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The aim was to adapt and validate a nutrition literacy instrument for adults with cancer in the UK.

March 13, 2026Journal of Human Nutrition and Dietetics1 citations

Cultural and Linguistic Adaptation and Validation of a Nutrition Literacy Instrument for Use in People With Cancer in the United Kingdom

LML. J. MillerNottingham University Hospitals NHS Trust GPG.‐I. PostavaruUniversity of Leicester GRGill RowlandsUniversity of Newcastle Australia

Key Points

The aim was to adapt and validate a nutrition literacy instrument for adults with cancer in the UK.
Cultural adaptation of the NLit instrument through expert recommendations and patient consensus groups.
Validation conducted in an observational study of adults undergoing cancer treatment.
Data collected anonymously online, including NLit-UK, Newest Vital Signs, and demographic information.
Qualitative data analyzed thematically and quantitative data analyzed using descriptive statistics.
Construct validity assessed through confirmatory factor analysis.
Key adaptations included changes to language, images, and food label policy for UK audiences.
Substantial reliability found in the NLit-UK (entire reliability 0.90; Cronbach's α 0.83).
Only 10% of participants were identified with adequate nutrition literacy despite 71.8% with adequate health literacy.
Sample size limitations hindered further analysis of relationships between nutrition literacy and demographic factors.

Abstract

ABSTRACT Background Nutrition literacy is a person's ability to gain, retain and use nutrition information to inform healthy lifestyle choices. Low nutrition literacy (NL) can limit understanding of nutrition information and how it is subsequently applied, impacting the quality of a person's diet. Malnutrition and poor diet quality are linked to many cancers and/or treatment recovery. Measuring NL, using culturally adapted and validated tools, may support improved understanding of nutrition education needs for more people with cancer. However, no validated NL measure exists for adults with cancer in the United Kingdom (UK). Aim This study undertook cultural and linguistic adaptations of an NL instrument (NLit) for use in UK adults with cancer. Methods The study was approved by UK ethics and regulatory authorities. NLit, was culturally adapted (NLit‐UK) following guideline review, expert recommendation, and two patient nominal consensus groups. NLit‐UK was then validated in an observational cross‐sectional study of on‐treatment adults with cancer. NLit‐UK, Newest Vital Signs (NVS‐UK), demographic information and consent, were collected anonymously via an online platform between June 2019 and March 2020, the target sample size was 366. Qualitative data were thematically analysed. Quantitative data were presented using descriptive statistics. Construct validity was determined using single factor classical confirmatory factor analysis (CFA). Results Seven experts and 16 service users took part in cultural and linguistic adaptations. Key adaptations included UK to US language, images, food label policy and numeracy progression. Answer formats, purpose and concepts remained consistent. Forty‐two people with cancer completed NLit‐UK (63‐item), recruitment terminated early due to COVID. CFA on NLit‐UK (63‐item) and its shorter (42‐item) version showed substantial reliability (entire reliability, 0.90; Cronbachs α 0.83) and good reliability (entire reliability, 0.86; Cronbachs α, 0.8), respectively. While NVS‐UK identified 71.8% ( n = 28) as having adequate health literacy, only 10% ( n = 4) were identified as having adequate NL. Conclusions Content reliability and validity of NLit‐UK was excellent. The small sample size prohibited CFA between subscales or associations between NL and potential confounders such as ethnicity and educational status. Confirmation in a larger more diverse population and other conditions is warranted. Adequate health literacy may not predict adequate NL. Trial No: NCT03978312 www.clinicaltrials.gov .

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