The Association of Health Literacy and Self-Efficacy to Cancer Chemotherapy Self-Management Behaviours and Health Service Utilization

Abstract Background Increasing demands on Canadaâ s healthcare system require patients to take on more active roles in their health [1]. Effective self-management has been linked to improved health outcomes; and there is evidence that effective behaviours are linked to health literacy, however, this link has had minimal testing in the cancer context [2, 3]. Firmly establishing this link is important because those aged 65 years and older comprise the majority of the users of the cancer care system, and these individuals are most at risk for inadequate health literacy [4]. As such, the cancer care system may require increased self-management by patients least able to do so and, in doing so, fail to provide adequate care and incur substantial cost [5-7]. Objectives To examine the association between health literacy and cancer chemotherapy self-management behaviours (CSMB) and health service utilization (HSU) and test the hypothesized relationship between self-efficacy and these outcomes. Design Cross-sectional survey. Methods Participants completed a questionnaire package with socio-demographic information and validated measures of health literacy, cancer coping self-efficacy, symptom severity, symptom interference, CSMB score, and HSU. Multivariate modeling using hierarchical linear regression was used to examine the association of health literacy to CSMB health services utilization. Results Education and language spoken at home explained a significant amount of variance (22.5%) in health literacy score. Health literacy was not significantly associated with any of the dependent variables in multivariate analysis. The analyses conducted to explore the association of self-efficacy to CSMB score and HSU showed that self-efficacy contributed to explaining variation in CSMB score but did not contribute significantly to explaining HSU. Conclusion This study provides new knowledge that advances understanding of the association of health literacy and self-efficacy on CSMBs and HSU in the context of cancer care.Ph.D