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ORIGINAL RESEARCH article

Front. Cancer Control Soc.
Sec. Social Determinants in Cancer
Volume 3 - 2025 | doi: 10.3389/fcacs.2025.1452970
This article is part of the Research Topic Sustainable and Mission-oriented Innovation in Economic Systems and Governance for Equitable Global Health and Wellbeing View all 21 articles

Running Head: Financial Hardship Item Response Theory Development of Item Banks to Assess Financial Hardship in Cancer Survivors Using Item Response Theory Authors

Provisionally accepted
Salene MW Jones Salene MW Jones 1*Jean Yi Jean Yi 1Nora B Henrikson Nora B Henrikson 2Laura Panattoni Laura Panattoni 1Veena Shankaran Veena Shankaran 1
  • 1 Fred Hutchinson Cancer Center, Seattle, United States
  • 2 Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States

The final, formatted version of the article will be published soon.

    Background: Financial hardship is common after cancer diagnosis. Current financial hardship measures have advanced the field but a remaining challenge is assessing dimensions of financial hardship. We created item banks to assess four financial hardship dimensions using item response theory (IRT). IRT-based item banks can be tailored to each context and used in computerized adaptive testing (CAT) to reduce participant burden. Methods: Cancer survivors (n=459) were recruited from a survivorship program and online survey panel to complete an online or paper survey. Item banks were developed based on previous studies, expert feedback and patient interviews. Each bank had the following number of items: 41-financial coping; 21-financial consequences; 15-financial depression; and 21financial worry. We used the two-parameter logistic and graded response models for analysis. Results: The IRT model fit well for all four item banks: financial coping root mean square error of approximation (RMSEA)=0.06; financial consequences RMSEA=0.03; financial depression RMSEA=0.05; and financial worry RMSEA=0.03. The accuracy parameters ranged from 1.01 to 6.53 indicating good reliability for each item. The severity parameters showed each item bank assessed financial hardship across two to three standard deviations, supporting content validity. Short forms were developed for financial consequences, depression and worry. Conclusions: The item banks can be used to create brief screening measures and with CAT to efficiently screen for each dimension of financial hardship while minimizing burden. Future research is required to assess the clinical utility of using the item banks to screen for financial hardship.

    Keywords: Financial burden, Financial toxicity, Economic wellbeing, economic hardship, Financial anxiety

    Received: 05 Jul 2024; Accepted: 13 Jan 2025.

    Copyright: © 2025 Jones, Yi, Henrikson, Panattoni and Shankaran. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Salene MW Jones, Fred Hutchinson Cancer Center, Seattle, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.