A patient’s experience with lung cancer symptom self-management during treatment varies depending on their interactive health literacy (IHL), according to a study recently published in Cancer Nursing.

A team of researchers conducted a cross-sectional mixed-methods study to explore how interactive health literacy is related to lung cancer patients’ symptom self-management. They also explored the potential of integrating interactive health literacy into the Individual and Family Self-Management Theory (IFSMT), a theory that explains how patients engage in the process of self-management. 

They recruited 12 participants between the ages of 48 and 73 who had recently undergone treatment for lung cancer. Eleven of the patients were recruited virtually from online support groups. Of the 12 participants, 11 were white and 1 was black; 9 were female.

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The participants completed the All Aspects of Health Literacy Scale (AAHLS). However, only the IHL subset of the AAHLS was used for this study, with scores ranging from 3 to 9 (mean, 8.33). The researchers noted that average IHL level was in the moderate range. 

The participants also completed the Memorial Symptom Assessment Scale-Short Form (MSAS-SF). The results showed that all the participants experienced symptoms related to their cancer or treatment, with an average of 14 symptoms reported.

The most distressing symptom reported was lack of energy, with a mean distress score of 2.55. This symptom was also cited most frequently, with 10 patients reporting they experienced lack of energy. Meanwhile, the least distressing symptom was vomiting, with a mean distress score of 0.15. It was 1 of 2 symptoms that were cited by only 1 patient. 

After synthesizing qualitative and quantitative data, the researchers identified 3 themes:

  • Patients experience multiple symptoms, and symptom self-management is challenging.
  • Patients obtain and process symptom self-management information from multiple sources with varying levels of credibility.
  • Interactive health literacy plays a role in how patients access their providers and engage in conversations about symptom self-management.

The patient-provider relationship is a key factor in how patients with lung cancer obtain and process symptom management information, the researchers concluded. This influences how effectively patients can self-manage their symptoms. 

“It is vital for oncology providers to have increased awareness of patients’ IHL skills and to meet the social facilitation needs of patients with lower IHL,” the researchers wrote, in calling for provider training in communication skills that could mitigate health literacy disparities and improve patient-provider interactions. 


Campbell JK and Erickson JM. Interactive Health Literacy and Symptom Self-management in Patients with Lung Cancer: A Critical Realist Analysis. Cancer Nursing. Published online May 9, 2023. doi: 10.1097/NCC.0000000000001245