Validity of a low literacy version of the Decisional Conflict Scale

Abstract

Objective: To evaluate the psychometric properties of the 4-factor low literacy Decisional Conflict Scale (DCS-LL) with men eligible for prostate cancer screening (PCS).

Methods: We used baseline (T0; n=149) and post-intervention (T2; n=89) data from a randomized, controlled trial of a PCS decision aid to assess internal consistency reliability and construct, discriminant, and factor validity.

Results: There was evidence of excellent internal consistency reliability (α's≥.80) and fair construct validity (most r's≥.40) for the DCS-LL except for the Supported subscale. The DCS-LL was able to discriminate between men who had decided and those who had not. There was evidence for the original 4-factor model at T0 but exploratory analysis suggested a 3-factor solution at T0 and T2 with Informed and Value Clarity as one factor.

Conclusion: For men eligible for PCS, feeling informed and feeling clear about values may not reflect distinct cognitive processes. Feeling supported may not be a factor contributing to uncertainty.

Practice implications: Research should address whether current DCS subscales best represent the factors that contribute to uncertainty for PCS and for other screening decisions. Research should also explore the influence of health literacy on the factor structure of the DCS-LL.

Figure 1

Four–Factor Model of the Low Literacy Decisional Conflict Scale (DCS-LL)