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

Nicholas Clarke, Simon Dunne, Laura Coffey, Linda Sharp, Deirdre Desmond, Jean O’Conner, Eleanor O’Sullivan, Conrad Timon, Claire Cullen, Pamela Gallagher

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)855-865
Number of pages11
JournalJournal of Cancer Survivorship
Issue number6
Publication statusPublished - Dec 2021
Externally publishedYes


  • Fear of recurrence
  • Head and neck cancer
  • Health literacy
  • Health-related quality of life
  • Psycho-oncology
  • Self-management


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