Health literacy and colorectal cancer screening decision-making among African Americans

African Americans are disproportionately impacted by colorectal cancer (CRC) incidence and mortality. Early detection of CRC can lead to reduced incidence and mortality. However, African Americans are screened for CRC at lower rates than Whites. The ability to make an informed decision regarding CRC screening is related to increased screening completion. Health literacy has been linked to increased CRC screening knowledge, however research investigating the link between health literacy and CRC screening decision-making is limited. The study was conducted in the context of Project HEAL (Health through Early Awareness and Learning), a church-based intervention focusing on cancer early detection intervention. A total of 97 participants attended a series of 3 workshops and completed surveys at baseline and 12-months, and an additional follow-up survey at 14-months focusing on health literacy and decision-making. Health literacy was a significant predictor of decisional conflict, decisional self-efficacy, and state of decision-making for CRC screening. Individuals with greater health literacy had greater decisional self-efficacy (β = .39, p < .001) and health literacy was inversely related to decisional conflict (β = -.41, p < .001). Lastly, individuals with increased health literacy were closer to making a CRC screening decision (β = .32, p < .05). The findings suggest health literacy is associated with CRC screening decision-making among this sample of church-attending African Americans. Future studies should further investigate the relationship between health literacy and decision-making as well as the inclusion of health literacy in decision-making tools for CRC screening.