Part 1:
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).
Health Literacy Measure for Adolescents (HELMA)
Citation: Ghanbari S, Ramezankhani A, Montazeri A, Mehrabi Y (2016) Health Literacy Measure for Adolescents (HELMA): Development and Psychometric Properties. PLoS ONE 11(2): e0149202. doi:10.1371/journal.pone.0149202
2.What was the definition of the construct?
Health literacy is defined as the ability to access, understand, appraise, and apply health information in order to make decisions in everyday life in the three main areas of disease prevention, healthcare, and health promotion
Health literacy one of the most important social determinant of health and outcome of health education endeavors. It includes competencies such as interactive and critical skills that are necessary to better control one's health. In public health, health literacy is an asset that can reduce health disparities and improve social capital. Health literacy brings together the fields of education and health and creates the framework to enhance individuals' abilities to achieve good health throughout their life.
The authors note that adolescence is an important period of life, with specific regard to independent decision-making. It is therefore a crucial time to arm adolescents with accurate and reliable health information so they can develop lifelong healthy behavior, as well as to enable them to take control of the condition of their own health. This provided the rationale for the development of a Health literacy measure for adolescents. I can attest to the importance of this – in my own work regarding adolescent sexual reproductive health, adolescents now contribute the highest proportion of new HIV infections in the country, the highest HIV associated mortality in the country and to 15% of adolescents aged 13-19 are pregnant each year contributing greatly to the total fertility rate in the country.
3.How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
In order to provide evidence on the validity of the measure, the authors conducted a 2 part mixed methods study.
In phase 1 they conducted in-depth interviews with 67 adolescents aged 15–18 were carried in 4 high schools to generate the initial item pool for the survey (Item generation). The content validity of the items was then assessed by an expert panel review (n = 13) using both quantitative and qualitative methods. They then assessed face validity by interviewing adolescents (n = 16) using qualitative methods and then an impact score of each item was generated using quantitative methods.
Phase 2: In order to describe the psychometric properties of the scale, validity, reliability (internal consistency and test-retest) and factor analysis were assessed. This phase was quantitative
4. Could you think of additional approaches to validating the measure?
Because health literacy is a context specific concept and there are disparities even among adolescent groups, I would have conducted univariate tests (chi-square and t-tests) to examine differences between students’ health literacy levels across socio demographic, and (2) multivariate tests (linear and binary logistic regressions) to determine the association between health literacy levels and other important covariates.
5.Describe the implications of a lack of measurement validity or reliability for future research applications.
As stated above, health literacy is a context-specific concept. If the tool lacks validity and reliability then the measures in the tool will not be adequately responsive to changes of interest in future research applications where improvement in outcomes as a result of “treatment” is a primary goal. In my opinion this will adversely affect research quality
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)
Racial and ethnic differences in contraceptive use among women who desire no future children, 2006-2010 National Survey of Family Growth
Contraception. 2015 Jul;92(1):62-70. doi: 10.1016/j.contraception.2015.03.017. Epub 2015 Apr 9.
Grady CD, Dehlendorf C, Cohen ED, Schwarz EB, Borrero S.
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).
Race/ethnicity: They categorized race/ethnicity as non-Hispanic white, non-Hispanic black, Hispanic, and non-Hispanic other (Asian, Pacific Islander, Alaskan native, and Native American)
Outcome: use of any contraceptive method at last heterosexual intercourse and 2) effectiveness of contraceptive method used among women who stated that they did not desire any (more) children
3.What is the evidence for the validity and reliability of the measures?
No evidence is provided in this paper
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 reference category is white women and
This reference category makes sense because 1) it is the largest 2) has the “best off” rates of contraceptive use and as such is a viable option. The “best off” groups implicitly assumes that every social group in the society has the potentital to achieve the health of the “best off group”
5.How is the disparity quantified or measured? Is this an absolute or relative measure or are both provided?
The disparity is measured using simple pairwise comparisons – they provide rates for each group and its possible to calculate the absolute differences between the races
They also provide regression based measures with white females as the reference point
Describe which type of measure you would prefer for this research area, or, if both, why.
I think both measures provide valuable information. The pairwise comparisons are straightforward however they have the drawback of that disparities will be different based on which groups are getting compared (can inadvertently ignore certain groups) and also differ based on reference group. The regression based measures thus have an appeal since they are able to do multiple pairwise comparisons with one group as the reference.