National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (2)
- Autism (1)
- Blood Pressure (1)
- Cancer (2)
- Caregiving (1)
- Children/Adolescents (3)
- Clinician-Patient Communication (1)
- Communication (3)
- Decision Making (1)
- Dental and Oral Health (1)
- Diabetes (1)
- Digestive Disease and Health (2)
- Education: Patient and Caregiver (6)
- Elderly (3)
- Electronic Health Records (EHRs) (2)
- Eye Disease and Health (1)
- Health Information Technology (HIT) (6)
- (-) Health Literacy (24)
- Hospital Discharge (1)
- Medication (3)
- Medication: Safety (1)
- Obesity (1)
- Outcomes (1)
- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (2)
- Patient Experience (1)
- Patient Safety (2)
- Patient Self-Management (1)
- Prevention (1)
- Quality of Care (1)
- Quality of Life (1)
- Racial and Ethnic Minorities (3)
- Research Methodologies (1)
- Risk (1)
- Surgery (2)
- Transplantation (1)
- Vaccination (1)
- Vulnerable Populations (1)
- Web-Based (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 24 of 24 Research Studies DisplayedShaffer VA, Wegier P, Valentine KD
Patient judgments about hypertension control: the role of patient numeracy and graph literacy.
The purpose of this study was to assess the impact of patient health literacy, numeracy, and graph literacy on perceptions of hypertension control using different forms of data visualization. Forms of visualization included data tables, graphs with raw values, and graphs with smoothed values only. Findings showed that judgments about hypertension data presented as a smoothed graph were significantly more positive than judgments about the same data presented as either a data table or an unsmoothed graph. Hypertension data viewed in tabular form was perceived more positively than graphs of the raw data. Data visualization had the greatest impact on participants with high graph literacy.
AHRQ-funded; HS023328.
Citation: Shaffer VA, Wegier P, Valentine KD .
Patient judgments about hypertension control: the role of patient numeracy and graph literacy.
J Am Med Inform Assoc 2022 Oct 7;29(11):1829-37. doi: 10.1093/jamia/ocac129..
Keywords: Health Literacy, Blood Pressure, Decision Making
Colditz JB, Shensa A, Kennedy AJ
Acceptability and efficacy of the SMARxT media literacy education program to counter pharmaceutical marketing influences among medical trainees.
This article looked at the results of a media literacy education program called SMARxT, whose goal was to counter pharmaceutical marketing influences among resident physicians. In 2017, the authors assessed program feasibility, acceptability, and efficacy of enhancing knowledge among resident physicians at the University of Pittsburgh. The residents (n=73) responded to pre-test items assessing prior knowledge, viewed six SMARxT videos, and responded to post-test items. The residents completed a 6-month follow-up test to quantitatively assess sustained changes in knowledge and to qualitatively assess feedback about the program. The proportion of correct knowledge responses increased from pre-test to immediate post-test (31% to 64%) at baseline. Correct responses also increased from pre-test to 6-month follow-up (31% to 43%). Acceptability of the program quantitatively yielded positive scores and qualitative responses indicated participants' increased confidence in understanding and countering marketing influences due to the intervention. However, participants shared they would prefer shorter videos, feedback about test scores, and additional resources to reinforce learning objectives.
AHRQ-funded; HS022927.
Citation: Colditz JB, Shensa A, Kennedy AJ .
Acceptability and efficacy of the SMARxT media literacy education program to counter pharmaceutical marketing influences among medical trainees.
Interdiscip J Virtual Learn Med Sci 2022 Sep; 13(3):213-20. doi: 10.30476/ijvlms.2022.95137.1151..
Keywords: Health Literacy, Medication
Lindly OJ, Cabral J, Mohammed R
AHRQ Author: Mistry KB
"I don't do much without researching things myself": a mixed methods study exploring the role of parent health literacy in autism services use for young children.
This mixed-methods study examined how parent health literacy contributes to health-related outcomes for children with autism. This study included 82 US parents of a child with autism 2-5 years old and sought to describe (1) health literacy dimensions, (2) how health literacy influences services use, and (3) health literacy improvement strategies. The authors found that: autism information was accessed from multiple sources; understanding autism information involved "doing your own research"; autism information empowered decision-making; health literacy facilitated behavioral services use; health literacy influenced medication use; family and system characteristics also affected services use; autism education remains needed; services information is needed across the diagnostic odyssey; and greater scientific information accessibility would increase uptake.
AHRQ-authored; AHRQ-funded; HS000063.
Citation: Lindly OJ, Cabral J, Mohammed R .
"I don't do much without researching things myself": a mixed methods study exploring the role of parent health literacy in autism services use for young children.
J Autism Dev Disord 2022 Aug;52(8):3598-611. doi: 10.1007/s10803-021-05240-0..
Keywords: Children/Adolescents, Autism, Caregiving, Health Literacy
Theiss LM, Wood T, McLeod MC
The association of health literacy and postoperative complications after colorectal surgery: a cohort study.
The purpose of this retrospective cohort study of patients undergoing elective colorectal surgery between 2015 and 2020 was to describe the association between health literacy, a determinant of health, and surgical outcomes. The outcomes of the study included: postoperative complications, length of stay (LOS), readmissions, and mortality. The study found that of 552 patients, 8.3% (46) had limited health literacy. Patients with limited health literacy had higher rates of overall complications, especially surgical site infections, and longer LOS. Readmission and mortality rates did not differ between limited and non-limited patients. The researchers concluded that limited health literacy is related to an increased likelihood of post-surgical complications in elective colorectal surgery patients.
Citation: Theiss LM, Wood T, McLeod MC .
The association of health literacy and postoperative complications after colorectal surgery: a cohort study.
Am J Surg 2022 Jun;223(6):1047-52. doi: 10.1016/j.amjsurg.2021.10.024..
Keywords: Health Literacy, Surgery, Adverse Events
Di Tosto G, Walker DM, Sieck CJ
Examining the relationship between health literacy, health numeracy, and patient portal use.
The purpose of this randomized controlled trial study across the inpatient population of a U.S.-based academic medical center was to examine the association between health literacy and numeracy (HLN) and patient portal use. The researchers assessed the association between patients’ perceptions of health literacy and their skills, interpreting medical information with measurements of interaction with patient portals. The study reported that levels of HLN for the 654 patients in the study sample were not significantly associated with use of the inpatient portal. Six-month use of the outpatient portal after hospital discharge was also not related with HLN. There was a significant increase in self-reported levels of health literacy. The researchers concluded that although prior research suggested that low HLN can serve as a barrier to inpatient portal use and could limit interaction with outpatient portals, this study did not find the same associations. Instead, this study indicates that the inpatient setting might be effective in encouraging acceptance of technology such as hospital-provided tablets.
AHRQ-funded; HS024091; HS024349; HS024379.
Citation: Di Tosto G, Walker DM, Sieck CJ .
Examining the relationship between health literacy, health numeracy, and patient portal use.
Appl Clin Inform 2022 May;13(3):692-99. doi: 10.1055/s-0042-1751239..
Keywords: Health Literacy, Health Information Technology (HIT), Electronic Health Records (EHRs)
Jacobson CE, Heximer A, Olmeda-Barrientos R
Language accessibility of liver transplantation center websites.
This research letter describes an analysis of language accessibility of liver transplantation center websites. The authors surveyed patient-facing educational websites of all 140 active, accredited US liver transplantation centers. Thirty-eight states and the District of Columbia had websites. Inclusion criteria was that they were using the Organ Procurement and Transplantation Network website. They analyzed each website for non-English content. Excluded were websites from Puerto Rico, as Spanish is the predominant governmental language. A total of 23 states had no transplant websites with online materials in a second language, and 34 sites (24.3%) had resources other than English on their website. California had the highest number of centers with resources in a language other than English, followed by Texas and New York. Spanish was the most common language available at 100% of sites that had resources other than English, followed by Arabic at 38.9% and Mandarin Chinese at 38.9%. A total of 108 different languages were represented among 10 state websites.
AHRQ-funded; HS000053.
Citation: Jacobson CE, Heximer A, Olmeda-Barrientos R .
Language accessibility of liver transplantation center websites.
Liver Transpl 2022 Apr; 28(4):722-24. doi: 10.1002/lt.26343..
Keywords: Transplantation, Clinician-Patient Communication, Communication, Health Information Technology (HIT), Health Literacy
Carpenter K, Scavotto M, McGovern A
Early parental knowledge of late effect risks in children with cancer.
This study assessed early parental knowledge of late effect risks in children with cancer. The cohort included parents of children receiving cancer treatment at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. The parents were surveyed about their knowledge of their child’s likelihood of eight late effects. Only 11 out of 96 parents correctly identified all their child’s risk for the eight late effects. Five of eight effects were the median number of correctly identified late effect risks. Among the 21 parents whose children were at risk for ototoxicity, 95% correctly identified this risk. Conversely, parents were less knowledgeable about risks of second malignancy, cardiac toxicity, neurocognitive impairment, and infertility.
AHRQ-funded; HS022986.
Citation: Carpenter K, Scavotto M, McGovern A .
Early parental knowledge of late effect risks in children with cancer.
Pediatr Blood Cancer 2022 Feb;69(2):e29473. doi: 10.1002/pbc.29473..
Keywords: Children/Adolescents, Cancer, Risk, Education: Patient and Caregiver, Health Literacy
Dos Santos Marques IC, Herbey II, Theiss LM
Understanding the surgical experience for Black and White patients with inflammatory bowel disease (IBD): the importance of health literacy.
The purpose of this qualitative study was to describe the surgical experience for Black and White inflammatory bowel disease patients. Same race, semi-structured qualitative interviews with patients with IBD who had undergone surgery were conducted to explore barriers and facilitators to a positive or negative surgical experience. The study reported that 6 focus groups were conducted with 10 Black and 17 White IBD participants with a mean age of 44.8 years, 52% of whom were male and 65% of whom had Crohn’s disease. Four themes were identified that most characterized the surgical experience: the impact of the IBD diagnosis, the quality of the information that was provided, disease management, and the surgery. Within these theme groupings, identified barriers to a positive surgical experience included inadequate personal knowledge of IBD, ineffective written and verbal communication, lack of a support system and complications after surgery. Both groups indicated that information was provided inconsistently which led to unclear expectations of surgical outcomes. The study concluded that surgical experiences vary between Black and White patients, but both groups emphasized the need for understandable, accurate, and trustworthy health information.
AHRQ-funded; HS023009; HS013852.
Citation: Dos Santos Marques IC, Herbey II, Theiss LM .
Understanding the surgical experience for Black and White patients with inflammatory bowel disease (IBD): the importance of health literacy.
Am J Surg 2022 Feb;223(2):303-11. doi: 10.1016/j.amjsurg.2021.06.003..
Keywords: Health Literacy, Surgery, Racial and Ethnic Minorities, Racial and Ethnic Minorities, Digestive Disease and Health, Patient Experience
Valdovinos C, Perez-Aguilar G, Huerta RG
Electronic health literacy among linguistically diverse patients in the Los Angeles County safety net health system.
Few studies have been conducted which evaluate levels of eHealth literacy in underserved populations, yet eHealth literacy may affect telehealth utilization. The objective of this study was to describe eHealth literacy levels as well as technology use and access patterns among English-speaking and Limited English Proficiency (LEP) patients from three Los Angeles clinics for uninsured, Medicaid, and other vulnerable patients (“safety-net” clinics). Between June and July of 2017, patients aged 18 or over with diabetes mellitus and/ or hypertension and their caregivers were recruited for the study. The researchers asked both English-speaking and LEP Spanish-speaking patients about their technology use and access, and assessed their levels of health literacy using the eHealth Literacy Scale (eHeals). A total of 62 patients and 9 caregivers, with a mean age of 56, completed the questionnaire. The study found that 67% of participants used a telephone that had internet access. For the 10 items on the eHEALS instrument, the mean score was in the moderate range at 26/50 points. There was no difference in the mean eHEALS score between the English-speaking and LEP Spanish speaking groups, however 68% of English-speaking participants “agreed/ strongly agreed” that they knew how to use the internet to answer their health questions, compared to 47% of the Spanish-speaking participants (P<.05). The study concluded that despite moderate levels of electronic health literacy, participant’s perceived confidence and skills in engaging with electronic health systems were low.
AHRQ-funded; HS026407.
Citation: Valdovinos C, Perez-Aguilar G, Huerta RG .
Electronic health literacy among linguistically diverse patients in the Los Angeles County safety net health system.
Ethn Dis 2022 Winter;32(1):21-30. doi: 10.18865/ed.32.1.21..
Keywords: Health Literacy, Health Information Technology (HIT), Racial and Ethnic Minorities
Martin BA, Breslow RM, Sims A
Identifying over-the-counter information to prioritize for the purpose of reducing adverse drug reactions in older adults: a national survey of pharmacists.
This study’s objective was to determine which information on over-the-counter (OTC) Drug Facts Labels (DFS) is most critical in reducing adverse drug reactions (ADRs) among older adults and should be placed in front of the label. A national survey of practicing pharmacists knowledgeable about OTC medication use by older adults asked respondents to rank order the importance of the DFL sections to reduce ADRs. A total of 318 responses were analyzed. There was high consensus that uses and purposes, active ingredient, warnings, and directions for use were the most important sections on the label. Two specific warnings “Do not use” and “Ask a doctor or pharmacist” were deemed most important in the warnings section.
AHRQ-funded; HS025386.
Citation: Martin BA, Breslow RM, Sims A .
Identifying over-the-counter information to prioritize for the purpose of reducing adverse drug reactions in older adults: a national survey of pharmacists.
J Am Pharm Assoc 2022 Jan-Feb;62(1):167-75.e1. doi: 10.1016/j.japh.2021.08.019..
Keywords: Elderly, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Health Literacy, Education: Patient and Caregiver
Tieu L, Sarkar U, Schillinger D
Barriers and facilitators to online portal use among patients and caregivers in a safety net health care system: a qualitative study.
The researchers explored patient and caregiver perspectives on online patient portal use before its implementation at San Francisco General Hospital. Despite concerns about security, difficulty understanding medical information, and satisfaction with current communication processes, respondents generally expressed enthusiasm about portal use. Their findings suggest a strong need for training and support to assist vulnerable patients with portal registration and use, particularly those with limited health literacy.
AHRQ-funded; HS022561; HS022047; HS022408.
Citation: Tieu L, Sarkar U, Schillinger D .
Barriers and facilitators to online portal use among patients and caregivers in a safety net health care system: a qualitative study.
J Med Internet Res 2015 Dec 03;17(12):e275. doi: 10.2196/jmir.4847.
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Keywords: Web-Based, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Literacy
Petkovic J, Epstein J, Buchbinder R
Toward ensuring health equity: Readability and cultural equivalence of OMERACT patient-reported outcome measures.
The goal of the Outcome Measures in Rheumatology (OMERACT) 12 (2014) equity working group was to determine whether and how comprehensibility of patient-reported outcome measures (PROM) should be assessed, to ensure suitability for people with low literacy and differing cultures. The results of this preconference work were presented to the equity working group participants to gain their perspectives on the importance of comprehensibility and cross-cultural adaptation for PROM.
AHRQ-funded; HS021110.
Citation: Petkovic J, Epstein J, Buchbinder R .
Toward ensuring health equity: Readability and cultural equivalence of OMERACT patient-reported outcome measures.
J Rheumatol 2015 Dec;42(12):2448-59. doi: 10.3899/jrheum.141168.
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Keywords: Patient-Centered Outcomes Research, Outcomes, Health Literacy
Hahn EA, Burns JL, Jacobs EA
Health literacy and patient-reported outcomes: a cross-sectional study of underserved English- and Spanish-speaking patients with type 2 diabetes.
The investigators examined associations between patient characteristics, health behaviors, and health outcomes and explored the role of health literacy as a potential mediator of outcomes. They found that health literacy was not associated with diabetes self-care, health status, or satisfaction with communication, and it did not mediate the effects of other factors on these outcomes. Diabetes self-efficacy was significantly associated with health behaviors and outcomes. The association between Spanish language preference and poorer health was not mediated by this group's lower health literacy.
AHRQ-funded; HS019335.
Citation: Hahn EA, Burns JL, Jacobs EA .
Health literacy and patient-reported outcomes: a cross-sectional study of underserved English- and Spanish-speaking patients with type 2 diabetes.
J Health Commun 2015;20 Suppl 2:4-15. doi: 10.1080/10810730.2015.1061071.
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Keywords: Communication, Diabetes, Health Literacy, Patient-Centered Outcomes Research, Racial and Ethnic Minorities
Brega AG, Freedman MA, LeBlanc WG
AHRQ Author: Brach C
Using the Health Literacy Universal Precautions Toolkit to improve the quality of patient materials.
The researchers conducted interviews to learn about practices’ implementation activities and assessed the readability, understandability, and actionability of patient education materials collected during pre- and postimplementation site visits. They found that many of the revised and newly developed documents had reading levels appropriate for most patients and better readability than the original materials.
AHRQ-authored.
Citation: Brega AG, Freedman MA, LeBlanc WG .
Using the Health Literacy Universal Precautions Toolkit to improve the quality of patient materials.
J Health Commun 2015 Oct;20 Suppl 2:69-76. doi: 10.1080/10810730.2015.1081997..
Keywords: Health Literacy, Education: Patient and Caregiver, Quality of Care
Goodman MS, Griffey RT, Carpenter CR
Do subjective measures improve the ability to identify limited health literacy in a clinical setting?
The researchers assessed whether the addition of Single-Item Literacy Screener (SILS) items or the Brief Health Literacy Screen (BHLS) to patient demographics readily available in ambulatory clinical settings reaching underserved patients improves the ability to identify limited health literacy. Their findings suggest that the BHLS and SILS items improve the ability to identify patients with limited health literacy compared with demographic predictors alone.
AHRQ-funded; HS020309.
Citation: Goodman MS, Griffey RT, Carpenter CR .
Do subjective measures improve the ability to identify limited health literacy in a clinical setting?
J Am Board Fam Med 2015 Sep-Oct;28(5):584-94. doi: 10.3122/jabfm.2015.05.150037..
Keywords: Health Literacy, Vulnerable Populations
Fink A, Beck JC
Developing and evaluating a website to guide older adults in their health information searches: a mixed-methods approach.
This mixed-methods study developed and evaluated an online program to improve older adults’ skills in identifying high-quality web-based health information. It found that experimental participants assigned significantly higher ratings of usability and learning to the new site than controls did to their tutorial although no differences were found in self-efficacy or knowledge.
AHRQ-funded; HS019745.
Citation: Fink A, Beck JC .
Developing and evaluating a website to guide older adults in their health information searches: a mixed-methods approach.
J Appl Gerontol 2015 Aug;34(5):633-51. doi: 10.1177/0733464813486961..
Keywords: Elderly, Web-Based, Health Information Technology (HIT), Health Literacy
Mueller SK, Giannelli K, Boxer R
Readability of patient discharge instructions with and without the use of electronically available disease-specific templates.
The investigators examined the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge. They concluded that the use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion.
AHRQ-funded; HS023331.
Citation: Mueller SK, Giannelli K, Boxer R .
Readability of patient discharge instructions with and without the use of electronically available disease-specific templates.
J Am Med Inform Assoc 2015 Jul;22(4):857-63. doi: 10.1093/jamia/ocv005.
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Keywords: Education: Patient and Caregiver, Health Literacy, Hospital Discharge, Patient Safety
Slota C, Sayner R, Vitko M
Glaucoma patient expression of medication problems and nonadherence.
The purpose of this article was to evaluate what patient characteristics led patients to express (1) medication problems, including difficulty with side effects and eye drop administration, and (2) problems with nonadherence to glaucoma medications. It found that patients with lower health literacy are less likely to express medication-related problems and patients who express medication problems often express nonadherence.
AHRQ-funded; HS023054.
Citation: Slota C, Sayner R, Vitko M .
Glaucoma patient expression of medication problems and nonadherence.
Optom Vis Sci 2015 May;92(5):537-43. doi: 10.1097/opx.0000000000000574..
Keywords: Eye Disease and Health, Patient Adherence/Compliance, Medication, Health Literacy
Kestenbaum LA, Feemster KA
Identifying and addressing vaccine hesitancy.
Despite, and perhaps because of, their public health impact, an increasing number of parents and patients are choosing to delay or refuse vaccines. These individuals are described as “vaccine hesitant.” This review explores the history of vaccine hesitancy, its causes, and suggests approaches for reducing hesitancy and strengthening vaccine acceptance.
AHRQ-funded; HS020939.
Citation: Kestenbaum LA, Feemster KA .
Identifying and addressing vaccine hesitancy.
Pediatr Ann 2015 Apr;44(4):e71-5. doi: 10.3928/00904481-20150410-07..
Keywords: Vaccination, Health Literacy, Patient Adherence/Compliance
Heerman WJ, White RO, Barkin SL
Advancing informed consent for vulnerable populations.
The authors suggest an innovative approach that uses low health-literacy communication strategies and visual aids to augment and potentially replace the traditional approach to informed consent. This approach involves: (1) the use of effective health communication and low-literacy techniques, (2) the use of visual aids and graphics to promote understanding and guide the reader toward key study concepts, and (3) careful attention to child dissenting behaviors.
AHRQ-funded; HS022990.
Citation: Heerman WJ, White RO, Barkin SL .
Advancing informed consent for vulnerable populations.
Pediatrics 2015 Mar;135(3):e562-4. doi: 10.1542/peds.2014-3041..
Keywords: Children/Adolescents, Communication, Health Literacy, Obesity, Research Methodologies
Lyles CR, Sarkar U
Health literacy, vulnerable patients, and health information technology use: where do we go from here?
The authors comment on an article in the same issue that found only 32 percent of older adults used the Internet to get health information and only 10 percent of older adults with limited health literacy did so. They discuss its implications for the related issues of access, training, and perhaps most importantly, the usability of websites and other technology platforms.
AHRQ-funded; HS023558; HS022047.
Citation: Lyles CR, Sarkar U .
Health literacy, vulnerable patients, and health information technology use: where do we go from here?
J Gen Intern Med 2015 Mar;30(3):271-2. doi: 10.1007/s11606-014-3166-5..
Keywords: Health Literacy, Education: Patient and Caregiver, Elderly, Health Information Technology (HIT)
Smith W, Brach C, Horowitz AM
AHRQ Author: Brach C
Poor oral health literacy: why nobody understands you.
The authors examined the mistaken interpretation of the word “individuals” to be limited almost exclusively to citizens and patients. They identified gaps in knowledge, understanding, and practices regarding caries prevention among the public and all provider groups.
AHRQ-authored.
Citation: Smith W, Brach C, Horowitz AM .
Poor oral health literacy: why nobody understands you.
J Dent Hyg 2015 Feb;89 Suppl 1:36-8.
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Keywords: Dental and Oral Health, Health Literacy, Prevention
Dorn SD, Palsson OS, Woldeghebriel M
Development and pilot testing of an integrated, web-based self-management program for irritable bowel syndrome (IBS).
The researchers developed, assessed, and refined an integrated IBS self-management program (IBS Self-care) and then conducted a 12-week pilot test. They found that the IBS Self-Care program was well received by users who after 12 weeks reported improved knowledge about IBS, but no significant changes in self-efficacy or quality of life.
AHRQ-funded; HS019468.
Citation: Dorn SD, Palsson OS, Woldeghebriel M .
Development and pilot testing of an integrated, web-based self-management program for irritable bowel syndrome (IBS).
Neurogastroenterol Motil 2015 Jan;27(1):128-34. doi: 10.1111/nmo.12487..
Keywords: Patient Self-Management, Health Literacy, Education: Patient and Caregiver, Digestive Disease and Health
Halverson JL, Martinez-Donate AP, Palta M
Health literacy and health-related quality of life among a population-based sample of cancer patients.
The authors examined the relation between health literacy and health-related quality of life among cancer patients. Their cross-sectional survey found that health literacy is positively and independently associated with health-related quality of life among cancer patients. Their findings support adoption of health literacy best practices by cancer care systems.
AHRQ-funded; HS000083.
Citation: Halverson JL, Martinez-Donate AP, Palta M .
Health literacy and health-related quality of life among a population-based sample of cancer patients.
J Health Commun 2015;20(11):1320-9. doi: 10.1080/10810730.2015.1018638..
Keywords: Health Literacy, Quality of Life, Cancer