Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 S. Euclid Ave. Campus Box 8100, St. Louis, MO, 63110, USA.
Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
J Cancer Educ. 2021 Apr;36(2):240-252. doi: 10.1007/s13187-020-01915-x. Epub 2020 Nov 5.
Approximately one-third of adults in the United States (U.S.) have limited health literacy. Those with limited health literacy often have difficultly navigating the health care environment, including navigating care across the cancer continuum (e.g., prevention, screening, diagnosis, treatment). Evidence-based interventions to assist adults with limited health literacy improve health outcomes; however, little is known about health literacy interventions in the context of cancer and their impact on cancer-specific health outcomes. The purpose of this review was to identify and characterize the literature on health literacy interventions across the cancer care continuum. Specifically, our aim was to review the strength of evidence, outcomes assessed, and intervention modalities within the existing literature reporting health literacy interventions in cancer. Our search yielded 1036 records (prevention/screening n = 174; diagnosis/treatment n = 862). Following deduplication and review for inclusion criteria, we analyzed 87 records of intervention studies reporting health literacy outcomes, including 45 pilot studies (prevention/screening n = 24; diagnosis/treatment n = 21) and 42 randomized controlled trials or quasi-experimental trials (prevention/screening n = 31; diagnosis/treatment n = 11). This literature included 36 unique interventions (prevention/screening n = 28; diagnosis/treatment n = 8), mostly in the formative stages of intervention development, with few assessments of evidence-based interventions. These gaps in the literature necessitate further research in the development and implementation of evidence-based health literacy interventions to improve cancer outcomes.
大约三分之一的美国成年人（U.S.）存在健康素养有限的问题。这些人在医疗保健环境中常常难以应对，包括在癌症全过程中（例如，预防、筛查、诊断、治疗）寻求医疗服务。有证据支持的干预措施可以帮助健康素养有限的成年人改善健康结果；然而，关于癌症背景下的健康素养干预措施及其对癌症特定健康结果的影响的了解甚少。本研究的目的是确定并描述癌症护理全过程中健康素养干预措施的文献。具体而言，我们的目的是审查现有文献中关于癌症健康素养干预措施的报告，评估证据强度、评估结果和干预方式。我们的搜索结果产生了 1036 条记录（预防/筛查 n = 174；诊断/治疗 n = 862）。在进行去重和纳入标准审查后，我们分析了 87 篇报告健康素养结果的干预研究记录，其中包括 45 项试点研究（预防/筛查 n = 24；诊断/治疗 n = 21）和 42 项随机对照试验或准实验研究（预防/筛查 n = 31；诊断/治疗 n = 11）。该文献包括 36 项独特的干预措施（预防/筛查 n = 28；诊断/治疗 n = 8），主要处于干预措施开发的形成阶段，很少评估基于证据的干预措施。这些文献中的空白需要进一步研究开发和实施基于证据的健康素养干预措施，以改善癌症结果。
