Kim Kyounghae, Xue Qian-Li, Walton-Moss Benita, Nolan Marie T, Han Hae-Ra
Department of Community-Public Health, School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, USA.
School of Medicine, Johns Hopkins University, 733 N Broadway, Baltimore, MD 21205, USA.
Eur J Oncol Nurs. 2018 Feb;32:55-62. doi: 10.1016/j.ejon.2017.12.001. Epub 2017 Dec 11.
Health literacy has emerged as a potential determinant of cancer screening, yet limited literature has investigated the pathways which health literacy influences Pap tests among immigrant women who experience a higher incidence of cervical cancer. This study aimed to test a health literacy-focused sociocognitive model which proposes motivational (knowledge, decisional balance) and volitional (self-efficacy) factors mediating the association between health literacy and triennial Pap tests.
Using structural equation modeling, we conducted a secondary analysis of baseline data obtained from a randomized controlled trial to promote breast and cervical cancer screenings among 560 Korean American women 21-65 years of age. They were interviewed on demographics such as education and English proficiency, provider advice, health literacy, knowledge of cervical cancer, decisional balance for Pap tests, self-efficacy, and Pap test use.
Higher health literacy predicted high level of knowledge and high decisional balance score, and greater self-efficacy and then only decisional balance and self-efficacy affected Pap tests. High level of knowledge predicted Pap tests through its impact on the decisional balance score. Receiving provider advice both directly and indirectly predicted Pap tests through high level of health literacy, high level of decisional balance and greater self-efficacy.
Findings from this study suggest possible pathways through which provider advice and health literacy affect Pap tests. Interventions targeting immigrant women with limited English proficiency should consider skill-based approaches such as health literacy training, promoting patient-provider communications and emphasizing decisional balance and self-efficacy as potentially sustainable ways of promoting Pap tests.
健康素养已成为癌症筛查的一个潜在决定因素，但针对宫颈癌发病率较高的移民女性群体，探讨健康素养影响巴氏试验的途径的文献有限。本研究旨在检验一个以健康素养为重点的社会认知模型，该模型提出动机因素（知识、决策平衡）和意志因素（自我效能感）在健康素养与每三年一次的巴氏试验之间的关联中起中介作用。
我们采用结构方程模型，对从一项随机对照试验获得的基线数据进行二次分析，该试验旨在促进560名年龄在21至65岁之间的韩裔美国女性进行乳腺癌和宫颈癌筛查。我们就人口统计学特征（如教育程度和英语水平）、医生建议、健康素养、宫颈癌知识、巴氏试验的决策平衡、自我效能感以及巴氏试验的使用情况对她们进行了访谈。
较高的健康素养预示着较高的知识水平和较高的决策平衡得分，以及较强的自我效能感，然后只有决策平衡和自我效能感影响巴氏试验。较高的知识水平通过对决策平衡得分的影响来预示巴氏试验。接受医生建议通过较高的健康素养、较高的决策平衡水平和较强的自我效能感直接和间接地预示巴氏试验。
本研究结果表明了医生建议和健康素养影响巴氏试验的可能途径。针对英语水平有限的移民女性的干预措施应考虑基于技能的方法，如健康素养培训、促进医患沟通以及强调决策平衡和自我效能感，将其作为促进巴氏试验的潜在可持续方式。
