Date of Award

December 2020

Degree Type


Degree Name

Doctor of Philosophy



First Advisor

Jeanne Erickson

Committee Members

Jennifer Doering, Kris Barnekow, Carol Klingbeil


health literacy, lung cancer, oncology, self-management, symptom management


Patients with lung cancer experience multiple symptoms requiring self-management. Health literacy skills are necessary for obtaining and processing information related to symptom self-management. Interactive health literacy involves communicating with healthcare providers regarding health-related information, but the role of interactive health literacy in self-management is not clear. This study used a critical realist approach to address these specific aims: 1) explore interactive health literacy and how it relates to symptom self-management for patients with lung cancer; and 2) describe patients’ experiences of interactive with healthcare providers regarding symptom self-management for lung cancer. The study was conducted using a cross-sectional mixed methods design. Participants included 12 adults who were receiving or had recently received treatment for lung cancer. Data collection included a demographic questionnaire, the All Aspects of Health Literacy Scale, the Memorial Symptom Assessment Scale-Short Form, and semi-structured individual interviews. Data analysis followed a critical realist methodology aimed at discovering patterns that explain how interactive health literacy relates to symptom self-management. Findings identified that interactive health literacy skills may play a role in patients’ ability and confidence to acquire and process symptom management information through interaction with an oncology provider. Furthermore, the relationship between patients with lung cancer and their oncology providers is a generative mechanism for obtaining credible symptom management information. There are factors related to both structure and personal agency that impact patients’ access to and engagement in relationships with providers. Additional research is needed to determine patient-centered strategies that address these factors to promote patient engagement in collaborative patient-provider relationships and effective symptom self-management.

Available for download on Thursday, January 12, 2023

Included in

Nursing Commons