title: Low subjective health literacy is associated with adverse health behaviors and worse health-related quality of life among colorectal cancer survivors: results from the profiles registry.
abstract: BACKGROUND
  The objectives of the study were to examine the prevalence of health literacy (HL) among colorectal cancer (CRC) survivors and the relation between HL and health behaviors and to explore whether or not HL and health behaviors are independently associated with health-related quality of life (HRQoL) and mental distress.
  
  
  METHODS
  This analysis is part of a longitudinal, population-based survey among CRC survivors diagnosed between 2000 and 2009 and registered by the Eindhoven Cancer Registry. Data collected during the second data wave was used (n = 1643; response rate 83%). Patients filled out a screening question on subjective functional HL, questions on health behaviors, HRQoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30), and mental distress (Hospital Anxiety and Depression Scale).
  
  
  RESULTS
  Subjective HL was low among 14%, medium among 45%, and high among 42% of the participants. CRC survivors with low HL were more often smokers and did not meet the prescribed physical activity guidelines compared with survivors with medium or high HL. CRC survivors with low HL reported statistically significantly lower levels of mental and physical HRQoL and higher distress levels compared with survivors with medium and high HL. HL, in addition to sociodemographic and clinical characteristics and health behaviors, significantly explained 1.5-6.2% of the variance in HRQoL and mental distress levels. Partial mediation is indicated for HRQoL and feelings of depression, but not for anxiety.
  
  
  CONCLUSIONS
  Low subjective functional HL among CRC survivors is associated with lower levels of physical activity, higher frequency of smoking, poorer HRQoL, and more mental distress. HL and health behaviors have both a unique as well as an overlapping contribution to the explained variances of HRQoL and mental distress.
authors.affiliation: CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Comprehensive Cancer Centre Netherlands South, Eindhoven Cancer Registry, Eindhoven, the Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: Husson
authors.forename: F
authors.initials: F
authors.lastname: Mols
authors.forename: M P
authors.initials: MP
authors.lastname: Fransen
authors.forename: L V
authors.initials: LV
authors.lastname: van de Poll-Franse
authors.forename: N P M
authors.initials: NP
authors.lastname: Ezendam
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology; D015179:Colorectal Neoplasms / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005260:Female; D015438:Health Behavior; D057220:Health Literacy; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011788:Quality of Life / Q000523:psychology*; D012042:Registries; D012907:Smoking; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*
keywords: cancer; health behavior; health literacy; mental distress; quality of life