{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T15:34:19Z","timestamp":1767972859773,"version":"3.49.0"},"reference-count":50,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T00:00:00Z","timestamp":1653004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia","doi-asserted-by":"publisher","award":["SFRH\/BPD\/120573\/2016"],"award-info":[{"award-number":["SFRH\/BPD\/120573\/2016"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia","doi-asserted-by":"publisher","award":["Programa Comunicar Sa\u00fade project ref# 45-2019\/410"],"award-info":[{"award-number":["Programa Comunicar Sa\u00fade project ref# 45-2019\/410"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ci\u00eancia Viva","award":["SFRH\/BPD\/120573\/2016"],"award-info":[{"award-number":["SFRH\/BPD\/120573\/2016"]}]},{"name":"Ci\u00eancia Viva","award":["Programa Comunicar Sa\u00fade project ref# 45-2019\/410"],"award-info":[{"award-number":["Programa Comunicar Sa\u00fade project ref# 45-2019\/410"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Assuming the multidimensionality of health literacy, new complex and comprehensive approaches are more adequate to specific disease contexts, such as cancer. Assessing cancer literacy levels is a priority, since it entails potential serious implications for disease outcomes and patient\u2019s quality of life. This article reports on the translation and cultural adaptation of the Cancer Health Literacy Test to measure cancer literacy in Portuguese cancer patients. A multidisciplinary team of experts ensured the translation and cultural adaptation of the CHLT-30. A pre-test was conducted in two stages to evaluate the Portuguese version (CHLT-30 PT) in a sample of cancer patients (n = 71). Descriptive statistics were used to characterize the sample. Reliability (test\u2013retest and internal consistency) and construct validity of CHLT-30 PT were assessed. The results obtained show a good internal consistency of the tool, respectively (Cronbach\u2019s alpha = 0.86 in the test and 0.80 in the retest). Patients\u2019 raw score mean in both test (23.96) and retest (25.97) and the distribution of scores categories are not statistically different. A suggestive association between higher education level and better total score was found compared to the results reported in CHLT-30-DKspa. The results obtained in the pre-test are favorable, and the instrument is now suitable for the next steps of the validation process. A Portuguese version of this tool will allow outlining patients\u2019 cancer literacy along the cancer care continuum, enabling the identification and implementation of adequate socio-educational strategies with highly positive impacts on health outcomes.<\/jats:p>","DOI":"10.3390\/ijerph19106237","type":"journal-article","created":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T13:56:12Z","timestamp":1653054972000},"page":"6237","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Translation and Cross-Cultural Adaptation of the Cancer Health Literacy Test for Portuguese Cancer Patients: A Pre-Test"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9935-1246","authenticated-orcid":false,"given":"Ana","family":"Barros","sequence":"first","affiliation":[{"name":"i3S\u2014Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal"},{"name":"IPATIMUP\u2014Institute of Pathology and Molecular Immunology, University of Porto, Rua J\u00falio Amaral de Carvalho 45, 4200-135 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8230-6166","authenticated-orcid":false,"given":"Helena","family":"Santos","sequence":"additional","affiliation":[{"name":"FEP\u2014Faculty of Economics, University of Porto, Rua Dr. Roberto Frias, 4200-464 Porto, Portugal"},{"name":"CITCEM\u2014Transdisciplinary Research Centre \u201cCulture, Space and Memory\u201d, University of Porto, Via Panor\u00e2mica s\/n, 4150-564 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8426-6871","authenticated-orcid":false,"given":"Lu\u00eds","family":"Moreira","sequence":"additional","affiliation":[{"name":"RECI\u2014Research Unit in Education and Community Intervention, Piaget Institute, Av. Jo\u00e3o Paulo II, Lote 544, 2.\u00ba, 1950-157 Lisboa, Portugal"},{"name":"Health School of Vila Nova de Gaia, Piaget Institute, Alameda Jean Piaget 106, 4405-678 Vila Nova de Gaia, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7143-1025","authenticated-orcid":false,"given":"Filipe","family":"Santos-Silva","sequence":"additional","affiliation":[{"name":"i3S\u2014Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal"},{"name":"IPATIMUP\u2014Institute of Pathology and Molecular Immunology, University of Porto, Rua J\u00falio Amaral de Carvalho 45, 4200-135 Porto, Portugal"},{"name":"FMUP\u2014Faculty of Medicine, University of Porto, Alameda Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,20]]},"reference":[{"key":"ref_1","unstructured":"ISSC (2016). World Social Science Report, 2016: Challenging Inequalities, Pathways to a Just World, UNESCO."},{"key":"ref_2","unstructured":"OECD (2018). OECD Science, Technology and Innovation Outlook, OECD Publishing."},{"key":"ref_3","unstructured":"OECD (2017). OECD Digital Economy Outlook 2017, OECD Korea Policy Centre."},{"key":"ref_4","unstructured":"UNESCO (2015). Rethinking Education. Towards a Global Common Good, UNESCO."},{"key":"ref_5","unstructured":"UNESCO (2020, April 27). Literacy. Available online: https:\/\/en.unesco.org\/themes\/literacy."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"S\u00f8rensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., Brand, H., and Consortium Health Literacy Project European (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-80"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1093\/heapro\/15.3.259","article-title":"Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century","volume":"15","author":"Nutbeam","year":"2000","journal-title":"Health Promot. Int."},{"key":"ref_8","unstructured":"Giddens, A. (1990). The Consequences of Modernity, Stanford University Press."},{"key":"ref_9","unstructured":"Beck, U., Giddens, A., and Lash, S. (1994). Living in a post-traditional society. Reflexive Modernisation. Politics, Traditions and Aesthetics in the Modern Social Order, Polity Press."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/j.jbi.2012.04.001","article-title":"Health literacy screening instruments for eHealth applications: A systematic review","volume":"45","author":"Collins","year":"2012","journal-title":"J. Biomed. Inform."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1197\/jamia.M1687","article-title":"Promoting Health Literacy","volume":"12","author":"McCray","year":"2004","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.pec.2016.07.007","article-title":"Improving low health literacy and patient engagement: A social ecological approach","volume":"100","author":"McCormack","year":"2016","journal-title":"Patient Educ. Couns."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1001\/jama.2015.9978","article-title":"The Arc of Health Literacy","volume":"314","author":"Koh","year":"2015","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s10900-009-9167-3","article-title":"African American Men\u2019s Understanding and Perceptions About Prostate Cancer: Why Multiple Dimensions of Health Literacy are Important in Cancer Communication","volume":"34","author":"Friedman","year":"2009","journal-title":"J. Commun. Health"},{"key":"ref_15","first-page":"487","article-title":"What should laypersons know about cancer?","volume":"85","author":"Diviani","year":"2011","journal-title":"Towards an operational definition of cancer literacy. Patient Educ. Couns."},{"key":"ref_16","unstructured":"INE (2017). Causas de Morte 2017, Instituto Nacional de Estat\u00edstica."},{"key":"ref_17","unstructured":"International Agency for Research on Cancer, and WHO (2020, May 18). Population Factsheet Portugal, Globocan. Available online: https:\/\/gco.iarc.fr\/today\/data\/factsheets\/populations\/620-portugal-fact-sheets.pdf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1177\/1403494817715400","article-title":"The global cancer burden and human development: A review","volume":"46","author":"Fidler","year":"2017","journal-title":"Scand. J. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Global Burden of Disease Cancer Collaboration (2018). Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol., 4, 1553\u20131568.","DOI":"10.1200\/JCO.2018.36.15_suppl.1568"},{"key":"ref_20","unstructured":"Portugal Ministry of Health (2020, March 20). Relat\u00f3rio Anual sobre o Acesso a Cuidados de Sa\u00fade nos Estabelecimentos do SNS e Entidades Convencionadas em 2018, Available online: https:\/\/ds3.sns.gov.pt\/wp-content\/uploads\/2019\/09\/Relatorio_Acesso_2018-v.final_.pdf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1007\/s13187-015-0892-2","article-title":"The Cancer, Educate to Prevent Model\u2014The Potential of School Environment for Primary Prevention of Cancer","volume":"31","author":"Barros","year":"2015","journal-title":"J. Cancer Educ."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1038\/sj.bjc.6605385","article-title":"Development of a measurement tool to assess public awareness of cancer","volume":"101","author":"Stubbings","year":"2009","journal-title":"Br. J. Cancer"},{"key":"ref_23","unstructured":"UK, Cancer Research (2020, March 20). Cancer Awareness Measure (CAM). Available online: https:\/\/www.cancerresearchuk.org\/health-professional\/awareness-and-prevention\/the-cancer-awareness-measures-cam."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.pec.2011.08.016","article-title":"First insights on the validity of the concept of Cancer Literacy: A test in a sample of Ticino (Switzerland) residents","volume":"87","author":"Diviani","year":"2012","journal-title":"Patient Educ. Couns."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.pec.2011.12.009","article-title":"Health literacy and cancer prevention: Two new instruments to assess comprehension","volume":"88","author":"Mazor","year":"2012","journal-title":"Patient Educ. Couns."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.pec.2012.06.018","article-title":"The Cancer Message Literacy Tests: Psychometric analyses and validity studies","volume":"89","author":"Mazor","year":"2012","journal-title":"Patient Educ. Couns."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1007\/s13187-013-0549-y","article-title":"Bringing the Real World to Psychometric Evaluation of Cervical Cancer Literacy Assessments with Black, Latina, and Arab Women in Real-World Settings","volume":"28","author":"Williams","year":"2013","journal-title":"J. Cancer Educ."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1080\/10810730.2013.778367","article-title":"Answering the Call: A Tool That Measures Functional Breast Cancer Literacy","volume":"18","author":"Williams","year":"2013","journal-title":"J. Health Commun."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1080\/10810730.2014.943377","article-title":"Measurement of Cancer Health Literacy and Identification of Patients with Limited Cancer Health Literacy","volume":"19","author":"Dumenci","year":"2014","journal-title":"J. Health Commun."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1080\/10810730.2015.1131777","article-title":"Cancer Health Literacy Test-30-Spanish (CHLT-30-DKspa), a New Spanish-Language Version of the Cancer Health Literacy Test (CHLT-30) for Spanish-Speaking Latinos","volume":"21","author":"Echeverri","year":"2016","journal-title":"J. Health Commun."},{"key":"ref_31","unstructured":"PORDATA (2020, April 27). Foreign Population with Legal Resident Status: Total and by Certain Nationalities. Available online: https:\/\/www.pordata.pt\/en\/Portugal\/Foreign+population+with+legal+resident+status+total+and+by+certain+nationalities-24."},{"key":"ref_32","unstructured":"Barros, P., and Gomes, J.-P. (2002). Os Sistemas Nacionais de Sa\u00fade da Uni\u00e3o Europeia, Principais Modelos de Gest\u00e3o Hospitalar e Efici\u00eancia no Sistema Hospitalar Portugu\u00eas, Universidade Nova de Lisboa."},{"key":"ref_33","unstructured":"Espanha, R., \u00c1vila, P., and Mendes, R. (2016). Literacia em Sa\u00fade em Portugal, Funda\u00e7\u00e3o Calouste Gulbenkian."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.rpsp.2016.07.002","article-title":"Literacia em sa\u00fade, dos dados \u00e0 a\u00e7\u00e3o: Tradu\u00e7\u00e3o, valida\u00e7\u00e3o e aplica\u00e7\u00e3o do European Health Literacy Survey em Portugal","volume":"34","author":"Pedro","year":"2016","journal-title":"Rev. Port. Sa\u00fade P\u00fablica"},{"key":"ref_35","unstructured":"Benavente, A., Rosa, A., Costa, A.F.d., and \u00c1vila, P. (1996). A Literacia em Portugal. Resultados de uma Pesquisa Extensiva e Monogr\u00e1fica, Funda\u00e7\u00e3o Calouste Gulbenkian."},{"key":"ref_36","unstructured":"Gomes, M., \u00c1vila, P., Sebasti\u00e3o, J., and Costa, A. (2020, March 20). Novas An\u00e1lises dos N\u00edveis de Literacia em Portugal: Compara\u00e7\u00f5es Diacr\u00f3nicas e Internacionais; 2002. Available online: https:\/\/aps.pt\/wp-content\/uploads\/2017\/08\/DPR462de53172c7d_1.pdf."},{"key":"ref_37","unstructured":"Coord, A.M. (2013). 25 Anos de Portugal Europeu: A Economia, a Sociedade e os Fundos Estruturais, Funda\u00e7\u00e3o Francisco Manuel dos Santos."},{"key":"ref_38","unstructured":"European Comission (2013). Responsible Research and Innovation (RRI), Science and Technology, Special Eurobarometer 401: Survey Summary, European Comission."},{"key":"ref_39","unstructured":"European Comission (2014). Special Eurobarometer 419: Public Perceptions of Science, Research and Innovation, Survey Summary, European Comission."},{"key":"ref_40","unstructured":"Barros, A. (2016). Bridging the Cancer Communication Gap\u2014An Integrative Approach to Improve Communication between Patients and Healthcare Professionals in a Cancer Care Unit. i3S\u2014Institute for Research and Innovation in Health, University of Porto. Post-Doctoral Project."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/j.1743-7563.2012.01522.x","article-title":"Importance of health literacy in oncology","volume":"8","author":"Koay","year":"2012","journal-title":"Asia-Pacific J. Clin. Oncol."},{"key":"ref_42","unstructured":"Bourdieu, P., Chamboredon, J., and Passeron, J. (1968). The Craft of Sociology: Epistemological Foundations, Aldine de Gruyter."},{"key":"ref_43","first-page":"A30","article-title":"A Note on \u201cA Catalog of Biases in Questionnaires\u201d","volume":"2","author":"Choi","year":"2004","journal-title":"Prev. Chronic Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/j.1524-4733.2005.04054.x","article-title":"Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation","volume":"8","author":"Wild","year":"2005","journal-title":"Value Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/0895-4356(93)90142-N","article-title":"Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines","volume":"46","author":"Guillemin","year":"1993","journal-title":"J. Clin. Epidemiol."},{"key":"ref_46","unstructured":"Beaton, D., Bombardier, C., Guillemin, F., and Ferraz, M.B. (1998). Recommendations for the Cross-Cultural Adaptation of Health Status Measures, American Academy of Orthopaedic Surgeons."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1146\/annurev.soc.29.110702.110112","article-title":"The Science of Asking Questions","volume":"29","author":"Schaeffer","year":"2003","journal-title":"Annu. Rev. Sociol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5116\/ijme.4dfb.8dfd","article-title":"Making sense of Cronbach\u2019s alpha","volume":"2","author":"Tavakol","year":"2011","journal-title":"Int. J. Med. Educ."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Kosir, U., and S\u00f8rensen, K. (2020). COVID-19: The key to flattening the curve is health literacy. Perspect. Public Health.","DOI":"10.1177\/1757913920936717"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.ijrobp.2020.05.036","article-title":"Propelling a New Era of Patient Education into Practice\u2014Cancer Care Post\u2013COVID-19","volume":"108","author":"Giuliani","year":"2020","journal-title":"Int. J. Radiat. Oncol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/10\/6237\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:15:38Z","timestamp":1760138138000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/10\/6237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,20]]},"references-count":50,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["ijerph19106237"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19106237","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,20]]}}}