Article Data

  • Views 484
  • Dowloads 125

Original Research

Open Access

Health literacy, cancer literacy, comprehensions and knowledge among men attending a urology clinic

  • Timothy A Skyring1,2
  • Kolten Abbott1
  • Judy R Mullan1,3
  • Kylie J Mansfield1,*,

1Graduate School of Medicine, University of Wollongong, 2522 Wollongong, NSW, Australia

2South Coast Urology, 2522 Wollongong, NSW, Australia

3CHRISP, University of Wollongong, 2522 Wollongong, NSW, Australia

DOI: 10.22514/jomh.2023.053 Vol.19,Issue 7,July 2023 pp.16-23

Submitted: 06 October 2022 Accepted: 06 February 2023

Published: 30 July 2023

*Corresponding Author(s): Kylie J Mansfield E-mail:


Health literacy (HL) is essential for men receiving urological treatment so that they can be involved in the shared decision making process. HL is supported by domain specific background knowledge which also informs cancer literacy and comprehension. Comprehension is in turn a determinant of HL. This study aimed to assess the level of HL among a group of men receiving urological treatment and to investigate if there were any correlations between the two different measures of HL, cancer literacy and comprehension, and prostate cancer knowledge. A survey was mailed to 200 men attending a urological clinic. The survey included: demographic questions, two validated tests of HL, (1) the Brief Health Literacy Score (BHLS) and (2) the Health Literacy Management Scale (HeLMS); a test of cancer comprehension; the Cancer Message Literacy Tests Reading (CMLT); and a prostate cancer knowledge test. Descriptive statistics were used to analyse the data. Surveys from 72 respondents, average age of 65 years, were included in the final analysis. Based on the BHLS, 22%of respondents had inadequate HL and 50% of respondents had inadequate HL in one or more of the HeLMS domains. Overall, the study participants had relatively high cancer literacy, comprehensions, and knowledge. However, for men with inadequate HL, based on the BHLS and the HeLMS, there were strong correlations with poor cancer literacy, comprehension, and knowledge. Our study highlights that many men receiving urological treatment with inadequate HL, require additional support to access health information which they can understand and act on to be part of the shared decision-making process.


Health literacy; Prostate cancer; Knowledge; Cancer literacy and comprehension

Cite and Share

Timothy A Skyring,Kolten Abbott,Judy R Mullan,Kylie J Mansfield. Health literacy, cancer literacy, comprehensions and knowledge among men attending a urology clinic. Journal of Men's Health. 2023. 19(7);16-23.


[1] Nielsen-Bohlman L, Panzer AM, Kindig DA. Health literacy: a prescription to end confusion. Institute of Medicine. National Academies Press: Washington DC. 2004.

[2] Australian Bureau of Statistics. Literacy and life skills survey, summary results. 2008. Available at: https://www.$File/42280_2006%20(reissue).pdf (Accessed: 21 June 2021).

[3] Seaton CL, Oliffe JL, Rice SM, Bottorff JL, Johnson ST, Gordon SJ, et al. Health literacy among Canadian men experiencing prostate cancer. Health Promotion Practice. 2020; 21: 1004–1011.

[4] Nutbeam D. Defining and measuring health literacy: what can we learn from literacy studies? International Journal of Public Health. 2009; 54: 303–305.

[5] Nutbeam D. The evolving concept of health literacy. Social Science & Medicine. 2008; 67: 2072–2078.

[6] Greenberg D. Background knowledge: the neglected component in adult literacy. Journal of Adolescent & Adult Literacy. 2021; 64: 460–463.

[7] Chin J, Morrow DG, Stine-Morrow EAL, Conner-Garcia T, Graumlich JF, Murray MD. The process-knowledge model of health literacy: evidence from a componential analysis of two commonly used measures. Journal of Health Communication. 2011; 16: 222–241.

[8] McCarthy KS, Guerrero TA, Kent KM, Allen LK, McNamara DS, Chao S, et al. Comprehension in a scenario-based assessment: domain and topic-specific background knowledge. Discourse Processes. 2018; 55: 510–524.

[9] Smith R, Snow P, Serry T, Hammond L. The role of background knowledge in reading comprehension: a critical review. Reading Psychology. 2021; 42: 214–240.

[10] van Moort ML, Jolles DD, Koornneef A, van den Broek P. What you read versus what you know: neural correlates of accessing context information and background knowledge in constructing a mental representation during reading. Journal of Experimental Psychology: General. 2020; 149: 2084–101.

[11] Australian Institute of Health and Welfare. Australia’s health 2012. 2012. Available at: (Accessed: 11 May 2017).

[12] Friedman DB, Corwin SJ, Dominick GM, Rose ID. African American men’s understanding and perceptions about prostate cancer: why multiple dimensions of health literacy are important in cancer communication. Journal of Community Health. 2009; 34: 449–460.

[13] Mazor KM, Rubin DL, Roblin DW, Williams AE, Han PKJ, Gaglio B, et al. Health literacy-listening skill and patient questions following cancer prevention and screening discussions. Health Expectations. 2016; 19: 920–934.

[14] Naeim A. Communication and treatment decision making. Management of Cancer in the Older Patient. 2012; 16: 109–112.

[15] Australian Commission on Safety and Quality in Health Care. Health literacy: taking action to improve safety and quality. 2014. Available at: (Accessed: 27 January 2022).

[16] Song L, Chen RC, Bensen JT, Knafl GJ, Nielsen ME, Farnan L, et al. Who makes the decision regarding the treatment of clinically localized prostate cancer-the patient or physician? Cancer. 2013; 119: 421–428.

[17] Kim SP, Knight SJ, Tomori C, Colella KM, Schoor RA, Shih L, et al. Health literacy and shared decision making for prostate cancer patients with low socioeconomic status. Cancer Investigation. 2001; 19: 684–691.

[18] Goodwin BC, March S, Zajdlewicz L, Osborne RH, Dunn J, Chambers SK. Health literacy and the health status of men with prostate cancer. Psycho-Oncology. 2018; 27: 2374–2381.

[19] Clouston SA, Manganello JA, Richards M. A life course approach to health literacy: the role of gender, educational attainment, and lifetime cognitive capability. Age & Ageing. 2017: 46: 493–499.

[20] Australian Bureau of Statistics. Australian Social Trends. Health literacy. 2009. Available at: (Accessed: 21 June 2021).

[21] O’Shaughnessy P’, Laws TA. Australian men’s long term experiences following prostatectomy: a qualitative descriptive study. Contemporary Nurse. 2010; 34: 98–109.

[22] Peerson A, Saunders M. Men’s health literacy in Australia: in search of a gender lens. International Journal of Men’s Health. 2011; 10: 111–135.

[23] Australian Bureau of Statistics. Census of population and housing: socio-economic indexes for areas (SEIFA), Australia, 2016. 2016. Available at: 55.001 (Accessed: 23 September 2021).

[24] Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, et al. Validation of screening questions for limited health literacy in a large VA outpatient population. Journal of General Internal Medicine. 2008; 23: 561–566.

[25] Jordan JE, Buchbinder R, Briggs AM, Elsworth GR, Busija L, Batterham R, et al. The health literacy management scale (HeLMS): a measure of an individual’s capacity to seek, understand and use health information within the healthcare setting. Patient Education and Counseling. 2013; 91: 228–235.

[26] Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Family Medicine. 2004; 36: 588–594.

[27] Wallston KA, Cawthon C, McNaughton CD, Rothman RL, Osborn CY, Kripalani S. Psychometric properties of the brief health literacy screen in clinical practice. Journal of General Internal Medicine. 2014; 29: 119–126.

[28] Sand-Jecklin K, Coyle S. Efficiently assessing patient health literacy. Clinical Nursing Research. 2014; 23: 581–600.

[29] Louis AJ, Arora VM, Matthiesen MI, Meltzer DO, Press VG. Screening hospitalized patients for low health literacy: beyond the REALM of possibility? Health Education & Behavior. 2017; 44: 360–364.

[30] Briggs AM, Jordan JE, O’Sullivan PB, Buchbinder R, Burnett AF, Osborne RH, et al. Individuals with chronic low back pain have greater difficulty in engaging in positive lifestyle behaviours than those without back pain: an assessment of health literacy. BMC Musculoskeletal Disorders. 2011; 12: 161.

[31] Jayasinghe UW, Harris MF, Parker SM, Litt J, van Driel M, Mazza D, et al. The impact of health literacy and life style risk factors on health-related quality of life of Australian patients. Health and Quality of Life Outcomes. 2016; 14: 68.

[32] Mazor KM, Rogers HJ, Williams AE, Roblin DW, Gaglio B, Field TS, et al. The cancer message literacy tests: psychometric analyses and validity studies. Patient Education and Counseling. 2012; 89: 69–75.

[33] Ogunsanya ME, Brown CM, Odedina FT, Barner JC, Adedipe T. Determinants of prostate cancer screening intentions of young black men aged 18 to 40 years. Journal of Racial and Ethnic Health Disparities. 2017; 4: 1009–1020.

[34] Fisher KA, Tan ASL, Matlock DD, Saver B, Mazor KM, Pieterse AH. Keeping the patient in the center: common challenges in the practice of shared decision making. Patient Education and Counseling. 2018; 101: 2195–2201.

[35] DeWalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes. Journal of General Internal Medicine. 2004; 19: 1228–1239.

[36] Liddelow C, Mullan B, Boyes M. Adherence to the oral contraceptive pill: the roles of health literacy and knowledge. Health Psychology and Behavioral Medicine. 2020; 8: 587–600.

[37] Beauchamp A, Buchbinder R, Dodson S, Batterham RW, Elsworth GR, McPhee C, et al. Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the health literacy questionnaire (HLQ). BMC Public Health. 2015; 15: 678.

[38] Chang ME, Baker SJ, Dos Santos Marques IC, Liwo AN, Chung SK, Richman JS, et al. Health literacy in surgery. Health Literacy Research and Practice. 2020; 4: e46–e65.

[39] van Weert JCM, van Munster BC, Sanders R, Spijker R, Hooft L, Jansen J. Decision aids to help older people make health decisions: a systematic review and meta-analysis. BMC Medical Informatics and Decision Making. 2016; 16: 45.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Directory of Open Access Journals (DOAJ) DOAJ is a unique and extensive index of diverse open access journals from around the world, driven by a growing community, committed to ensuring quality content is freely available online for everyone.

SCImago The SCImago Journal & Country Rank is a publicly available portal that includes the journals and country scientific indicators developed from the information contained in the Scopus® database (Elsevier B.V.)

Publication Forum - JUFO (Federation of Finnish Learned Societies) Publication Forum is a classification of publication channels created by the Finnish scientific community to support the quality assessment of academic research.

Scopus: CiteScore 0.7 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Norwegian Register for Scientific Journals, Series and Publishers Search for publication channels (journals, series and publishers) in the Norwegian Register for Scientific Journals, Series and Publishers to see if they are considered as scientific. (

Submission Turnaround Time