title: Measuring Nutrition Literacy in Breast Cancer Patients: Development of a Novel Instrument.
abstract: No nutrition literacy instruments have been tested in breast cancer survivors, yet nutrition is a critical lifestyle factor for optimizing weight and improving quality of life in breast cancer survival. Our objectives were to adapt our Nutrition Literacy Assessment Instrument for breast cancer populations and to pilot test its validity and reliability. We modified the instrument based on review by content experts in cancer and nutrition and cognitive interviews with 18 cancer survivors. The modified instrument (Nutrition Literacy Assessment Instrument for Breast Cancer, NLit-BCa) was pilot-tested with 17 high-risk women and 55 breast cancer survivors. We conducted the NLit-BCa on two separate occasions 4 weeks apart and assessed reliability by confirmatory factor analysis. Construct validity was evaluated by comparing results of the NLit-BCa to a Healthy Eating Index score derived from two separate 24-h dietary recalls. Content validity of the NLit-BCa was acceptable (0.93). Entire reliability for three instrument domains was substantial (>0.80), while remaining domains demonstrated fair or moderate reliability. Significant relationships were found between five of the six domains of nutrition literacy and diet quality (P < 0.05). The NLit-BCa is content valid and demonstrates promising reliability and construct validity related to diet quality, through a larger sample size, and removal of non-discriminating items is needed to confirm these findings. Thus, the NLit-BCa demonstrates potential for comprehensively measuring nutrition literacy in breast cancer populations.
authors.affiliation: Department of Dietetics & Nutrition, University of Kansas Medical Center, Mail Stop 4013, Kansas City, KS, 66208, USA. hgibbs@kumc.edu.
authors.forename: Heather D
authors.initials: HD
authors.lastname: Gibbs
authors.affiliation: Department of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.affiliation: Department of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Christie
authors.initials: C
authors.lastname: Befort
authors.affiliation: Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Byron
authors.initials: B
authors.lastname: Gajewski
authors.affiliation: Department of Dietetics & Nutrition, University of Kansas Medical Center, Mail Stop 4013, Kansas City, KS, 66208, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Kennett
authors.affiliation: Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Qing
authors.initials: Q
authors.lastname: Yu
authors.affiliation: Department of Dietetics & Nutrition, University of Kansas Medical Center, Mail Stop 4013, Kansas City, KS, 66208, USA.|Department of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Christifano
authors.affiliation: Department of Dietetics & Nutrition, University of Kansas Medical Center, Mail Stop 4013, Kansas City, KS, 66208, USA.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control* / Q000523:psychology; D000073116:Cancer Survivors / Q000523:psychology*; D004032:Diet; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D010353:Patient Education as Topic; D010865:Pilot Projects; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Health education; Health literacy; Nutrition therapy education