1. Choose a paper describing the development or validation of a measure of relevance in health disparities research (please give the full citation and/or upload the paper if that's possible).
Sarkar, U., et al. (2011). "Validation of Self-Reported Health Literacy Questions Among Diverse English and Spanish-Speaking Populations." Journal of General Internal Medicine 26(3): 265-271.
2. What was the definition of the construct?
Health Literacy is defined as “the ability to obtain, process or understand basic health information needed to make appropriate health care decisions.”
3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
The authors administered 3 self-reported health literacy questions and used a summative scale and compared this to the participants scores on a validated health literacy scale that has been performed in both English in Spanish. They then assessed this for variations in performance by language, race/ethnicity, age, and education.
4. How did the authors provide evidence on the reliability of the measure? Could you think of additional approaches to evaluating the reliability of the measure?
The authors used C-Indices to measure the reliability of their measure. A C-Index score of 1 reflects perfect prediction while a score of 0.5 is no better than chance. They also calculated multi level LR Ratios, sensitivity, and specify for each question and the summative scale. This study was done in only patients with poorly controlled diabetes, limiting its generalizability, but potentially its reliability in other populations as well.
5. Describe the implications of a lack of measurement validity or reliability for future research applications.
The implications of lack of measurement validity or reliability for future research applications means that we could not use these questions in English or Spanish speaking populations as a quick way to access health literacy rather than using a formalized long and lengthy questionnaire to assess health literacy. Which may cause questionnaires to be too long and cumbersome for participants.
Part 2:
1. Find a paper describing a health disparity (please give the full citation or, even better, upload the paper so everyone else can look at it too)
Kirby JB, Zuvekas SH, Borsky AE, Ngo-Metzger Q. Rural Residents With Mental Health Needs Have Fewer Care Visits Than Urban Counterparts. Health affairs (Project Hope). 2019;38:2057-2060.
2. Summarize the construct and measurement of the dimension of disparity (e.g., racial inequalities?, SES inequalities?) and the outcome measured (e.g., self-rated health).
Rural urban disparities in terms of mental health visits for patients
3. What is the evidence for the validity and reliability of the measures?
The study used Medical Expenditure Panel Survey (MEPS) data and identified counties in which respondents lived by geocoding the address where MEPS interviews took place. They were then divided into three rural urban categories (urban, rural adjacent (living next to metropolitan county), rural non-adjacent (not living close to metropolitan counties). To identify patients with mental health issues they looked for scores of 13 or higher on the Kessler K6 Psychological Distress scale or 3 or higher on PHQ-2 (both scales which have been validated to identify patients with mental health issues). They then classified ambulatory mental health visits as all office based or hospital outpatient visits in which the respondent reported mental health treatment as the main reason for the visit.
4. What is the reference category used for the disparity measure (ie, who is the comparison group)? Why does this reference category make sense (or not) for this research question?
The comparison group was those who lived in urban counties
5. How is the disparity quantified or measured? Is this an absolute or relative measure or are both provided? Describe which type of measure you would prefer for this research area, or, if both, why.
They looked at the adjusted mean number of visits for mental health in the three rural urban categories and compared the means to one another. While comparing mean annual mental health visits is a bare bones comparison, I think when examining the disparity between mental health in rural and urban environments, this serves as a fine comparison. I would consider this an absolute measure.
Part 3:
1. Read someone else's response to part 1 above (identifying a construct) and comment, specifically noting whether you can see any additional implications of measurement quality for future research or whether you agree with those noted by your classmate.
Responded to Carol Tran:
I enjoyed reading through your comments on the validation of “trust” for Korean speaking women in America. I think an important consideration is that this can also be used in Korea to evaluate women’s trust in the Korean healthcare system and could potentially be used to explore disparities in Korea as well.