Online Program

Health literacy and cancer screening in rural populations

Monday, November 4, 2013

Christine Huynh, MD, Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA
Arpita Aggarwal, MD, Msc, Department of Internal Medicine, Virginia Commonwealth Univeristy, Richmond, VA
Donna McClish, PhD, Department of Biostatistics, Virginia Commonwealth University Health System, Richmond, VA
Amy H Smith, PhD, CHES, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
Saba Masho, MD, MPH, DrPH, Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA
Wally Smith, MD, Division of Quality Health Care, Virginia Commonwealth University Center on Health Disparities (VCU CoHD), Richmond, VA
Background: Limited health literacy may impede individuals' capacity to obtain, process, and understand basic health information about cancer risk factors, guidelines for cancer screening and appropriate cancer screening tests. This Community Based Participatory Research (CBPR) study seeks to understand the receipt of cancer screening in two rural health districts of Virginia with diverse health literacy and resources.

Methods and Design: As part of a pilot intervention to improve cancer screening in rural populations, we assessed demographics and current cancer screening behavior at baseline (following USPSTF guidelines) for four preventable cancers: Breast, Cervical, Colorectal, and Prostate. An audible, third grade literacy level, self-administrated pre-intervention survey was conducted using tablet computers in the presence of a facilitator. An intensive CBPR approach guided survey development and participant recruitment. The Rapid Estimate of Adult Literacy in Medicine (REALM-R) was used to measure health literacy. Limited health literacy was defined as a REALM-R score of less than 6.

Results: During 6 weeks of recruitment, 443 participants completed a pre-intervention survey. Mean age was 42.9 years, 63.5% were women, 55% were white, 35% completed high school or less, 38% had insurance and 71% had a primary care provider. 25.3% had low REALM-R scores. Average screening rates in the overall sample were Cervical-66.7%, Colorectal-57.1%, Breast-46.4%, and Prostate-32.1%. Limited health literacy was associated with lower current colorectal cancer screening (41.2% versus 64.1%, p=0.0058) but not with breast, cervical and prostate cancers.

Conclusion: Patients with limited health literacy have a significantly lower uptake of preventative colorectal cancer screening.

Learning Areas:

Assessment of individual and community needs for health education
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
Describe one innovative approach for administering surveys in a limited health literacy population. List one preventable cancer where limited health literacy is associated with lower screening rates in a rural community.

Keyword(s): Cancer Screening, Rural Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a scientific interest in cancer screening in limited health literacy populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.