@article{ba0534a3205345a2a833b4b103b2ab06,
title = "Development and Psychometric Evaluation of Healthcare Access Measures among Women with Ovarian Cancer",
abstract = "Abstract: Introduction: There are no validated instruments for measuring healthcare access (HCA). This study aimed to develop a cohesive HCA instrument for cancer survivors and evaluate the factor structure, reliability, and psychometric properties of two HCA domains—Acceptability and Accommodation—that require patient-reported survey data. Methods: This study reports data from three general methodological approaches: (1) concept elicitation using focus groups with 32 cancer survivors (63% Black, 18% Hispanic) to inform the development of new HCA survey items; (2) refining the new survey items using cognitive interviews with seven ovarian cancer survivors (n = 3 Black, n = 1 Hispanic) and pilot testing with 54 ovarian cancer survivors (74% White, 14% Black); and (3) psychometric evaluation of the Acceptability and Accommodation items among 333 ovarian cancer survivors (82% White, 13% Black). Multiple model structures were assessed for each HCA dimension using confirmatory factor analysis methods, and composite reliability was estimated for selected models. Results: In focus group discussions, cancer survivors expressed challenges navigating cancer treatment across multiple HCA domains, with the Acceptability domain (quality of patient–provider interaction) being the most salient across all racial groups. Lack of empathy, compassion, and poor communication overshadowed positive aspects of providers{\textquoteright} specialty, experience, or reputation. Cognitive interviews and pilot testing of new HCA survey items helped to clarify the language of specific items and refine the recruitment and consent process for implementation of the survey. In psychometric evaluation, the Accommodation domain (convenience and organization of services) was best accounted for by a two-factor structure: satisfaction with care and access to support services (comparative fit index (CFI) = 0.99). For the Acceptability domain, all fit indices supported the retention of a five-factor higher-order model (CFI = 0.96). Composite reliability estimates were >0.80 for all latent factors in the two-factor Accommodation model and the higher-order Acceptability model. Conclusions: Empirical evidence supports the utility of standardized measures of Accommodation and Acceptability using self-reported survey items, which will contribute to the better characterization of HCA dimensions among diverse cancer survivors.",
keywords = "cancer, concept elicitation, healthcare access, psychometrics, qualitative study, racial disparities",
author = "Tomi Akinyemiju and Ashwini Joshi and April Deveaux and Wilson, {Lauren E.} and Dandan Chen and Clare Meernik and Malcolm Bevel and Jen Gathings and Laura Fish and Nadine Barrett and Valarie Worthy and Xiomara Boyce and Keshia Martin and Corre Robinson and Maria Pisu and Margaret Liang and Arnold Potosky and Bin Huang and Kevin Ward and Schymura, {Maria J.} and Andrew Berchuck and Reeve, {Bryce B.}",
note = "Funding Information: Kentucky cancer data have been provided by the Kentucky Cancer Registry, 2365 Harrodsburg Road, Lexington, KY 40504 ( www.kcr.uky.edu (8 March 2022). Data from the Kentucky Cancer Registry is supported by the following: Cooperative Agreement #NU58DP007144 from the Centers for Disease Control and Prevention and Contract #HHSN261201800013I from the National Cancer Institute{\textquoteright}s Surveillance, Epidemiology, and End Results (SEER) Program. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the National Cancer Institute, the Centers for Disease Control and Prevention or their Contractors and Subcontractors, and the Commonwealth of Kentucky. Funding Information: Texas cancer data have been provided by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 West 49th Street, Austin, TX 78756 ( www.dshs.texas.gov/tcr (19 January 2022)). Data from the Texas Cancer Registry is supported by the following: Cooperative Agreement #1NU58DP007140 from the Centers for Disease Control and Prevention, Contract #75N91021D00011 from the National Cancer Institute{\textquoteright}s Surveillance, Epidemiology, and End Results (SEER) Program, and the Cancer Prevention and Research Institute of Texas. Funding Information: The collection of cancer incidence data in Georgia was supported by contract HHSN261201800003I, Task Order HHSN26100001 from the NCI and cooperative agreement 6NU58DP006352-05-01 from the CDC. Funding Information: The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention{\textquoteright}s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the National Cancer Institute{\textquoteright}s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors. Funding Information: This work was supported in part by the Centers for Disease Control and Prevention{\textquoteright}s National Program of Cancer Registries through cooperative agreement NU58DP007218 awarded to the New York State Department of Health and by Contract 75N91018D00005 (Task Order 75N91018F00001) from the National Cancer Institute, National Institutes of Health. Funding Information: Cancer data were used by the Maryland Cancer Registry, Center for Cancer Prevention and Control, Maryland Department of Health, with funding from the State of Maryland and the Maryland Cigarette Restitution Fund to provide assistance in patient recruitment. The collection and availability of cancer registry data is also supported by the Cooperative Agreement NU58DP006333, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services Funding Information: This research was funded by the National Institutes of Health/National Cancer Institute (Grant Number R37CA233777 and 5R37CA23377). Publisher Copyright: {\textcopyright} 2022 by the authors.",
year = "2022",
month = dec,
doi = "10.3390/cancers14246266",
language = "English (US)",
volume = "14",
journal = "Cancers",
issn = "2072-6694",
publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",
number = "24",
}
