Introduction

Research Problem

Prostate Cancer is the most common among men in the United States. It is also the most diagnosed among African American. Many African American men tend to not know information about prostate cancer. The research problem is health literacy where patients do not understand the information that is given to them.

Research Purpose

The purpose of this formative study was to explore the implications of applying Nutbeam’s multidimensional health literacy framework to African American men’s understanding of Prostate Cancer information. (Corwin et al., 2009)

Literature Review

The literature review for this study included 25 year old African American men to 45 year old African American men in South Carolina. This study also included an experiment on how prostate cancer patients were involved in treatment decision making. This study the authors discuss the issue of health literacy. The article states that "in the context of the study, the problem is of greater concern since South Carolina ranks 49th of all the states in the number of ninth graders completing high school within 4 years" (Corwin 2009). The references for this article were current and ranged from 1957-2008, with majority of the references from the past 5 years. This article was published online on June 11, 2009 in the Journal of Community Health.

Framework

Corwin and colleagues uses D. Nutbeam's article "Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century", as a main source. According to Nutbeam the definition of health literacy is a composite term to describe a range of outcomes to health education and communication activities (Nutbeam, D. 2006). Corwin also used the definition from US Department of Health and Human Services and the American Medical Association, which is the ability to understand health information (Corwin 2009). In the framework it states that that health literacy skills are positioned along a continuum progressing from basic functional health literacy, to interactive health literacy, and finally to critical health literacy. The basic functional which is reading and comprehension skills. The interactive part of health literacy is the personal skills involved in health information and help seeking. The critical of the health literacy is the individual and community capacity to use health information and be empowered to take control of one's health. The framework gives a better understanding of health literacy and talks about the three parts and explain each part of the health literacy.

Method

Design

This study employed a two step data collection process with the same group of participants. This study had two phases, which were phase one: functional health literacy assessment and quantitative analysis and phase two: functional, interactive and critical health literacy assessment and qualitative analysis.

Sample

"A pilot sample of AA men aged 45 years and older in a Southeast US city was purposively recruited for the study. Additional inclusion criteria for participation were: English as a primary language and no personal history of PrCA. A local state service agency assisted in the recruitment of participants and provided on-site space for data collection. All plans for recruitment and data collection procedures were approved by the university’s Office of Research Compliance Institutional Review Board" (Corwin 2009).

Intervention

In phase one a descriptive participant survey containing 24 items was also administered. While, phase two consisted of interviews and focus groups with participants to assess their functional, interactive, and critical health literacy skills. The test in phase one was created using evidence-based prostate cancer prevention information cut and pasted into a word document from two reputable heath related web site: CDC and the Prostate Cancer Foundation. In the quantitative analysis of phase one data were analyzed using descriptive and nonparametric inferential statistics. In the phase two: functional, interactive, and critical health literacy assessment was completed after the quantitative assessments and the participants were interviewed in either a group or one-on-one. Because six to eight participants were not always available at one time, a combination of focus groups and one-on-one interviews were conducted. The second part of phase two: qualitative analysis, The ‘‘cleaned’’ files were imported to NVivo7, a qualitative software tool for data management and analysis (QSR NVivo7, computer software, 2006).

Data Collection

According to the article in phase one the Cloze- Test had a total of 36 items on the test on passages about preparation for an upper gastrointestinal series and the patient rights and responsibilities section of a Medicaid application for,. The scoring is as follows: 23-36 items correct = adequate health literacy; 17-22 items correct = marginal health literacy; 0-16 items correct = inadequate health literacy.

Results

The mean Cloze score was .71 (±.05; 95% CI = .60, .82) and .66 (±.04; 95% CI = .59, .73) for the Grade 8 (CDC) document and for the Grade 13 (PCF) documents respectively. Both scores indicate ‘‘adequate’’ comprehension. When speaking of dietary risk factors for PrCA, several men suggested that fatty and fried foods could be a cause. Further, a few participants characterized the AA diet as ‘more fatty than other races.’’

Discussion

This study explored the implications of applying a multidimensional health literacy approach to African American men’s understanding and knowledge about Prostate Cancer.