Abstract P6-11-06: The association of health literacy with internet usage for breast cancer patient education
Authors: Julian Bao-Quynh , Karamanos Efstathios , Smith Kari Eugenia , Elmi Maryam , Shah Amita Rashmikant 
Published: March 2020

Abstract
Introduction: As more breast cancer educational resources are transitioned from printed materials to online formats, it is important to identify the patients that are at risk for low health literacy and who still need access to printed materials. The purpose of this study is to evaluate breast cancer patient health literacy and internet access in the South Texas region and to establish how they prefer to learn about their condition and surgical options.
Methods: A 15-item questionnaire was given to patients with newly diagnosed breast cancer at the University Texas Health San Antonio Mays Cancer Center including a validated 3-question health question health literacy assessment, defining patients with high (HHL) or low health literacy (LHL). Patients enrolled in the study were 21 years old or older and planning to undergo mastectomy or lumpectomy for ductal carcinoma in situ, stage I, II, III, or prophylaxis (n=112). Patients who had cancers other than breast cancer were not eligible to participate. Questionnaires were included in the analysis if they were greater than 90% completed. Relationships between demographics, and type of media use were assessed.
Results: English was the preferred language for 79.5% of the patients followed by Spanish for 17.9%. Seventy nine percent of breast cancer patients had high health literacy while 21% had low healthy literacy. LHL was associated with high school level education (High school: 83%, College: 17%, p=0.001) and patients with LHL were less likely to access the Internet for healthcare information, (LHL: 28%, HHL 69%, p&lt; 0.001). After adjusting for differences: language, education, age, and cancer stage, possession of a smartphone and access to Internet at home was not associated with Internet use for healthcare information. Regardless of level of education, patients preferred receiving information via printed materials (High school: 60.2%, College: 71%, p=0.581). Neither groups preferred using supplemental videos (High school: 79% and College: 89%, p=0.58). There was no correlation between the level of education and the number of resources patients used to gain knowledge about their breast cancer and reconstructive options (Spearman correlation = 0.111).
Conclusion: The majority of South Texas breast cancer patients do have access to the internet but still prefer written materials over online resources. This preference was not driven by patients’ language, educational level, or access to the internet or a smartphone. However, patients that had low health literacy were less likely to use the internet for health related information. As more healthcare information is being digitized, access to printed materials and traditional methods of education should still be available to avoid disparities in health education delivery. Further study will be done to determine the reason for preference of written over online educational materials and the utility of implementing interventions such as courses to teach patients about utilization of online resources.
Citation Format: Bao-Quynh Julian, Efstathios Karamanos, Kari Eugenia Smith, Maryam Elmi, Amita Rashmikant Shah. The association of health literacy with internet usage for breast cancer patient education [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-06.