Table 1.
Theoretical Multidimensional Cancer Literacy Framework (MCLF): Domains, factors and items.
| Domains and Factors | Item Content | Sources of Items or Item Themes |
|---|---|---|
| Facilitators Domain | ||
| E1. Motivations to screen (9 items) 1 | I have had regular cancer screening because a-I asked my doctor to order the test; b-An interpreter was available during the exam; c-The doctor/nurse recommended it; d-A family member or friend recommended it; e-I got a reminder card in the mail; f-I had a symptom that made me worry; g-I did not have to pay for it; h-I had the money to pay for the exam; i-I had somebody to go with me to the appointment | a–h Adapted from Buki [32]; i-added by participants in the pilot-test |
| E2. Access to information (8 items) 2 | How much information about cancer have you received from a-Doctors or other health professionals; b-Family or friends; c-Newspapers or magazines; d-The radio or television; e-The Internet; f-Religious organizations and leaders; g-Government health agencies; h-Community health fairs | Adapted from HINTS [34]; Buki [32] |
| L1. English skills (3 items) 3 | How well do you a-speak English; b-read English; c-write English | Adapted from HINTS [34] |
| L2. Communication skills (3 items) 1 | a-It is difficult for me to fill out medical forms; b-I have a hard time understanding when health professionals speak to me quickly; c-I have had difficulties understanding doctors who come from other regions and have a different English accent | a-Adapted from Buki [32]; b-Adapted Morris [36]; c-Recommended by Latino participants in pilot-test |
| P1. Trust in Physicians (4 items) 4 | a-How much do you trust your doctor’s decisions about which medical screenings are best for you; b-How much do you trust doctors of a different race/ethnicity from you; c-How much do you trust doctors of same cultural background; d-How effective are doctors at curing illness | all-Adapted from Mayfield [35]; Buki [32] |
| P2. Preferences about Providers (4 items) 1 | a-I prefer my doctor to be of my same gender; b-I prefer my doctor to be of my same racial/ethnic and cultural background; c-I prefer a doctor who speaks my language; d-I prefer my doctor to be of my same religion | Added by participants in pilot-test and adapted by authors’ experience with previous research |
| Barriers Domain | ||
| B1. Perceived barriers to screening (7 items) 1 | The following would be barriers or obstacles for me to have regular cancer screenings a-The doctor does not order the tests; b-Being unsure if there is a need for testing; c-Lack of trust on these cancer tests; d-Being afraid the test will cause harm if it is not well done; e-Being afraid the test will cause cancer; f-Dislike having exams in those parts of the body; g-Do not want to know if cancer is present | a–g Adapted from Buki [32] |
| B2. Symptomatic deterrents (4 items) 1 | There is no need to have cancer screenings when a-Feeling healthy; b-Having several normal screening test results; c-Not feeling anything abnormal (symptoms); d-Being too young or too old | a–c Adapted from Betancourt [31]; d-added by participants in the pilot-test |
| B3. Sociocultural deterrents (13 items) 5 | I have had the following problems to get the cancer screening exams a-Do not know where to go for the exam; b-Have forgotten to make the appointment; c-Have had problems making the appointment; d-Do not know if it is time to have the exams; e-Have not received a reminder postcard; f-Waiting too long for an appointment; g-Not able to get time off work; h-Lack of transportation to go to the appointment; i-Need somebody to take care of my children or family; j-Lack of health insurance; k-Lack of money to pay for the exam; l-Need an interpreter during the appointment; m-Need a friend/family to go with me to the appointment | a,c,e,g–k Adapted from Betancourt [31]; b,d,f, Adapted Buki [32]; l–m Added by Latino participants |
| Cultural Domain | ||
| C1. Beliefs about cancer as a disease (7 items) 1 | a-It seems like almost everything causes cancer; b-Cancer is due to bad luck; c-Cancer is a punishment from God; d-Cancer is the worst thing that can happen to a person; e-Cancer is a deadly disease; f-When I think of cancer, I automatically think of death; g-Everybody has cancer but only some develop the disease | a-Adapted from Morris [36]; HINTS [34]; b-Adapted Buki [32]; c-Adapted Buki [32]; d-e Adapted Betancourt [31]; f-HINTS [34]; g-added by participants in pilot-test |
| C2. Beliefs about cancer treatment (5 items) 1 | a-All you need to beat cancer is a positive attitude, no treatment; b-Treating cancer with surgery can cause it to spread throughout the body; c-Cancer can be only cured if it is God’s will; d-There is a cure for cancer but it is only available to the rich and privileged; e-There is nothing I can do to change my fate if I find out I have cancer. | a-b Adapted from Gansler [33]; c-Added by participants in pilot-test; d-Recommended by participants in pilot-test; e-Adapted HINTS [34] |
| C3. Beliefs about screening as a preventive measure (10 items) 1 | a-It is not necessary to have cancer screening regularly because it is in God’s hands anyway; b-It is not necessary to have cancer screening regularly because everyone will eventually die of something anyway; c-It is not necessary to have cancer screening regularly because if you are meant to get cancer you will get it no matter what you do; d-There are so many recommendations about preventing cancer; it’s hard to know which ones to follow; e-There is not much people can do to lower their chances of getting cancer; f-Cancer screenings help to save lives; g-Other people my age have cancer screenings regularly; h-All people should have regular cancer screenings; i-Routine cancer screening is a way to show that people care for their health and their families; j-It is possible for me to get cancer during my lifetime | a–b Adapted from Betancourt [31]; Morris [36], HINTS [34]; Buki [32] |
| C4. Self-Determination (8 items) 1 | a-I feel comfortable checking my own body for signs of health problems; b-If I noticed a symptom, I would go to the doctor to get it checked immediately; c-If I found out I have cancer, I would seek a second opinion about my condition and treatment options; d-I would offend my doctor if I were to make my own decision(s) about my health; e-I don’t know enough to make my own medical decisions; f-I’d rather be given many choices about what’s best for my health than have the doctor make the decision for me; g-Sometimes, there are good reasons not to follow the advice of a doctor; h-I feel that some doctors treat me differently because of my different racial background | a–h Adapted from Buki [32] |
| R1. Perceived cancer risk (7 items) 6 | Compared to other people my age and my same gender, I think that my risk of getting the following cancers are a-Breast cancer; b-Cervical cancer; c-Colon cancer; d-Stomach cancer; e-Liver cancer; f-Skin cancer; g-Prostate cancer | Adapted from HINTS [34] |
| R2. Worriedness about cancer (7 items) 7 | How often do you worry about getting one of the following cancer types in your lifetime a-Breast cancer; b-Cervical cancer; c-Colon cancer; d-Stomach cancer; e-Liver cancer; f-Skin cancer; g-Prostate cancer | Adapted from HINTS [34] |
1 Items beginning with the following phrase: ‘‘How much do you agree or disagree with the following statements.” Response choices were: strongly disagree; slightly disagree; undecided; slightly agree; strongly agree. 2 Response choices were: none, a little, a fair amount, enough, a lot. 3 Response choices were: not at all; a little well; somewhat well; well; very well. 4 Response choices were: not at all; a little bit; some; quite a bit; a lot. 5 Response choices were: never; rarely; sometimes; frequently; always. 6 Response choices were: much lower, lower, about the same; higher; much higher; no applicable. 7 Response choices were: never; few times; fairly often; many times; always, no applicable.