Measurement of cancer health literacy

Health literacy encompasses a broad range of skills, including the ability to understand health – related information, apply it in daily life, and communicate it to others. It is a dynamic term affected by large-scale social changes such as the development of medical sciences, the emergence of mass media tools, the prevalence of the internet and the development of artificial intelligence. Moreover, it is also affected by factors such as age, gender, sexual orientation, culture, faith, social status and education.

According to the World Health Organization, health literacy represents daily activities, social interactions and personal knowledge and skills accumulated over generations. Personal knowledge and competencies enable people to access, understand, appraise, and use information and services in ways that promote and maintain good health and well-being for themselves and those around them. In other words, health literacy “is about guiding individuals’ decisions and behaviours relating to themselves and society, building knowledge about key health services and information, accessing this information and services, understanding, evaluating and using them and passing this knowledge on to future generations”. 

Cancer health literacy measurement methods

There is no general accepted measurement method of health literacy. When it comes to diseases requiring different competence and knowledge, the measurement method of health literacy changes. Therefore, the measurement methods of cancer health literacy differ from the general measurement methods of health literacy.

Cancer Health Literacy 30 (CHLT-30) and Cancer Health Literacy – 6 (CHLT-6) were used in a study conducted at Virginia Commonwealth University Massey Cancer Center and in oncology clinics with 1306 cancer patients between April 2011 and 2013. 

CHLT-30, one of the measurement methods, was described as a psychometric tool to measure cancer health literacy in a continuum by the research team. The research team claimed that CHLT-30 can be completed in between 10 and 15 minutes. It has extensive content, and its score ranges from 0 to 30. CHLT-6 was designed to determine people with limited cancer health literacy swiftly. The research team emphasised that the CHLT-6 can be completed in 2 minutes and yields two results: the probability of belonging to the limited cancer health literacy class, and the probability of belonging to the adequate cancer health literacy class.

Cancer awareness measurement

Cancer Awareness Measurement (CAM) is another measurement tool to measure cancer health literacy that was developed in 2007 and 2008 by Cancer Research UK, University College London, King’s College London, and Oxford University. The Cancer Awareness Measurement (CAM) was designed to measure cancer awareness in the general population, identify risk factors for low awareness, and assess the impact of interventions aimed at increasing it. It has been designed to track the development of cancer awareness over the years. 

Research frequently conducted by Cancer Research UK over different years also aims to reveal the impact of CAM on the development of cancer awareness. CAM 2008 version includes titles such as “warning signs”, “seeking help”, “barriers to seeking help”, “risk factors”, “cancer and age”, “most common cancers”, and “NHS screening programmes”. It was conducted as a national survey with 2216 samples in 2008. The survey, which was developed and used as CAM+ in 2024, has open-ended questions and extensive blanks for participants to write their knowledge.

Cancer health literacy in Turkey

In the field of cancer health literacy research in Turkey, there is a prevailing tendency to choose Turkey Health Literacy Scale-32 (TSOY-32). In research on these topics,  the Turkey Health Literacy Scale-32 (TSOY-32) is often used with other scales. For example, the study entitled “Relationship between Health Literacy and Medication Adherence of Turkish Cancer Patients Receiving Oral Chemotherapy” used the Turkey Health Literacy Scale-32 (TSOY-32) together with the Oral Chemotherapy Adherence Scale. 

In a separate study conducted to determine the relationship between the attitudes of adults registered at a family health centre towards cancer screening, their participation in National Cancer Screening Programmes, and their health literacy levels, the Attitude Scale for Cancer Screening, the Turkish Health Literacy Scale-32 (TSOY-32), and the Standardised Mini Mental Test (SMMT) were used together. 

Another study examined the relationship between adults’ cancer information overload and their attitudes toward cancer screening, and it used the Attitude Scale for Cancer Screening and the Cancer Information Overload Scale (CIO). Although it was developed specifically for cancer screening programmes and therefore does not directly measure cancer health literacy, it can be noted as one of the tools for measuring cancer health literacy in Turkey. It is generally observed that measurement tools developed around the research are used only once or in limited numbers. 

One of CancerDisinfo’s most significant contributions to cancer health literacy will be providing researchers with a rich repository of authentic, real-life stories to draw upon in the development and implementation of cancer health literacy measurement tools in Turkey. Based on real-world contexts in Turkey, it appears necessary to develop a shared cancer health literacy measurement tool, implement it continuously, and develop health communication campaigns and health policies to improve cancer health literacy by explaining the results comparatively.