Comparing Written and Oral Measures of Comprehension of Cancer Information by English-as-a-Second-Language Chinese Immigrant Women

The Short Test of Functional Health Literacy for Adults (S-TOFHLA) and Cloze test are commonly used tools to measure comprehension of health information (i.e., health literacy); however, little is known about their use in English-as-a-Second-Language (ESL) populations. In this study, we compared written (Cloze test) and oral (Teach Back) measures of colon cancer information comprehension among ESL Chinese immigrant women to Canada. Performances on colon cancer-specific measures were compared to a general measure of health literacy (S-TOFHLA). On the S-TOFHLA, Cloze, and Teach Back, respectively, the following percentage of participants had adequate comprehension: 62.1%, 14.8%, and 89.7%. Correlation between performance on the Cloze and Teach Back was significant albeit weakly so (r = 0.38, p = 0.04); performances on the S-TOFHLA and Teach Back were not correlated. Measures of health literacy skill that require written English language skills may not be appropriate for measuring understanding of health information for ESL populations.