Original Article

Evidence for Cancer Literacy Knowledge Retention among Kentucky Middle and High School Students after a Brief Educational Intervention

Authors: Lauren Hudson, , Chris Prichard, BS, L. Todd Weiss, BS, MSPH, Nathan L. Vanderford, PhD, MBA

Abstract

Objectives: Although cancer is seen in every state in the United States, it does not affect every geographic area and population equally. Kentucky has the highest cancer incidence and mortality rates in the country, with an unusually high number of cases localized in its Appalachian region. Risk factors such as sun exposure, tobacco use, poor diet/exercise, poverty, and lack of access to healthcare centers contribute to this disparity. Because education levels in the area are low, cancer literacy (defined as how well a person can understand the advice of a healthcare professional and make appropriate lifestyle decisions) also is low. In this study, we examined the short-term and long-term effects of a brief cancer-related intervention on the cancer literacy of Kentucky middle and high school students.

Methods: This study targeted middle and high school students in Kentucky. We administered an online 10-item cancer literacy pretest, followed by a brief educational intervention and a posttest to 164 students at six Kentucky middle and high schools. This posttest also included questions asking how likely students would be to change their habits or to encourage others to change their habits as a result of the intervention. All of the participating students also were sent a 3-month follow-up online survey with items identical to the pretest; 48 students completed the 3-month follow-up test, leading to a response rate of 29.2%. The data were summarized as frequencies, averages, median, and confidence intervals (CIs) of correctly marked answers. A paired t test was used to test for significance.

Results: We observed an increase in the overall average test score from 50.2% (95% CI 47.8%–52.6%) on the pretest to 77.1% (95% CI 74.6%–79.7%) on the posttest immediately following the intervention. There also was an increase in the average number of correct responses on each item. The 3-month follow-up test similarly showed average test score improvement (75.4%). When asked how likely students would be to change their habits as a result of the intervention on a scale from 1 to 10 (1 = extremely unlikely, 10 = extremely likely), the median was 6. When asked how likely students would be to encourage another to change their habits, the median was an 8.

Conclusions: These results provide evidence that a brief educational intervention can increase cancer literacy, improve cancer knowledge retention, and encourage behavior change in Appalachian Kentucky students. Increasing cancer literacy may result in increased participation in preventive cancer screenings and improved health habits, which could ultimately lower cancer rates in the region.
Posted in: Medical Oncology46

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References

1. Leading Causes of Death. Centers for Disease Control and Prevention. 2017. Available at: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_06-508.pdf. Accessed October 6, 2020. 2. Rodriguez S, Vanderford NL, Huang B, et al. A social-ecological review of cancer disparities in Kentucky. South Med J 2018;111:213–219. 3. Charlton M, Schlichtling J, Chioreso C, et al. Challenges of rural cancer care in the United States. Oncology (Williston Park) 2015;29:633–640. 4. Crosby RA, Wendel ML, Vanderpool RC, Casey BR. Rural Populations and Health: Determinants, Disparities, and Solutions. Hoboken, NJ: Wiley, 2012:416. 5. Schoenberg NE, Studts CR, Shelton BJ, et al. A randomized controlled trial of a faith-placed, lay health advisor delivered smoking cessation intervention for rural residents. Prev Med Rep 2016;3:317–323. 6. National Cancer Institute. State cancer profiles. https://statecancerprofiles.cancer.gov. Accessed September 13, 2020. 7. Centers for Disease Control and Prevention. US Cancer Statistics: Highlights from 2016 Incidence. https://www.cdc.gov/cancer/uscs/about/data-briefs/no8-USCS-highlights-2016-incidence.htm. Accessed September 13, 2020. 8. Mokdad AH, Dwyer-Lindgren L, Fitzmaurice C, et al. Trends and patterns of disparities in cancer mortality among US counties, 1980-2014. JAMA 2017;317:388–406. 9. Blake KD, Moss JL, Gaysynsky A, et al. Making the case for investment in rural cancer control: an analysis of rural cancer incidence, mortality, and funding trends. Cancer Epidemiol Biomarkers Prev 2017;26:992–997. 10. McCann A. Most & least educated states in America. https://wallethub.com/edu/e/most-educated-states/31075. Published January 20, 2020. Accessed September 13, 2020. 11. Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Affairs 2002;21:60–76. 12. Kutner M, Greenberg E, Jin Y, et al. The health literacy of America's adults: results from the 2003 National Assessment of Adult Literacy. https://nces.ed.gov/pubs2006/2006483.pdf. Published 2006. Accessed September 13, 2020. 13. Sanders LM, Federico S, Klass P, et al. Literacy and child health: a systematic review. Arch Pediatr Adolesc Med 2009;163:131–140. 14. Rakhshkhorshid M, Navaee M, Nouri N, et al. The association of health literacy with breast cancer knowledge, perception and screening behavior. Eur J Breast Health 2018;14:144–147. 15. Golbeck AL, Ahlers-Schmidt CR, Paschal AM, et al. A definition and operational framework for health numeracy. Am J Prev Med 2005;29:375–376. 16. Hudson L, Samons KM, Dicken HE, et al. A brief educational intervention enhances basic cancer literacy among Kentucky middle and high school students. J Cancer Educ January 28, 2020; doi: 10.1007/s13187-020-01696-3. 17. United States Census. 2018. Available at: https://www.census.gov/quickfacts/KY. Accessed October 6, 2020. 18. Meade CD, McKinney WP, Barnas GP. Educating patients with limited literacy skills: the effectiveness of printed and videotaped materials about colon cancer. Am J Public Health 1994;84:119–121. 19. Von Wagner C, Semmler C, Good A, et al. Health literacy and self-efficacy for participating in colorectal cancer screening: the role of information processing. Patient Educ Couns 2009;75:352–537. 20. Donelle L, Arocha JF, Hoffman-Goetz L. Health literacy and numeracy: key factors in cancer risk comprehension. Chronic Dis Can 2008;29:1–8. 21. Lindau ST, Tomori C, Lyons T, et al. The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women. Am J Obstet Gynecol 2002;186:938–943. 22. Fincham JE. Response rates and responsiveness for surveys, standards, and the Journal. Am J Pharm Educ 2008;72:43.