The effect of health literacy on knowledge and receipt of colorectal cancer screening: a survey study Public Deposited

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  • Brownlee, Caroline D
    • Other Affiliation: Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • Miller, David P
    • Other Affiliation: Department of Internal Medicine, Section of General Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  • McCoy, Thomas P
    • Other Affiliation: Department of Biostatistical Sciences, Section of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  • Pignone, Michael
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology
  • Abstract Background An estimated one-half of Americans have limited health literacy skills. Low literacy has been associated with less receipt of preventive services, but its impact on colorectal cancer (CRC) screening is unclear. We sought to determine whether low literacy affects patients' knowledge or receipt of CRC screening. Methods Pilot survey study of patients aged 50 years and older at a large, university-affiliated internal medicine practice. We assessed patients' knowledge and receipt of CRC screening, basic sociodemographic information, and health literacy level. We defined limited literacy as reading below the ninth grade level as determined by the Rapid Estimate of Adult Literacy in Medicine. Bivariate analyses and exact logistic regression were used to determine the association of limited health literacy with knowledge and receipt of CRC screening. Results We approached 105 patients to yield our target sample of 50 completing the survey (recruitment rate 48%). Most subjects were female (72%), African-American (58%), and had household incomes less than $25,000 (87%). Overall, 48% of patients had limited literacy skills (95% CI 35% to 61%). Limited literacy patients were less likely than adequate literacy patients to be able to name or describe any CRC screening test (50% vs. 96%, p < 0.01). In the multivariable model, limited literacy patients were 44% less likely to be knowledgeable of CRC screening (RR 0.56, p < 0.01). Self-reported screening rates were similar (54% vs. 58%, p = 0.88). Conclusion Patients with limited literacy skills are less likely to be knowledgeable of CRC screening compared to adequate literacy patients. Primary care providers should ensure patients' understanding of CRC screening when discussing screening options. Further research is needed to determine if educating low literacy patients about CRC screening can increase screening rates.
Date of publication
  • 17394668
  • doi:10.1186/1471-2296-8-16
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • David P Miller et al.; licensee BioMed Central Ltd.
Journal title
  • BMC Family Practice
Journal volume
  • 8
Journal issue
  • 1
Page start
  • 16
  • English
Is the article or chapter peer-reviewed?
  • Yes
  • 1471-2296
Bibliographic citation
  • BMC Family Practice. 2007 Mar 30;8(1):16
  • Open Access
  • BioMed Central Ltd

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