Health literacy and the provision of information to women with breast cancer

Clin Oncol (R Coll Radiol). 2011 Apr;23(3):223-7. doi: 10.1016/j.clon.2010.11.010. Epub 2010 Dec 24.


Aims: Health literacy and functional health literacy are important for patients with cancer, as key information regarding treatment complications and clinical trials is often imparted using written educational material. This study measured the health literacy and functional health literacy levels in a population of women with breast cancer and compared these with the level of written information provided.

Materials and methods: A cross-sectional survey of women with stage I-III breast cancer attending an outpatient clinic was conducted. Health literacy levels were assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM) score and functional health literacy was assessed using three validated screening questions. Patient education materials were assessed using the Simple Measure of Gobbledygook (SMOG) and Flesch Reading Ease (FRE) systems.

Results: One hundred and twenty-seven women were recruited. For patients, the mean REALM score was 64.3 (≥US 9th grade/reading age 14 years). The mean SMOG score of patient education materials was 80.5 (reading age 17 years). The mean FRE score of patient education materials was 55.7 (reading age 15-17 years). All patient information sheets assessed were written at ≥8th grade (reading age 13 years) and as a result up to 9% of patients would be unable to read them. Nineteen per cent of the population had inadequate functional health literacy.

Conclusions: Health literacy levels were high in the population studied. However, the reading level of written patient information was also high, meaning that up to 9% of patients would be unable to read the information provided. Functional health literacy levels were lower, with 19% of patients having inadequate ability. This means that although most patients are able to read the information sheets provided, there is a larger proportion that would be unable to understand and act upon this information. Patient education materials should be written at an appropriate level and different modalities of communication should be used to ensure adequate comprehension.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms*
  • Consumer Health Information
  • Cross-Sectional Studies
  • Female
  • Health Literacy / statistics & numerical data*
  • Humans
  • Middle Aged
  • Patient Education as Topic / methods*