The Conceptualization and Measurement of Cognitive Health Sophistication

Abstract

This article develops a conceptualization and measure of cognitive health sophistication—the complexity of an individual's conceptual knowledge about health. Study 1 provides initial validity evidence for the measure—the Healthy-Unhealthy Other Instrument—by showing its association with other cognitive health constructs indicative of higher health sophistication. Study 2 presents data from a sample of low-income adults to provide evidence that the measure does not depend heavily on health-related vocabulary or ethnicity. Results from both studies suggest that the Healthy-Unhealthy Other Instrument can be used to capture variability in the sophistication or complexity of an individual's health-related schematic structures on the basis of responses to two simple open-ended questions. Methodological advantages of the Healthy-Unhealthy Other Instrument and suggestions for future research are highlighted in the discussion.

Acknowledgments

This research was supported by a seed grant from the Regenstrief Center for Healthcare Engineering at Purdue University and a Dean's Incentive Grant from Louisiana State University. The authors thank Aubrey Heinsz and Sebastien Zweidler for their assistance with data coding.

Notes

¹All specific coding rubrics and other information are available upon request.

²All specific coding rubrics and other information are available upon request.

Note. HUHOI = Healthy-Unhealthy Other Instrument; REALM = Rapid Estimate of Adult Literacy in Medicine; ESL = English as a second language.

***p < . 001. **p < .01. *p < .05.

Note. Different superscripts across a single row indicate a statistically significant difference (p < .05). HUHOI = Healthy-Unhealthy Other Instrument; REALM = Rapid Estimate of Adult Literacy in Medicine.

³Low cell sizes for those reporting either mixed (n = 5) or other (n = 1) race categories did not allow for adequate power to detect significant effects of any magnitude. All descriptive data are available from the authors upon request.

⁴For example, although the instructions lead participants to describe the healthy and unhealthy others as fully as possible, it does not stipulate whether that means the inclusion of as many dimensions of health as possible or whether it means a fuller discussion of individual elements. Of course, the HUHOI represents a sample of the total population of an individual's cognitive health constructs; individuals who think of health in more nuanced ways will have at their disposal more constructs and will, thus, score higher. In a similar way, individuals who discuss a given dimension with greater depth will also be able to score higher. Future research that explores various ways to code HUHOI responses and the relation among these various coding schemes and variables thought to represent relative breadth versus depth of an individual's cognitive health makeup would help to answer these types of important questions. We would like to thank one of the anonymous reviewers on a previous version of this manuscript for pointing out this limitation and providing some of the phrasing we use to address it.