting efforts towards people’s understanding of basic health and cancer terminologies.
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Affiliation(s)
- Reecha Koirala
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
- * E-mail:
| | - Nisha Gurung
- Department of Community Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Lekhnath, Gandaki Province, Nepal
| | - Sarita Dhakal
- Kathmandu Model Research Foundation, Kathmandu, Nepal
| | - Sulata Karki
- Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
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Huang CH, Lo YJ, Kuo KM, Lu IC, Wu H, Hsieh MT, Liu IT, Lin YC, Lai YC, Huang RY, Hung WC, Lin CW. Health literacy and cancer screening behaviors among community-dwelling female adults in Taiwan. Women Health 2021; 61:408-419. [PMID: 33902386 DOI: 10.1080/03630242.2021.1917477] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study was designed to explore the association among health literacy and cancer screening behaviors in Taiwanese females. A total of 353 community-dwelling females were recruited in this cross-sectional study from February to October 2015. Demographic, socioeconomic and personal behavior variables including physical activity, community activity, smoking, alcohol consumption, and betel nut chewing were recorded. Health literacy was evaluated using the Mandarin version of the European Health Literacy Survey Questionnaire. Data on screening behaviors for cervical, breast and colorectal cancers were confirmed by the Taiwanese National eHealth Database. Most respondents with inadequate or problematic general health literacy had no or irregular screening behaviors for cervical, breast and colorectal cancers. In multivariable regression analysis, women with inadequate health literacy were at a greater risk (Odds ratio = 5.71; 95% CI: 1.40-23.26) of having no previous Pap smear screening or >3 years screening interval regardless of education level. However, this association was not detected for breast or colorectal cancer. Women with inadequate health literacy were more likely to have irregular cervical cancer screening, however no associations among health literacy and breast or colorectal cancer were detected. The impact of health literacy on cancer screening behavior warrants further attention and research.
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Affiliation(s)
- Chi-Hsien Huang
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Yen-Ju Lo
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - Kuang-Ming Kuo
- Department of Business Management, National United University, Miaoli County, Taiwan
| | - I-Cheng Lu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Hsing Wu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,Department of Information Management, National Yunlin University of Science and Technology, Yunlin County, Taiwan
| | - Ming-Ta Hsieh
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - I-Ting Liu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Yu-Ching Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - Yu-Cheng Lai
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - Ru-Yi Huang
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan.,Center for International Medical Education, E-Da Hospital, Kaohsiung City, Taiwan
| | - Wei-Chieh Hung
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan.,Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Chi-Wei Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
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Literacy of Breast Cancer and Screening Guideline in an Immigrant Group: Importance of Health Accessibility. J Immigr Minor Health 2021; 22:563-570. [PMID: 31956925 DOI: 10.1007/s10903-020-00973-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Little is known about predictors of breast cancer literacy among immigrant women. A cross-sectional survey investigated predisposing, enabling, and need factors of breast cancer literacy among 233 Korean American women living in a southeastern U.S. city. Breast cancer literacy was measured by questions that asked awareness of cancer screening methods and a 5-item questionnaire derived from the American Cancer Society's breast cancer screening guidelines and risk factors. Annual checkup was an enabling factor of awareness of Clinical Breast Exam (CBE) and mammogram, and also for breast cancer literacy covering the knowledge of breast cancer screening guidelines and risk factors. Health status was a need factor of CBE awareness. Marital status was a predisposing factor of mammogram awareness, and age and years of residence in the US were predisposing factors of breast cancer literacy. The findings of the study illuminate probable avenues of intervention to promote breast health knowledge for Korean American women.
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Yoon S, Wang K, Luo Y, Lee J, Neese J, Lee H. Cancer Screening Literacy among Vietnamese Population: Does Annual Checkup Improve Cancer Screening Literacy? Asian Pac J Cancer Prev 2021; 22:927-933. [PMID: 33773559 PMCID: PMC8286676 DOI: 10.31557/apjcp.2021.22.3.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Colorectal, breast, and cervical cancers disproportionately impact the Vietnamese population. However, research on cancer prevention among this population was very limited. The purpose of this study is to examine the cancer screening literacy levels for these three types of cancers among rural Vietnamese and investigate correlates of cancer screening literacy. METHODS A sample of 226 Vietnamese men and women aged 25-70 years old was recruited from rural Vietnam and finished a self-administered questionnaire. Andersen's Behavioral Model was used to guide this cross-sectional study to identify modifiable variables. Bivariate analysis was used to explore the relationship between demographic factors and cancer screening literacy levels. Multiple linear regressions were also used to identify significant factors for cancer literacy levels. RESULTS Cancer screening literacy levels of Vietnamese men and women were low regarding all three types of cancers, especially HPV symptom questions. Only about 24% of women answered correctly on "most people with genital HPV have no visible signs/symptoms" and less than 18% answered correctly on "I can transmit HPV to my partner(s) even if I have no HPV symptoms." Findings suggested that having an annual checkup was associated with higher colorectal (β=.15, p <.05), breast (β=.25, p <.001), and cervical (β=.18, p <.01) cancer screening literacy. CONCLUSIONS Public health efforts should focus on encouraging annual checkups in the Vietnamese population. During the annual checkup, health care professionals should educate patients about importance of cancer screening and provide recommendations for regular cancer screenings to reduce cancer health disparities.
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Affiliation(s)
| | - Kun Wang
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Yan Luo
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Jongwook Lee
- Department of Agricultural Economics and Rural Development, Seoul National University, Building, Seoul, Republic of Korea
| | - Jessica Neese
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Hee Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
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Cha EY, Chun H. Barriers and Challenges to Cervical Cancer Screening, Follow-Up, and Prevention Measures among Korean Immigrant Women in Hawaii. Asia Pac J Oncol Nurs 2021; 8:132-138. [PMID: 33688561 PMCID: PMC7934592 DOI: 10.4103/2347-5625.308302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/13/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Despite being the fastest-growing population in the United States, Asian American women have one of the lowest cancer screening rates and the least attention given to cancer-related research. Cervical cancer screening disparities among Korean immigrant women (KIWs) in Hawaii have been reported. METHODS The qualitative ethnographic study was to explore the health barriers and challenges of cervical cancer prevention among KIWs in Hawaii. The Social Ecological Model was used to guide the study. Data were collected using individual structured interviews with 20 KIWs aged 21-65 years. The data were coded and analyzed to identify themes in exploring health barriers. RESULTS The findings revealed that participants (a) lacked knowledge about the U.S. health-care system; (b) lacked access; (c) had limited resources regarding cervical cancer screening communicated in Korean; (d) lacked an understanding of cultural and psychosocial beliefs on preventive care; (e) lacked female and Korean-speaking providers; and (f) experienced language barriers and limited coverage of health insurance. CONCLUSIONS A multicomponent intervention combining individual and community-based, Internet-accessible, culturally, and linguistically appropriate approaches may enhance effective cervical cancer screening rates and positive health outcomes among KIWs in Hawaii.
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Affiliation(s)
- Eurina Yujin Cha
- School of Nursing and Health Professions, Chaminade University, Honolulu, HI, USA
| | - Hans Chun
- School of Education and Behavioral Sciences, Chaminade University, Honolulu, HI, USA
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Jin SW, Lee Y, Dia DA. Analyzing paths from online health information seeking to colorectal cancer screening using health literacy skills frame and cognitive mediation model. PATIENT EDUCATION AND COUNSELING 2019; 102:416-423. [PMID: 30448041 DOI: 10.1016/j.pec.2018.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/19/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To test the hypothesized paths for Online Health Information Seeking (OHIS) behaviors in developing health literacy, leading to colorectal cancer (CRC) screening among Korean Americans (KAs) using Health Literacy Skills Frameworks (HLSF) and Cognitive Mediation Model (CMM). METHODS A total of 433 KAs aged 50 through 75 in a metropolitan area in the Southeastern U.S. completed a cross-sectional survey regarding sociodemographics, OHIS behaviors, information overload, health literacy, decisional balance, and CRC screening history. Path analyses were implemented to assess the hypothesized causal models by examining the relationships among these variables. RESULTS OHIS was positively associated with information overload and health literacy; information overload was negatively associated with health literacy. Health literacy was positively associated with decisional balance; decisional balance was positively associated with uptake of sigmoidoscopy and colonoscopy. CONCLUSION The findings supported both theoretical frameworks, HLSF and CMM, for OHIS to develop health literacy, leading to CRC screening. These findings highlight the significant roles of information overload and attitudes and beliefs about screening in enhancing health literacy and CRC screening among KAs. PRACTICE IMPLICATIONS Practice efforts for facilitating CRC screening among medically underserved older KAs should target improving access to and use of OHIS and culturally-tailored health information delivery.
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Affiliation(s)
- Seok Won Jin
- School of Social Work, The University of Memphis, 226 McCord Hall, Memphis, TN 38152, USA.
| | - Yeonggeul Lee
- Department of Social Welfare, University of Seoul, 163 Seoulsiripdaero, Dongdaemun-gu, Seoul 02504, South Korea.
| | - David A Dia
- School of Social Work, The University of Memphis, 226 McCord Hall, Memphis, TN 38152, USA.
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Hagger MS, Hardcastle SJ, Hu M, Kwok S, Lin J, Nawawi HM, Pang J, Santos RD, Soran H, Su TC, Tomlinson B, Watts GF. Health literacy in familial hypercholesterolemia: A cross-national study. Eur J Prev Cardiol 2018; 25:936-943. [DOI: 10.1177/2047487318766954] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background High rates of inadequate health literacy are associated with maladaptive health outcomes in chronic disease including increased mortality and morbidity rates, poor treatment adherence and poor health. Adequate health literacy may be an important factor in the effective treatment and management of familial hypercholesterolemia, and may also be implicated in genetic screening for familial hypercholesterolemia among index cases. The present study examined the prevalence and predictors of health literacy in familial hypercholesterolemia patients attending clinics in seven countries. Design Cross-sectional survey. Methods Consecutive FH patients attending clinics in Australia, Brazil, China, Hong Kong, Malaysia, Taiwan and the UK completed measures of demographic variables (age, gender, household income and highest education level) and a brief three-item health literacy scale. Results Rates of inadequate health literacy were lowest in the UK (7.0%), Australia (10.0%), Hong Kong (15.7%) and Taiwan (18.0%) samples, with higher rates in the Brazil (22.0%), Malaysia (25.0%) and China (37.0%) samples. Income was an independent predictor of health literacy levels, accounting for effects of age. Health literacy was also independently related to China national group membership. Conclusions Findings indicate non-trivial levels of inadequate health literacy in samples of familial hypercholesterolemia patients. Consistent with previous research in chronic illness, inadequate health literacy is related to income as an index of health disparities. Chinese familial hypercholesterolemia patients are more likely to have high rates of inadequate health literacy independent of income. Current findings highlight the imperative of education interventions targeting familial hypercholesterolemia patients with inadequate health literacy.
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Affiliation(s)
- Martin S Hagger
- School of Psychology, Curtin University, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Finland
- School of Applied Psychology, Griffith University, Australia
| | | | - Miao Hu
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR
| | - See Kwok
- Cardiovascular Trials Unit, Central Manchester University Hospital NHS Foundation Trust, UK
- Lipoprotein Research Group, University of Manchester, UK
| | - Jie Lin
- Department of Atherosclerosis,Beijing Anzhen Hospital Capital, Medical University, China
| | - Hapizah M Nawawi
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA, Malaysia
| | - Jing Pang
- School of Medicine, University of Western Australia, Australia
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, Brazil
| | - Handrean Soran
- Cardiovascular Trials Unit, Central Manchester University Hospital NHS Foundation Trust, UK
| | - Ta-Chen Su
- Department of Internal Medicine and Cardiovascular Centre and College of Medicine, National Taiwan University Hospital, Taiwan
| | - Brian Tomlinson
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR
| | - Gerald F Watts
- School of Medicine, University of Western Australia, Australia
- Lipid Disorders Clinic, Royal Perth Hospital, Australia
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Simulation study of activities of daily living functions using online computerized adaptive testing. BMC Med Inform Decis Mak 2016; 16:130. [PMID: 27724939 PMCID: PMC5057399 DOI: 10.1186/s12911-016-0370-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/04/2016] [Indexed: 12/13/2022] Open
Abstract
Background Computer adaptive testing (CAT) of the activities of daily living (ADL) functions is required (i) to reveal the advantages of using an efficient and accurate estimation method, (ii) to determine the cutpoint for classifying ADL strata in patients with stroke, and (iii) to evaluate the feasibility of online CAT used in clinical settings for smartphones. Methods Normally standardized distributions of ADL measurements were simulated using item parameters from published papers. We retrieved item parameters of the combined Barthel Index and Frenchay Activities Index from the literature (the 23-item comprehensive ADL [CADL] and 34-item ADL scales) and simulated three 1000-person measures from a normal standard CAT distribution: [i] CADL (CADL-CAT), [ii] ADL (ADL-CAT), and [iii] NAT (Non-Adaptive Testing). The cutpoints of ADL person strata were determined using a norm-reference method. Maximum a posteriori estimation, expected a posteriori estimation, and maximum likelihood estimation (MAP) were used to compare the Pearson correlation coefficients and different number ratios of paired measures yielded by CAT and NAT. The number of items and the cutpoints for the scale were separately determined. Results We found that (i) correlation coefficients for the three CAT-estimated measures were 0.77 (CADL), 0.93 (Male ADL), and 0.93 (Female ADL) compared with their NAT counterparts. Different number ratios of person-paired measures between CAT and NAT for the three scales were all less than 5 %, indicating no difference exists between CAT and NAT. However, CAT might be 66 % more efficient than NAT. (ii) The estimated cutpoints of T scores (i.e., with a mean of 50 and a standard deviation of 10) were 45, 55, and 65 (e.g., separating person ADL function to four strata with not active, fairly active, active, and very active). (iii) An available-for-download online ADL-CAT APP for clinical practice was demonstrated. Conclusions An online ADL-CAT APP using the MAP method was created and used on smartphones to classify ADL strata in patients with stroke. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0370-8) contains supplementary material, which is available to authorized users.
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Djaja N, Janda M, Olsen CM, Whiteman DC, Chien TW. Estimating Skin Cancer Risk: Evaluating Mobile Computer-Adaptive Testing. J Med Internet Res 2016; 18:e22. [PMID: 26800642 PMCID: PMC4744332 DOI: 10.2196/jmir.4736] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/06/2015] [Accepted: 10/07/2015] [Indexed: 01/01/2023] Open
Abstract
Background Response burden is a major detriment to questionnaire completion rates. Computer adaptive testing may offer advantages over non-adaptive testing, including reduction of numbers of items required for precise measurement. Objective Our aim was to compare the efficiency of non-adaptive (NAT) and computer adaptive testing (CAT) facilitated by Partial Credit Model (PCM)-derived calibration to estimate skin cancer risk. Methods We used a random sample from a population-based Australian cohort study of skin cancer risk (N=43,794). All 30 items of the skin cancer risk scale were calibrated with the Rasch PCM. A total of 1000 cases generated following a normal distribution (mean [SD] 0 [1]) were simulated using three Rasch models with three fixed-item (dichotomous, rating scale, and partial credit) scenarios, respectively. We calculated the comparative efficiency and precision of CAT and NAT (shortening of questionnaire length and the count difference number ratio less than 5% using independent t tests). Results We found that use of CAT led to smaller person standard error of the estimated measure than NAT, with substantially higher efficiency but no loss of precision, reducing response burden by 48%, 66%, and 66% for dichotomous, Rating Scale Model, and PCM models, respectively. Conclusions CAT-based administrations of the skin cancer risk scale could substantially reduce participant burden without compromising measurement precision. A mobile computer adaptive test was developed to help people efficiently assess their skin cancer risk.
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Affiliation(s)
- Ngadiman Djaja
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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