Supportive Care in Cancer

, Volume 21, Issue 8, pp 2237–2245

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

  • Kelvin Koay
  • Penelope Schofield
  • Karla Gough
  • Rachelle Buchbinder
  • Danny Rischin
  • David Ball
  • June Corry
  • Richard H. Osborne
  • Michael Jefford
Original Article

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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

Keywords

Consumer health information Health communication Health literacy Neoplasms Patient education as topic Physician–patient relations 

References

  1. 1.
    Nielsen-Bohlman L, Panzer A, Kindig D (2004) Health literacy: a prescription to end confusion. The National Academies, Washington, D.C.Google Scholar
  2. 2.
    Jordan JE, Buchbinder R, Osborne RH (2010) Conceptualising health literacy from the patient perspective. Patient Educ Couns 79:36–42PubMedCrossRefGoogle Scholar
  3. 3.
    Laine C, Davidoff F (1996) Patient-centered medicine. A professional evolution. JAMA 275:152–156PubMedCrossRefGoogle Scholar
  4. 4.
    Australian Bureau of Statistics (2006) Health literacy, Australia cat. no. 4833.0. Australian Bureau of Statistics, CanberraGoogle Scholar
  5. 5.
    Barber MN, Staples M, Osborne RH, Clerehan R, Elder C, Buchbinder R (2009) Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey. Health Promot Int 24:252–261PubMedCrossRefGoogle Scholar
  6. 6.
    Jordan JE, Osborne RH, Buchbinder R (2011) Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses. J Clin Epidemiol 64:366–379PubMedCrossRefGoogle Scholar
  7. 7.
    Parker RM, Baker DW, Williams MV, Nurss JR (1995) The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med 10:537–541PubMedCrossRefGoogle Scholar
  8. 8.
    Jordan JE (2010) Understanding the role and impact of health literacy on patient health outcomes to facilitate effective health interventions. Ph.D. thesis, University of Melbourne, MelbourneGoogle Scholar
  9. 9.
    Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, Ren J, Peel J (2002) Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health 92:1278–1283PubMedCrossRefGoogle Scholar
  10. 10.
    Baker DW, Parker RM, Williams MV, Clark WS (1998) Health literacy and the risk of hospital admission. J Gen Intern Med 13:791–798PubMedCrossRefGoogle Scholar
  11. 11.
    Gansler T, Henley SJ, Stein K, Nehl EJ, Smigal C, Slaughter E (2005) Sociodemographic determinants of cancer treatment health literacy. Cancer 104:653–660PubMedCrossRefGoogle Scholar
  12. 12.
    Brewer NT, Tzeng JP, Lillie SE, Edwards AS, Peppercorn JM, Rimer BK (2009) Health literacy and cancer risk perception: implications for genomic risk communication. Med Decis Making 29:157–166PubMedCrossRefGoogle Scholar
  13. 13.
    Koay K, Schofield P, Jefford M (2012) Importance of health literacy in oncology. Asia Pac J Clin Oncol 8:14–23PubMedCrossRefGoogle Scholar
  14. 14.
    Jefford M, Tattersall MH (2002) Informing and involving cancer patients in their own care. Lancet Oncol 3:629–637PubMedCrossRefGoogle Scholar
  15. 15.
    Fallowfield LJ, Hall A, Maguire GP, Baum M (1990) Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial. BMJ 301:575–580PubMedCrossRefGoogle Scholar
  16. 16.
    Mohan R, Beydoun H, Barnes-Ely ML, Lee L, Davis JW, Lance R, Schellhammer P (2009) Patients' survival expectations before localized prostate cancer treatment by treatment status. J Am Board Fam Med 22:247–256PubMedCrossRefGoogle Scholar
  17. 17.
    Lillie SE, Brewer NT, O'Neill SC, Morrill EF, Dees EC, Carey LA, Rimer BK (2007) Retention and use of breast cancer recurrence risk information from genomic tests: the role of health literacy. Cancer Epidemiol Biomarkers Prev 16:249–255PubMedCrossRefGoogle Scholar
  18. 18.
    Sturgis EM, Wei Q, Spitz MR (2004) Descriptive epidemiology and risk factors for head and neck cancer. Semin Oncol 31:726–733PubMedCrossRefGoogle Scholar
  19. 19.
    Thun MJ, Lally CA, Flannery JT, Calle EE, Flanders WD, Heath CW Jr (1997) Cigarette smoking and changes in the histopathology of lung cancer. J Natl Cancer Inst 89:1580–1586PubMedCrossRefGoogle Scholar
  20. 20.
    Siminoff LA, Ravdin P, Colabianchi N, Sturm CM (2000) Doctor–patient communication patterns in breast cancer adjuvant therapy discussions. Health Expect 3:26–36PubMedCrossRefGoogle Scholar
  21. 21.
    von Wagner C, Knight K, Steptoe A, Wardle J (2007) Functional health literacy and health-promoting behaviour in a national sample of British adults. J Epidemiol Community Health 61:1086–1090CrossRefGoogle Scholar
  22. 22.
    Jefford M, Moore R (2008) Improvement of informed consent and the quality of consent documents. Lancet Oncol 9:485–493PubMedCrossRefGoogle Scholar
  23. 23.
    Buchbinder R, Hall S, Youd JM (2006) Functional health literacy of patients with rheumatoid arthritis attending a community-based rheumatology practice. J Rheumatol 33:879–886PubMedGoogle Scholar
  24. 24.
    Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J (1999) Development of a brief test to measure functional health literacy. Patient Educ Couns 38:33–42PubMedCrossRefGoogle Scholar
  25. 25.
    Dewalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP (2004) Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med 19:1228–1239PubMedCrossRefGoogle Scholar
  26. 26.
    National Comprehensive Cancer Network (2003) Distress management. Clinical practice guidelines. J Natl Compr Cancer Netw 1:344–374Google Scholar
  27. 27.
    Australian Bureau of Statistics (2006) Socio-economic indexes for areas: introduction, use and future directions. Australian Bureau of Statistics, CanberraGoogle Scholar
  28. 28.
    Williams MV, Parker RM, Baker DW, Parikh NS, Pitkin K, Coates WC, Nurss JR (1995) Inadequate functional health literacy among patients at two public hospitals. JAMA 274:1677–1682PubMedCrossRefGoogle Scholar
  29. 29.
    Gazmararian JA, Baker DW, Williams MV, Parker RM, Scott TL, Green DC, Fehrenbach SN, Ren J, Koplan JP (1999) Health literacy among Medicare enrollees in a managed care organization. JAMA 281:545–551PubMedCrossRefGoogle Scholar
  30. 30.
    Baker DW, Wolf MS, Feinglass J, Thompson JA, Gazmararian JA, Huang J (2007) Health literacy and mortality among elderly persons. Arch Intern Med 167:1503–1509PubMedCrossRefGoogle Scholar
  31. 31.
    Gazmararian JA, Williams MV, Peel J, Baker DW (2003) Health literacy and knowledge of chronic disease. Patient Educ Couns 51:267–275PubMedCrossRefGoogle Scholar
  32. 32.
    Donelle L, Arocha JF, Hoffman-Goetz L (2008) Health literacy and numeracy: key factors in cancer risk comprehension. Chronic Dis Can 29:1–8PubMedGoogle Scholar
  33. 33.
    Jefford M, Mileshkin L, Matthews J, Raunow H, O'Kane C, Cavicchiolo T, Brasier H, Anderson M, Reynolds J (2011) Satisfaction with the decision to participate in cancer clinical trials is high, but understanding is a problem. Support Care Cancer 19:371–379PubMedCrossRefGoogle Scholar
  34. 34.
    Joffe S, Cook EF, Cleary PD, Clark JW, Weeks JC (2001) Quality of informed consent: a new measure of understanding among research subjects. J Natl Cancer Inst 93:139–147PubMedCrossRefGoogle Scholar
  35. 35.
    Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR (2005) The prevalence of limited health literacy. J Gen Intern Med 20:175–184PubMedCrossRefGoogle Scholar
  36. 36.
    Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363:24–35PubMedCrossRefGoogle Scholar
  37. 37.
    Rischin D, Young RJ, Fisher R, Fox SB, Le QT, Peters LJ, Solomon B, Choi J, O'Sullivan B, Kenny LM, McArthur GA (2010) Prognostic significance of p16INK4A and human papillomavirus in patients with oropharyngeal cancer treated on TROG 02.02 phase III trial. J Clin Oncol 28:4142–4148PubMedCrossRefGoogle Scholar
  38. 38.
    Davis TC, Williams MV, Marin E, Parker RM, Glass J (2002) Health literacy and cancer communication. CA Cancer J Clin 52:134–149PubMedCrossRefGoogle Scholar
  39. 39.
    Ferreira MR, Dolan NC, Fitzgibbon ML, Davis TC, Gorby N, Ladewski L, Liu D, Rademaker AW, Medio F, Schmitt BP, Bennett CL (2005) Health care provider-directed intervention to increase colorectal cancer screening among veterans: results of a randomized controlled trial. J Clin Oncol 23:1548–1554PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kelvin Koay
    • 1
    • 2
  • Penelope Schofield
    • 1
    • 2
  • Karla Gough
    • 1
  • Rachelle Buchbinder
    • 3
    • 7
  • Danny Rischin
    • 2
    • 4
  • David Ball
    • 2
    • 5
  • June Corry
    • 2
    • 5
  • Richard H. Osborne
    • 6
  • Michael Jefford
    • 1
    • 2
    • 4
  1. 1.Department of Cancer Experiences ResearchPeter MacCallum Cancer CentreVictoriaAustralia
  2. 2.Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneMelbourneAustralia
  3. 3.Monash Department of Clinical EpidemiologyCabrini InstituteMelbourneAustralia
  4. 4.Division of Cancer MedicinePeter MacCallum Cancer CentreVictoriaAustralia
  5. 5.Division of Radiation Oncology and Cancer ImagingPeter MacCallum Cancer CentreVictoriaAustralia
  6. 6.Public Health Innovation, Population Health Strategic Research Centre, Faculty of HealthDeakin UniversityMelbourneAustralia
  7. 7.Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia

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