Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 12;16(11):e0259815.
doi: 10.1371/journal.pone.0259815. eCollection 2021.

The role of health literacy in cancer care: A mixed studies systematic review

Chloe E Holden  1   2 , Sally Wheelwright  1 , Amélie Harle  2 , Richard Wagland  1
Affiliations

The role of health literacy in cancer care: A mixed studies systematic review

Chloe E Holden et al. PLoS One. .

Abstract

Background: Patients diagnosed with cancer face many challenges and need a good understanding of their diagnosis and proposed treatments to make informed decisions about their care. Health literacy plays an important role in this and low health literacy has been associated with poorer outcomes. The aims of this review are to identify which outcomes relate to health literacy in patients with cancer, and to combine this through a mixed studies approach with the patient experience as described through qualitative studies.

Methods: Four electronic databases were searched in January 2021 to identify records relating to health literacy and patients with cancer. Records were independently screened then assessed for inclusion by two reviewers according to the following criteria: patients aged ≥18 years with cancer, English language publication AND health literacy measured with validated tool and measured outcome associated with health literacy OR qualitative study exploring the role of health literacy as patients make decisions about health. Quality was independently assessed by two reviewers. A narrative synthesis was performed, and findings integrated through concept mapping. This systematic review was registered with PROSPERO, entry CRD42020166454.

Results: 4441 records were retrieved. Following de-duplication, 2496 titles and abstracts were screened and full texts of 405 papers were reviewed for eligibility. 66 papers relating to 60 studies met the eligibility criteria. Lower health literacy was associated with greater difficulties understanding and processing cancer related information, poorer quality of life and poorer experience of care. Personal and situational influences contributed to how participants processed information and reached decisions about their care.

Conclusion: This review highlights the important role of health literacy for patients with cancer. Outcomes are poorer for those who experience difficulties with health literacy. Further efforts should be made to facilitate understanding, develop health literacy and support patients to become more involved in their care.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA diagram showing number of records reviewed at each step of the process.
From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.
Fig 2
Fig 2. Concept map demonstrating links between findings from quantitative and qualitative data as ‘Processes’, ‘Outcomes’ and ‘Influences’ of health literacy.
See this image and copyright information in PMC

References

    1. International Union for Health Promotion and Education. IUHPE Position Statement on Health Literacy: a practical vision for a health literate world. Global Health Promotion. 2018;25(4):79–88. doi: 10.1177/1757975918814421 - DOI
    1. Nutbeam D. The evolving concept of health literacy. Social Science & Medicine. 2008;67(12):2072–8. doi: 10.1016/j.socscimed.2008.09.050 - DOI - PubMed
    1. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107. Epub 2011/07/20. doi: 10.7326/0003-4819-155-2-201107190-00005 . - DOI - PubMed
    1. Visscher BB, Steunenberg B, Heijmans M, Hofstede JM, Devillé W, van der Heide I, et al.. Evidence on the effectiveness of health literacy interventions in the EU: a systematic review. BMC public health. 2018;18(1):1414-. doi: 10.1186/s12889-018-6331-7 . - DOI - PMC - PubMed
    1. Okan O, Bauer U, Levin-Zamir D, Pinheiro P, Sørensen K. International Handbook of Health Literacy: Research, practice and policy across the lifespan. Bristol: Policy Press; 2019.

Publication types