, Volume 21, Issue 8, pp 2237-2245
Date: 19 Mar 2013

Suboptimal health literacy in patients with lung cancer or head and neck cancer

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Health literacy is the capacity to seek, understand and utilise health information to make informed health decisions. Suboptimal health literacy has been linked to poor health outcomes. This study assessed health literacy in patients treated for head and neck or lung cancer and associations between health literacy and demographic factors and distress levels.


Consecutive English-speaking patients were approached at Peter MacCallum Cancer Centre. Face-to-face interviews were conducted. Health literacy was assessed using the Shortened Test of Functional Health Literacy in Adults (S-TOFHLA) and Health Literacy Management Scale (HeLMS). Distress was assessed by the Distress Thermometer.


Response rate was 73 % (n = 93). Using S-TOFHLA, prevalence of inadequate and marginal health literacy was 5.4 and 6.5 % respectively, and both groups were associated with older age (p = 0.043) and low education level (p = 0.009). Specific assessment of S-TOFHLA revealed that 70 % could not interpret prescription labels. HeLMS reported that 17 % had health literacy difficulties. Low scores on domains of HeLMS were associated with lower education level (p < 0.05) but younger age (p < 0.05). Distress was not associated with S-TOFHLA scores but related to low scores in two domains of HeLMS (p < 0.05).


Using two different measures, a substantial proportion of patients have poor health literacy abilities and may experience difficulties in accessing health services.

Partial results were presented at the 46th Annual Meeting of the American Society of Clinical Oncology, June 4–8, 2010, Chicago, IL, USA, and at the International Conference on Communication in Healthcare, 5–8 September 2010, Verona, Italy. Full results were presented at the Annual Scientific Meeting of the Clinical Oncological Society of Australia, November 15–17 2010, Melbourne, Victoria, Australia.