# Development of the Swahili Cancer Health Literacy Test for use in the African context

## TL;DR

This paper introduces a new health literacy test for Swahili speakers in Africa to help cancer patients make informed decisions.

## Contribution

The study develops the first culturally appropriate cancer health literacy test for Swahili-speaking populations in Africa.

## Key findings

- The SCHLT was developed through a seven-step process involving translation and cognitive testing.
- A Delphi process reduced 369 items to 52 for the final test version.
- Readability was assessed using Flesch–Kincaid Grade Level and interviews with target users.

## Abstract

As cancer treatment options advance, it is increasingly essential for patients and caregivers to possess adequate cancer-specific health literacy to engage in shared decision-making. While there is growing global interest in developing cultural and disease-specific health literacy tools, Africa remains underrepresented.

To develop the Swahili Cancer Health Literacy Test (SCHLT) for Swahili-speaking populations in Africa.

Two settings were involved in developing the SCHLT: Tanzania and South Africa.

A multimethod design was employed, guided by the MEASURE approach through seven steps: (1) establishing a rationale, (2) creating an empirical framework, (3) developing a theoretical blueprint, (4) constructing an item pool, (5) translating items into Swahili, (6) contextualising the pool and (7) assessing readability. The development process drew on the Integrated Model of Health Literacy (IMHL), the Cancer Control Continuum and the Sesotho Health Literacy Test (SHLT) frameworks.

Nine existing health literacy (HL) tests informed the development of an initial item pool (n = 369). Two Delphi rounds achieved consensus on 52 items for the final version. Readability was evaluated using Flesch–Kincaid Grade Level and cognitive interviews with sixth-grade pupils and the target population.

The SCHLT presents a novel, culturally appropriate tool for assessing cancer HL in Swahili-speaking populations. The theoretically grounded development process ensures rigour and provides a model for creating other disease-specific HL tools.

This study addresses a significant gap by contributing to the development of cancer HL assessments relevant to African contexts.