Instrument to measure health literacy about complementary and alternative medicine

Background and Purpose: Health literacy is an essential skill for today's health care consumers. The growth in use of complementary and alternative medicine (CAM) adds to the complexity of being sufficiently health literate. The purpose of this article is to describe the initial psychometric evaluation of the "Montana State University (MSU) CAM Health Literacy Scale," a newly developed instrument to measure an individual's health literacy about CAM. Methods: Exploratory factor analyses, reliabilities, and conceptual considerations were used. Results: The outcome is a 21-item instrument with Cronbach's alpha of .753 and 42.27%' explained variance. Convergent validity assessments revealed weak but significant correlations between the scale and measures of general health literacy. Conclusions: The MSU CAM Health Literacy Scale has promise for use in future research and clinical endeavors.Keywords: health literacy; complementary and alternative medicine; instrument evaluation; psychometric evaluation; CAM health literacyHealth literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (Centers for Disease Control and Prevention, 2013). Health literacy is both an essential and complex skill that improves consumers' ability to take an active role in decision making about their personal health care. The growth in the use of complementary and alternative medicine (CAM) among American consumers and the widespread availability of CAM has added to the complexity of being sufficiently health literate.The purpose of this article is to describe the initial psychometric evaluation of the "Montana State University (MSU) CAM Health Literacy Scale," a newly developed instrument to measure an individual's health literacy about CAM. The need for the instrument, conceptual considerations, and instrument development process are briefly described. Next, the preliminary procedures to evaluate scale items, the factor structure, and the validity of the instrument are described. Finally, the instrument is provided for use by others in research and clinical applications.Through a series of studies on the use of CAM among older adults living in sparsely populated rural areas in the western United States, the authors found considerable CAM use particularly among those with chronic health conditions. Participants in these studies primarily used self-prescribed CAM and often had limited health literacy about the CAM therapies they used (Nichols, Sullivan, Ide, Shreffler-Grant, & Weinert, 2005; Shreffler- Grant, Hill, Weinert, Nichols, & Ide, 2007; Shreffler-Grant, Nichols, Weinert, & Ide, 2013a; Shreffler- Grant, Weinert, Nichols, & Ide, 2005). Concerns about research participants' health literacy arose in part because of their reliance on informal information sources about CAM. These sources included word of mouth information from relatives or friends, consumer marketing, or reading. They often did not tell their regular allopathic providers about their CAM use because of a perception that the providers were too busy to discuss CAM. Some participants attempted to use reputable sources of information, but it was clear that some used CAM products in an inconsistent manner and did not understand what the products did.The need for education to improve CAM health literacy in this population became evident and an appropriate instrument to determine the effectiveness of an educational intervention was sought. The investigators found, however, that the available health literacy instruments measured consumers' reading and numeracy skills, not the broader range of knowledge and cognitive skills that are needed to act on health information and make informed self-management decisions in today's health care environment. The cunently available instruments also did not assess health literacy demands on consumers within different health contexts such as CAM. …