Literacy Barriers to Colorectal Cancer Screening in Community Clinics

Abstract

This article examines the relationship between literacy and colorectal cancer (CRC) screening knowledge, beliefs, and experiences, with a focus on fecal occult blood tests (FOBTs). Participants were 975 patients in 8 Louisiana federally qualified health centers. Participants were 50 years of age or older and not up to date with CRC screening; approximately half (52%) had low literacy (less than a 9th-grade level). Participants with low literacy were less likely than were those with adequate literacy to be aware of advertisements promoting CRC screening (58.7% vs. 76.3%, p < .0001) or to believe it was very helpful to find CRC early (74.5% vs. 91.9%, p < .0001). The majority of participants had positive beliefs about the benefits of CRC screening using FOBTs. Participants with low literacy had more perceived barriers to FOBT completion and were more likely to strongly agree or agree that FOBTs would be confusing, embarrassing, or a lot of trouble; however, none of these remained significant in multivariate analyses controlling for relevant covariates. Confidence in being able to obtain an FOBT kit was high among those with low and adequate literacy (89.8% vs. 93.1%, respectively, p = .20); yet multivariate analyses revealed a significant difference in regard to literacy (p = .04) with low-literacy participants indicating less confidence. There was no significant difference by literacy in ever receiving a physician recommendation for CRC screening (38.4% low vs. 39.0% adequate, p = .79); however, multivariate analyses revealed significant differences in FOBT completion by literacy (p = .036). Overall, findings suggest that literacy is a factor in patients’ CRC knowledge, beliefs, and confidence in obtaining a FOBT.

Evaluation of the Knowledge, Behavior and Health Beliefs of Individuals over 50 Regarding Colorectal Cancer Screening

“…In a similar vein, Greiner et al (2004) have found that older people and individuals with higher levels of education tend to participate more to the CRC screening programs. In another study, it has been found that individuals with lower levels of education have lower rates of awareness on CRC screening programs and that they are less likely to grasp the importance of early diagnosis of the colorectal cancer (Arnold et al, 2012).…”

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

“…Low health literacy is postulated to result in lower screening attendance through causing limited knowledge of health services and diseases, difficulty in understanding abstract concepts such as risk, a preference for emotional over factual information, and lower decision-making skills(von Wagner, Steptoe, et al, 2009). In the context of CRC screening, previous studies have shown that individuals with low levels of health literacy report more problems in seeking and processing health-related information (von Wagner, Semmler, Good, & Wardle, 2009), as well as barriers in understanding (Arnold et al, 2012;Peterson, Dwyer, Mulvaney, Dietrich, & Rothman, 2007) or completing screening (Kobayashi et al, 2014). In line with these hypotheses, we found that inadequate health literacy was associated with lower probability of screening uptake in univariate and multivariate models, and it contributed to nearly 8% of inequality.…”

Family Members' Obstructive Behaviors Appear to Be More Harmful Among Adults With Type 2 Diabetes and Limited Health Literacy

“…We also assessed whether supportive family behaviors were associated with better glycemic control only among patients with limited HL (HL X supportive), or whether supportive behaviors were more likely to protect against the effects of obstructive behaviors on worse glycemic control among patients with limited HL (HL X supportive X obstructive). Because limited HL is common among patients who receive care at Federally Qualified Health Centers (FQHCs) (Arnold et al, 2012), we explored these hypotheses with a racially diverse sample of adults with T2DM receiving care at a FQHC.…”