Health Literacy Among Long-Term Breast Cancer Survivors; Exploring Associated Factors in a Nation-Wide Sample

Abstract Background Poor health literacy (HL) likely hampers health management and outcomes in cancer survivorship. Knowledge of associated factors is needed to identify at-risk sub-groups of survivors, but is currently scant. Here, we explore HL and associated factors in a nation-wide sample of long-term breast cancer survivors (BCSs). Material and methods All BCSs aged 20-65 years, diagnosed with early-stage BC in 2011-2012, were identified through the Norwegian Cancer Registry and invited to participate in the Survivorship, Work and Sex (SWEET)-study. HL was measured using The European Health Literacy Survey Questionnaire-12 (HLS-EU-Q12) as a continuous and categorical variable. Associations between HL and sociodemographic-, physical- and mental health variables, including the most common late effects, were explored in uni- and multivariable linear regression models. Results The final sample consisted of 1355 survivors (48%). Median age was 60 years and the majority of survivors had high socioeconomic status (SES). Median HL sum-score corresponded to an intermediate HL level (36.2, SD 5.4), while 19.3% reported marginal or inadequate HL. Education, income, age at diagnosis, the personality trait neuroticism and fear of cancer recurrence (FCR) remained significantly associated with HL in the multivariate model, explaining 12% of the variance in HL scores. Conclusion Low levels of HL were prevalent, potentially affecting the provision of effective survivorship care and BCS’s self-management abilities. Identifying individuals at risk of low HL based on knowledge readily available to clinicians remains challenging and warrants further investigation.