Development of a Culturally Relevant Health Assessment for Low-Income African-American Females

Low-income African-American women are disproportionately affected by many preventable diseases that could be detected earlier through effective health screening. Health disparities experienced by this population result from multiple personal, social, environmental and cultural factors. The purpose of this study was to develop the Taylor Ecological Health Assessment (TEHA), a culturally relevant holistic health screening questionnaire that can be used by primary care providers to gain information about personal, social, environmental and cultural factors that may put low-income African-American women between the ages of 18 and 49 at risk for adverse health outcomes. Development of this health screening questionnaire was accomplished using a three-phased mixed-methods research design, and was guided by Brofenbrenner’s Ecological Systems theory. Phase I involved the generation of a health assessment item pool. In phase II, these items were presented to experts and laypeople for review to establish evidence for content and face validity of the TEHA respectively. A feasibility study was conducted to assess the amount of time it took to complete the TEHA, clarity of the TEHA instructions, and effectiveness of recruitment strategies. In phase III, the TEHA was pilot tested in sample of 208 low-income African-American females between the ages of 18 and 49. Factor analysis revealed that the TEHA contained eight subscales (personal/mental, personal/physical, personal/sexual, personal/routine screening, social, environmental/home, environmental/community, component 8) and two 1-item indexes (personal/educational, cultural). The TEHA demonstrated high internal consistency (.752). Test-retest reliability demonstrated significant correlations for TEHA total scores at time 1 and 2 (r = .398; p = .001). This study represented efforts to create a holistic health screening questionnaire for low-income African-American women ages 18 to 49. Primary care providers should take a more systematic approach when assessing health in this population.