Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California

Abstract

ObjectivesEmpirical evidence regarding cancer screening and health literacy is mixed. Cancer is the leading cause of death in Asian Americans, yet screening rates are notably low. Using a population-based sample, we determined if health literacy: (1) was associated with breast and cervical cancer screening, and (2) helped to explain Asian cancer screening disparities.MethodsWe analyzed the 2007 California Health Interview Survey for Asian (Japanese, Chinese, Filipino, Korean, Vietnamese, other Asian) and white women within age groups relevant to US Preventive Services Task Force (USPSTF) screening guidelines: cervical: ages 21–65 (n = 15,210) and breast: ages 50–74 (n = 11,163). Multilevel logistic regression models predicted meeting USPSTF screening guidelines both with and without self-reported health literacy controlling for individual-level and contextual-level factors.ResultsLow health literacy significantly (p < 0.05) predicted lower cancer screening in final models for both cancer types. In unadjusted models, Asians were significantly less likely than whites to receive both screening types and significantly more likely to report low health literacy. However, in multivariable models, the addition of the low health literacy variable did not diminish Asian vs. white cancer screening disparities.ConclusionsSelf-reported health literacy predicted cervical and breast cancer screening, but was not able to explain Asian cancer screening disparities. We provide new evidence to support a relationship between health literacy and cancer screening. Health literacy is likely a useful focus for interventions to improve cancer screening and ultimately reduce the burden of cancer. To specifically reduce Asian cancer disparities, additional areas of focus should be considered.

Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis

“…It is also noteworthy that even in countries with organized screening services, these benefits are not maximized in underserved, uninsured and under-represented populations due to factors such as cost, access problems, anxiety, discomfort with the screening procedure, and fear of cancer or poor health literacy, all of which contribute to poor outcomes for cervical cancer. [ 21 – 25 ] Building health care systems that can address multiple factors simultaneously would improve cervical screening rates and overall outcomes for cervical cancer in populations at risk for this preventable cancer.…”

Familiarity, Navigation, and Comprehension: Key Dimensions of Health Literacy in Pap Test Use among Korean American Women

“…KAs, one of the largest Asian populations in the U.S., are predominantly foreign born (92.5%) and monolingual (70% do not speak English well) (Shin, 2003). Patients experiencing language discordance are more likely to have misconceptions and lack appropriate understanding of information provided; these differences negatively affect knowledge, attitude, and self-efficacy with regard to adequate utilization of preventive care (Davis et al, 1996;Lindau et al, 2002;Scott, Gazmararian, Williams, & Baker, 2002;Sentell, Braun, Davis, & Davis, 2015;Sentell & Halpin, 2006). Even highly educated individuals with high English proficiency skills find it difficult to correctly convert and interpret proportions commonly used to report cancer risks, resulting in increased misperceptions and lowered personalization of such risks (Lipkus, Samsa, & Rimer, 2001).…”

“…Even highly educated individuals with high English proficiency skills find it difficult to correctly convert and interpret proportions commonly used to report cancer risks, resulting in increased misperceptions and lowered personalization of such risks (Lipkus, Samsa, & Rimer, 2001). This problem is heightened among individuals in the U.S. with low English proficiency who are also predisposed to low health literacy (Fiscella, Franks, Doescher, & Saver, 2002;Jacobson, Hund, & Soto Mas, 2016;Sentell et al, 2015;Sentell & Halpin, 2006).…”

See, Test & Treat: A 5-Year Experience of Pathologists Driving Cervical and Breast Cancer Screening to Underserved and Underinsured Populations

“…The ability to understand information, such as written instructions from a doctor's office or reading instructions on a prescription bottle, has been used to assess health literacy. 5 In conjunction with other obstacles, such as language constraints and cultural biases, the need for cancer screening education is largely dependent on education level, cultural influences, and language barriers. To improve follow-up after screening studies, it may be helpful to have letters regarding results written in the language of the patient.…”