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).
Development and Validation of the Consumer Health Activation Index (CHAI)
(Wolf et al)
2. What was the definition of the construct?
The CHAI tool can be used to assess health activation among adults, including those with limited health literacy.
3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
To evaluate the construct validity of their tool, the authors examined bivariate correlations between the Multidimensional Health Locus of Control and the Conscientiousness subscale of the NEO personality assessment, which is the gold standard.
To evaluate the predictive validity of their tool, the authors looked at associations between the total CHAI score, and depression, anxiety, physical functioning, overall health (self-rate), and number of chronic conditions (self-reported). They also looked at the relationship between total CHAI score and meaningful decline in health over 3 years.
Finally, because previous work has shown that health literacy and patient activation are distinct constructs, they examined discriminant validity by examining correlations between the CHAI and Newest Vital Sign (NVS) scale, which is a validated screening tool that identifies patients at risk for low health literacy.
As they acknowledge in their limitations section, the authors did not validate their measure against the gold standard measure of activation, PAM (due to use prohibitions). In addition to this, they conducted their predictive validity analysis within their initial sample, and despite expanding their validation sample, the associations were cross-sectional.
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 reported a Cronbach’s alpha of 0.81, which demonstrates good internal consistency. They re-administered the test after a 2-week period, and had a ICC of 0.53, which demonstrated a moderate degree of reliability. They could have broadened their test-retest analyses, perhaps expanding the window or increasing the number of times the tool was re-administered. Because the tool is a self-report measure (not an interview), the authors did not examine inter-rater reliability. In-lieu of this they could have examined the coefficient of variance (within-person SD/mean).
5. Describe the implications of a lack of measurement validity or reliability for future research applications.
A lack of measurement validity or reliability narrows generalizability and repeatability of the tool and limits the scope of future research, which is especially impactful in a tool like this because it is studying populations that is typically underrepresented in medical research.
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)
Disparity in Breast Cancer Mortality By Age And Geography In 10 Racially Diverse US Cities
(Sighoko et al)
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).
Racial inequality in breast cancer mortality measured by deaths caused by malignant neoplasm of the breast. The outcome measure was the 15-year non-Hispanic Black (NHB) and non-Hispanic White (NHW) breast cancer mortality rate, rate ratio, and mortality risk differences.
3. What is the evidence for the validity and reliability of the measures?
The authors did not specifically address the validity and reliability of the measures. In their discussion and limitations sections, the authors acknowledged that the lack of information on breast cancer death by stage, subtype and incidence in the mortality data files, limits the scope and generalizability of their study.
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?
Non-Hispanic Whites. This reference category makes sense for this research question because it is well characterized in the literature and typically NHWs receive better care in the US healthcare system.
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.
Absolute and relative measures are provided. For this research area I prefer both. The absolute measure is important in terms of understanding BC mortality rates in the NHB population alone and would be useful for evaluating, but the relative measure is critical to continue to identify and address the fact that disparity exists and has not gone away.