Disparities in health literacy in patients with head and neck cancer: Considerations for understanding

Document Type

Conference Proceeding

Publication Date


Publication Title

Cancer Epidemiol Biomarkers Prev


Introduction: Health literacy is the ability to understand the basic health information and to receive and manage health services that allow an individual to make appropriate healthcare decisions. Within medicine, the recommendation is for patient education materials to be written at no higher than fifth grade. However, most materials have been found to be written at greater than eighth grade literacy. The health literacy of a patient with head and neck cancer (HNC) has an ability to affect cancer treatment and outcomes. We evaluated the health literacy and the associated factors in patients diagnosed with HNC.

Methods: This was a retrospective chart review of patients with HNC who presented for pretreatment evaluation with an embedded psych-oncologist in Otolaryngology department of an academic medical center from 2018 to 2021. The outcome variable was health literacy which was measured using the Rapid Evaluation of Adult Literacy in Medicine (REALM-SF) tool. The REALM-SF, a validated instrument, is a 7-item word recognition test which provides scores of zero to seven. Zero points correlate to third grade and below, one to three points correlate to between fourth and sixth grade, four to six points correlate to seventh to eighth grade, and seven points correlate to high school reading level. In this study, adequate health literacy was defined as having a score of seven. Independent variables assessed included sociodemographic factors (age, sex, race, education level, employment status), smoking status, and psychosocial factors (relationship status, social support). Multivariable logistic regression model was used to examine the association between sociodemographic factors, smoking status and psychosocial factors, and health literacy.

Results: A total of 421 patients were included in the study, of which 65.6% (n=276) had adequate health literacy. The average age of patients was 63.4 years (SD=10.9); and majority of patients were male (72.4%), white race (74.6%), married (64.7%), and had emotional support (73.3%). Approximately 43% of patients had a high school diploma or less, and 30% were current smokers. In the adjusted analyses, sex, race, education, and emotional support were associated with health literacy. Compared to females, males (aOR=0.34; 95% CI: 0.14-0.82) were less likely to have adequate health literacy, as were Blacks (aOR=0.26; 95% CI: 0.11-0.65) compared with Whites. Patients who had a high school diploma or less were 89% less likely to have adequate health literacy compared to those with college degree or higher (aOR=0.11; 95% CI: 0.04-0.33). Patients who had no emotional support (aOR=4.25; 95% CI: 1.40-12.91) were more likely to have adequate health literacy compared to those with emotional support.

Conclusion: Males, Blacks, and patients with lower education were more likely to have inadequate health literacy. Future investigation in quantifying these gaps is needed to ensure these patients are receiving adequate knowledge support throughout their treatment to improve shared decision making and outcomes.





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