Functional health literacy in Spanish-speaking Latinas seeking breast cancer screening through the National Breast and Cervical Cancer Screening Program

Abstract

Background:This analysis examines the association between functional health literacy and follow-up after mammography among women receiving breast cancer screening at a National Breast and Cervical Cancer Early Detection Program site in New York City that provides universal bilingual case management.Methods:A total of 707 Latinas who spoke Spanish as their primary language completed a survey of health and demographic characteristics and the Test of Functional Health Literacy in Spanish (TOFHLA-S). Survey results were matched with clinical outcome data.Results:Among the survey participants, 98% were foreign-born and 99% had no health insurance. While the study found significant differences in access to health information and past screening behavior, women without adequate health literacy in Spanish were no less likely to receive clinical resolution of abnormal mammograms within 60 days (81.8% overall; n = 110) or to return for a repeat mammogram within 18 months (57.2% overall; n = 697). In fact, among those referred for a Pap test (n = 310), women without adequate health literacy were more likely to receive a Pap test within 60 days of their mammogram than those with adequate health literacy (82% compared to 71%, OR: 1.83, 95% CI: 1.04–3.22).Discussion:The lack of significantly lower follow-up outcomes among women with inadequate and marginal functional health literacy in this population of primary Spanish-speaking Latinas suggests that, once women have accessed screening services, programmatic approaches may exist to mitigate barriers to follow-up and to ensure optimal cancer screening outcomes for women of all literacy levels.

Health literacy and cancer screening: A systematic review

“…The articles include 4 studies of colorectal cancer screening (Table 1) [38-41], 5 studies of breast cancer screening (Table 2) [39, 42-45], 3 studies of cervical cancer screening (Table 3) [39, 42, 46], and 2 studies of prostate cancer screening (Table 4) [39, 47]. …”

“…One study included only women older than 65 years of age [43]. All studies offered at least part of the interview in Spanish or English [39, 42-45]. Three of the five studies offered the health literacy assessment in Spanish or English [42, 44, 45].…”

“…All studies offered at least part of the interview in Spanish or English [39, 42-45]. Three of the five studies offered the health literacy assessment in Spanish or English [42, 44, 45]. All studies did not mention if individuals were excluded based on increased risk for breast cancer or included women at high-risk for breast cancer.…”

Fecal-Based Colorectal Cancer Screening Among the Uninsured in Northern Manhattan

“…The patient population is composed of predominantly female and foreign-born persons residing in northern Manhattan. Many patients are not fluent in English and have low literacy levels, even in their native language, 25 thus necessitating special measures to accommodate their particular language, educational, and literacy needs. Therefore, the NMCSP has historically provided face to face CRC education at the time of kit distribution by bilingual health educators, whose role is comparable to that of patient navigators in that they keep in contact with the patient until the screening test is complete, assess barriers, and provide counseling and education.…”

The Health Literacy and ESL Study: A Community-Based Intervention for Spanish-Speaking Adults

“…A recent study in California found persistent low health literacy among Hispanics with low English proficiency (Sentell, & Braun, 2012). Clinical-based studies conducted in North Carolina, New York, and California found high prevalence of low health literacy among male and female patients (Brice et al, 2008; Garbers, Schmitt, Rappa, & Chiasson, 2010; Sudore et al, 2009). One study with primary care patients on the U.S.-Mexico border found that more than 98% had adequate health literacy (Penaranda, Diaz, Noriega, & Shokar, 2012).…”