There is a need to investigate which health information sources are used and trusted by people with limited health literacy to help identify strategies for addressing knowledge gaps that can contribute to preventable illness. We examined whether health literacy was associated with people's use of and trust in a range of potential health information sources. Six hundred participants from a GfK Internet survey panel completed an online survey. We assessed health literacy using the Newest Vital Sign, the sources participants used to get health information, and the extent to which participants trusted health information from these sources. We performed multivariable regressions, controlling for demographic characteristics. Lower health literacy was associated with lower odds of using medical websites for health information and with higher odds of using television, social media, and blogs or celebrity webpages. People with lower health literacy were less likely to trust health information from specialist doctors and dentists, but more likely to trust television, social media, blogs/celebrity webpages, friends, and pharmaceutical companies. People with limited health literacy had higher rates of using and trusting sources such as social media and blogs, which might contain lower quality health information compared to information from healthcare professionals. Thus, it might be necessary to enhance the public's ability to evaluate the quality of health information sources. The results of this study could be used to improve the reach of high-quality health information among people with limited health literacy and thereby increase the effectiveness of health communication programs and campaigns.

Objective We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision-making is an advantageous model for studying patient treatment decision-making dynamics as there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Methods Men with newly diagnosed clinically localized prostate cancer (N=1529) completed measures of decisional control, prostate cancer knowledge, and their decision-making experience (decisional conflict, and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed 6-months after treatment. Results More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction, but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control predicted better QOL 6-months post-treatment. Conclusion Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects.

Purpose To determine if, among men with clinically localized prostate cancer (PCa), and in particular, men with low risk disease, greater emotional distress increases the likelihood of receiving surgery over radiation or active surveillance. Materials and Methods Participants were 1531 patients recruited from 2 academic and 3 community facilities (83% non-Hispanic white, 11% non-Hispanic black, 6% Hispanic; 36% low risk, 49% intermediate risk, 15% high risk; 24% chose active surveillance, 27% chose radiation, 48% chose surgery). Emotional distress was assessed shortly after diagnosis and after men made the treatment decision with the Distress Thermometer. We used multinomial logistic regression with robust standard errors to test if emotional distress at either time point predicted treatment choice in the sample as a whole and after stratifying by D’Amico risk score. Results and Conclusions In the sample as a whole, participants who were more emotionally distressed at diagnosis were more likely to choose surgery over active surveillance (RRR=1.07, 95% CI=1.01, 1.14, p=.02). Men who were more distressed close to the time they made their treatment choice were more likely to have chosen surgery over active surveillance (RRR = 1.16, 95% CI = 1.09, 1.24, p<.001) or surgery over radiation (RRR=1.12, 95% CI=1.05, 1.19, p=.001). This pattern was also found among men with low risk disease. Emotional distress may motivate men with low risk PCa to choose more aggressive treatment. Addressing emotional distress prior to, and during treatment decision-making may reduce a barrier to uptake of active surveillance.