Health Care Choices:
Measuring Health Literacy in a CAM Context
For today's health care consumers, adequate health literacy is necessary to understand
and evaluate the volume of information regarding allopathic health care. It is perhaps even more
important for evaluating complementary health care (CAM) approaches. Individuals are more
likely to have assistance from providers to interpret information about allopathic care, as well as,
instruct and give advice for health care decision-making and action-taking. This is less likely
with complementary therapy. These therapies are often self determined in nature and are less
regulated or controlled by governmental agencies or allopathic providers. Further, numerous
studies have found that consumers do not tell allopathic providers about their use of CAM.
Decision making about CAM use provides a unique context in which to examine more complex aspects of the health literacy construct. The health literacy instruments currently available evaluate basic reading and math skills in a health care context. In addition to these skills, health literacy includes a constellation of cognitive skills including conceptual knowledge that supports the capacity of the individual to be health literate. In a CAM health context, conceptual knowledge involves how much individuals know about a particular treatment or practice, how they evaluate what they know, and how/if they seek additional information.
The specific aims of this study are to: a) develop an instrument to measure the conceptual knowledge component of health literacy in a CAM health context and b) conduct preliminary psychometric evaluation of the instrument. The methods will be based on DeVellis' guidelines for scale development. This process involves clearly determining the construct to be measured, developing a large pool of potential items for the instrument, iterative review of the items by experts followed by revision, administering the preliminary instrument to a large national development sample by mail, followed by evaluation, analysis, and revision.
The long term goal of this research is a better understanding of the conceptual knowledge component of health literacy regarding CAM among middle aged and older adults with chronic illness who live in rural areas. This will ultimately facilitate their informed health seeking behaviors. Rural adults are known to be more independent, engage in more self-care, have less access to allopathic care, and have a higher prevalence of chronic illness than urban adults. Individuals with chronic illness are also more likely to use CAM treatments.