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.

Acknowledgments

The authors acknowledge Mr. Willie White, Mr. John Winston, Ms. Emma Tarver, Ms. Rosie Kye, Ms. Jeanetta Dean, and Dr. George Henderson for their willingness to participate in clinical research to help improve CRC screening in their clinics. The authors thank Cristalyn Reynolds, MA, Ivory Davis, MSN, Cara Pugh, BSN, David Neal, BSW, and Annie Miller, BSW, for their skill in interviewing patients and collecting and entering data. This study was sponsored by the National Cancer Institute (R01-CA115869).

Notes

Note. Univariate ps in parentheses were obtained using a chi-square test.

Note. Univariate ps were obtained using a chi-square test; multivariate ps were obtained using a logistic regression and were adjusted for age, gender, race, and location. CRC = colorectal cancer; FOBT = fecal occult blood test.

Note. Univariate ps were obtained using a chi-square test; multivariate ps were obtained using logistic regression and were adjusted for age, gender, race, and location. CRC = colorectal cancer; FOBT = fecal occult blood test.

Note. Univariate ps were obtained using a chi-square test; multivariate ps were obtained using logistic regression and were adjusted for age, gender, race, and location. FOBT = fecal occult blood test.

Note. Univariate ps were obtained using a chi-square test; multivariate ps were obtained using logistic regression and were adjusted for age, gender, race, and location. FOBT = fecal occult blood test.

Univariate ps were obtained using a chi-square test; multivariate ps were obtained using logistic regression and were adjusted for age, gender, race, and location. FOBT = fecal occult blood test.