Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
Health literacy as a determinant of psychosocial and functional outcomes in individuals at risk for lymphedema.
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Aslan Sefa Gümrük, İnan H Anıl, Köylü Sinem Uyar, Mandıroğlu Sibel
Аннотация
BACKGROUND: Health literacy may influence individuals' understanding of lymphedema, engagement in self-management, and perceived quality of life following breast cancer surgery. This study aimed to evaluate health literacy and its associations with demographic, clinical, functional, and psychosocial characteristics in women following breast cancer surgery.
METHODS: This cross-sectional study included 59 women who had undergone unilateral breast cancer surgery. Health literacy was assessed using the Turkish Health Literacy Scale-32 (TSOY-32), and lymphedema-related quality of life was evaluated using the LYMQOL-Arm questionnaire. Participants were classified according to lymphedema stage. Between-stage comparisons, correlation analyses, and exploratory ordinal logistic regression were performed.
RESULTS: The mean age was 55.71 ± 12.09 years. Health literacy was classified as inadequate in 11.9%, problematic/limited in 27.1%, sufficient in 33.9%, and excellent in 27.1% of participants. Lymphedema stage was associated with differences in the LYMQOL-Arm appearance domain (p = 0.045) and function domain (p = 0.046), although post hoc comparisons for function did not identify significant pairwise differences. Neither marital status nor occupation was significantly associated with lymphedema stage according to the Fisher-Freeman-Halton exact test (p = 0.372 and p = 0.761, respectively). In exploratory ordinal logistic regression, older age was associated with lower odds of higher health literacy (OR = 0.916, 95% CI 0.870-0.964; p < 0.001), whereas higher educational attainment was associated with greater odds (OR = 1.498, 95% CI 1.011-2.217; p = 0.044).
CONCLUSION: Health literacy varied considerably among women following breast cancer surgery and was associated with age and educational attainment. Functional and psychosocial quality-of-life domains were interrelated, while some differences were observed across lymphedema stages. These findings support further investigation of health-literacy-sensitive educational and self-management approaches in breast cancer-related lymphedema care.
METHODS: This cross-sectional study included 59 women who had undergone unilateral breast cancer surgery. Health literacy was assessed using the Turkish Health Literacy Scale-32 (TSOY-32), and lymphedema-related quality of life was evaluated using the LYMQOL-Arm questionnaire. Participants were classified according to lymphedema stage. Between-stage comparisons, correlation analyses, and exploratory ordinal logistic regression were performed.
RESULTS: The mean age was 55.71 ± 12.09 years. Health literacy was classified as inadequate in 11.9%, problematic/limited in 27.1%, sufficient in 33.9%, and excellent in 27.1% of participants. Lymphedema stage was associated with differences in the LYMQOL-Arm appearance domain (p = 0.045) and function domain (p = 0.046), although post hoc comparisons for function did not identify significant pairwise differences. Neither marital status nor occupation was significantly associated with lymphedema stage according to the Fisher-Freeman-Halton exact test (p = 0.372 and p = 0.761, respectively). In exploratory ordinal logistic regression, older age was associated with lower odds of higher health literacy (OR = 0.916, 95% CI 0.870-0.964; p < 0.001), whereas higher educational attainment was associated with greater odds (OR = 1.498, 95% CI 1.011-2.217; p = 0.044).
CONCLUSION: Health literacy varied considerably among women following breast cancer surgery and was associated with age and educational attainment. Functional and psychosocial quality-of-life domains were interrelated, while some differences were observed across lymphedema stages. These findings support further investigation of health-literacy-sensitive educational and self-management approaches in breast cancer-related lymphedema care.