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



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.


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


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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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