2021 Theses Doctoral

Development and Validation of a Stroke Literacy Assessment Test for Community Health Workers

Mallaiah, Janhavi

Stroke is the fifth leading cause of death in the United States. Minority groups are disproportionately affected, particularly African Americans, who are three times more likely to be affected than their White counterparts. An effective strategy for addressing these disparities is to improve knowledge of stroke risk factors through innovative and culturally tailored education programs delivered by community health workers (CHW), such as the Columbia Institute for Training Outreach and Community Health (InTOuCH) program.

The purpose of this study was to develop and validate outcome measures generated by the Stroke Literacy Assessment Test (SLAT) designed for use with community health workers (CHW) in a stroke prevention training program. The specific aims were to: 1) identify gaps in the literature related to assessment measures in stroke literacy for CHWs, 2) assess and evaluate the need for a stroke literacy assessment test for CHWs, 3) demonstrate evidence of the validity and reliability for the stroke literacy assessment test, and 4) assess stroke literacy in a sample of CHWs participating in the Columbia InTOuCH stroke prevention training program.

The scoping review of literature demonstrated that CHW–specific competency assessment methods were limited, with few or no domain-referenced tools on stroke risk factors that complied with measurement standards. Guided by the CHW assessment context, the study applied a unified instrument design and validation approach using an iterative Process Model to develop the SLAT. The SLAT content domain was first specified to produce an initial item pool. Both were content validated by external expert review and refined. Next, empirical validation continued with evidence on examinee response processes, diagnostic item statistics and quality, total score reliability and verification of theoretically expected subgroup differences in SLAT scores. The iterative design process yielded a subset of well-functioning items of the initial 46. These were assembled to construct a final assessment test for empirical evaluation. The final SLAT was administered to 68 CHW alumni of the InTOuCH training program. Results showed that a 34-item SLAT that assesses the factual knowledge and application levels of cognition demonstrates sufficient validity and reliability for use with CHWs specializing in stroke prevention efforts.