Health literacy and cancer screening in rural populations

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.