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Health literacy impacts self-management, quality of life and fear of recurrence in head and neck cancer survivors

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Abstract

Purpose

Little is known about whether health literacy is associated with affects certain key outcomes in head and neck cancer (HNC) survivors. We investigated (i) the socio-demographic and clinical profile of health literacy and (ii) associations among between health literacy and self-management behaviours, health-related quality of life (HRQL) and fear of recurrence (FoR) in HNC survivors.

Methods

A population-based survey was conducted in Ireland. Health literacy was assessed using a validated single-item question. Socio-demographic, clinical and psychosocial outcome variables (FoR, self-management behaviours, HRQL) were collected. Multivariable linear regression was performed to estimate associations between health literacy and each psychosocial outcome.

Results

Three hundred ninety-five (50%) individuals responded to the survey. Inadequate health literacy was evident among 47% of the sample. In adjusted models, HNC survivors with inadequate health literacy had significantly lower levels of self-management behaviours in the domains of health-directed behaviour, positive and active engagement in life, self-monitoring and insight, constructive attitudes and approaches and skills and technique acquisition. Inadequate health literacy was independently associated with lower functional well-being and HNC disease-specific HRQL. FoR was also significantly higher among those with inadequate health literacy.

Conclusions

HNC survivors with inadequate health literacy have lower levels of self-management behaviours, lower functional HRQL and increased FoR compared to those with adequate health literacy.

Implications for Cancer Survivors

Clinicians, healthcare providers and those developing interventions should consider how inadequate health literacy among HNC survivors might affect post-treatment outcomes when developing services and providing support for this group.

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Notes

  1. Those below a certain income threshold are provided with a medical card which entitles them to access healthcare, including primary care, in the Irish public health system, free at the point of delivery

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Funding

This research is partly funded by the Irish Cancer Society and the Health Research Board in Ireland. Health Research Board, Grant/Award Number: SRP13GAL, MRCG/2013/11.

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Authors

Contributions

Nicholas Clarke: Conceptualization, data analysis and interpretation, original manuscript preparation, writing, review and editing

Simon Dunne and Clare Cullen: Data curation and design, interpretation, manuscript review and editing

Jean O’Connor: Data curation, manuscript review and editing

Linda Sharp, Deirdre Desmond and Laura Coffey: Funding acquisition, data design, interpretation, manuscript review and editing

Pamela Gallagher: Funding acquisition, conceptualization, supervision, data design, manuscript review and editing

Conrad Timon: Funding acquisition, manuscript review and editing

Eleanor O’Sullivan: Manuscript review and editing

Corresponding author

Correspondence to Nicholas Clarke.

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Conflict of interest

There is no conflict of interest to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. We received formal ethical approval for the study from the following institutions in Ireland: Galway University Hospitals (Merlin Park University Hospital Clinical REC_C.A.1100); South/South West Hospital Group (UCC Clinical REC_ECM_4_(bbb)_03/06/14); St. James’s Hospital, Dublin (SJH/ J Cancer Surviv (2019) 13:43–55 53 AMNCH REC Reference: 2014/05/Chairman’s_Action); Royal Victoria Eye and Ear Hospital, Dublin (RVEEH REC_25/06/14).

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Informed consent was obtained from all individual participants included in the study.

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Clarke, N., Dunne, S., Coffey, L. et al. Health literacy impacts self-management, quality of life and fear of recurrence in head and neck cancer survivors. J Cancer Surviv 15, 855–865 (2021). https://doi.org/10.1007/s11764-020-00978-5

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