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).
Keene Woods N, Chesser AK. Validation of a Single Question Health Literacy
Screening Tool for Older Adults. Gerontol Geriatr Med. 2017 Jun
7;3:2333721417713095. doi: 10.1177/2333721417713095. eCollection 2017 Jan-Dec.
PubMed PMID: 28612043
2. What was the definition of the construct?
The authors here use definition described 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”, as defined in the Institute of Medicine’s definition. The authors sought to use a single survey question – ““How confident are you filling out medical forms by yourself?” – validated among a geriatric population in place of other time consuming methodologies.
3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
Using their gold standard estimate of the definition above with the 36-item Short Test of Functional Health Literacy Assessment (STOFHLA), they used nonparametric testing to assess between agreement/disagreement between the single question and 36 item question strategies. With a larger sample, could have provided sensitivity/specificity based on 36-item.
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 do not provide any measure of reliability. The could have tested test-retest reliability at two varying time-points. (although limited with one question screen).
5. Describe the implications of a lack of measurement validity or reliability for future research applications.
This study was notably limited in both validity and reliability measurement. The authors clearly state the lack of in-depth evaluation in limitation – stating that this single-item questionnaire should not be used as a substitute for longer-item screens among older populations. Further, they conducted a convenience sample in an academic setting – subject to wide array of biases that makes findings poorly generalizable.
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)
Traylor AH, Schmittdiel JA, Uratsu CS, Mangione CM, Subramanian U. Adherence to cardiovascular disease medications: does patient-provider race/ethnicity and language concordance matter? J Gen Intern Med. 2010 Nov;25(11):1172-7. doi: 10.1007/s11606-010-1424-8. Epub 2010 Jun 23. PubMed PMID: 20571929
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).
This article explores disparities in interpersonal physician-patient factors, mainly physician attitudes (stereotypes, biases) impact on quality of interpersonal care with the patient, thereby affecting health outcomes. The main measurements of physician-patient discord was self-reported patient race/ethnicity and physician race/ethnicity/language concordance. The main health outcome was continuous multiple interval measures of gaps in therapy (CMG), defined as the proportion of days a patient was prescribed medication and did not have the medication available.
3. What is the evidence for the validity and reliability of the measures?
The validity of race/ethnicity concordance is notably limited – as authors admit – “…linguistic, national background, immigrant status, acculturation and cultural diversity exists within each racial and ethnic category. We were unable to assess concordance beyond broad racial/ethnic categories”. There are no references provide as to the validity measurements of physician/provider discordant relationship, where the construct is difficult to establish a ‘gold standard’ measure. Further, there is no explanation re: the reliability aside from assumption these tools are widely used in self-reported surveys. Regarding clinical outcome validity – they do reference threshold (>20%) where med nonadherence translates to poor clinical relevance, but without reference to how this tool measured to poor outcomes directly.
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 references are white patients and discordant providers. There is no explanation provide, but assumption based on introduction is that white, English-speaking from both patient and provider standpoint is the ‘default’ or most-privileged group. ‘Default’ argument may serve to help compare across similar studies, assumption that this is the ‘healthiest group’ may serve to measure potential ‘how could do’. Further, this may be the largest subpopulation, so statistically limit masking disparities. Alternative would be to assess between group differences.
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.
The main measurement is absolute measure of % adherence by subgroup. This, along with absolute difference, is helpful from a public health and interpretability. I would prefer to present both absolute and relative measures and, if possible, over multiple time domains to explore the slope and potential change over time.