The Association Between Health Literacy and Cancer-Related Attitudes, Behaviors, and Knowledge

Nancy S. Morris University of Massachusetts Worcester, Graduate School of Nursing, Worcester, Massachusetts, USACorrespondence[email protected]

Terry S. Field University of Massachusetts Medical School, Worcester, Massachusetts, USA; Meyers Primary Care Institute, Worcester, Massachusetts, USA

Joann L. Wagner Meyers Primary Care Institute, Worcester, Massachusetts, USA

Sarah L. Cutrona University of Massachusetts Medical School, Worcester, Massachusetts, USA; Meyers Primary Care Institute, Worcester, Massachusetts, USA

Douglas W. Roblin Kaiser Permanente, Atlanta, Georgia, USA

Bridget Gaglio Mid-Atlantic Permanente Research Institute/Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA

Andrew E. Williams Kaiser Permanente, Honolulu, Hawaii, USA

Paul J. K. Han Center for Outcomes Research and Evaluation, Portland, Maine, USA

Mary E. Costanza University of Massachusetts Medical School, Worcester, Massachusetts, USA

Kathleen M. Mazor University of Massachusetts Medical School, Worcester, Massachusetts, USA; Meyers Primary Care Institute, Worcester, Massachusetts, USA

show all

Abstract

Using a multidimensional assessment of health literacy (the Cancer Message Literacy Test-Listening, the Cancer Message Literacy Test-Reading, and the Lipkus Numeracy Scale), the authors assessed a stratified random sample of 1013 insured adults (40–70 years of age). The authors explored whether low health literacy across all 3 domains (n =111) was associated with sets of variables likely to affect engagement in cancer prevention and screening activities: (a) attitudes and behaviors relating to health care encounters and providers, (b) attitudes toward cancer and health, (c) knowledge of cancer screening tests, and (d) attitudes toward health related media and actual media use. Adults with low health literacy were more likely to report avoiding doctor's visits, to have more fatalistic attitudes toward cancer, to be less accurate in identifying the purpose of cancer screening tests, and more likely to avoid information about diseases they did not have. Compared with other participants, those with lower health literacy were more likely to say that they would seek information about cancer prevention or screening from a health care professional and less likely to turn to the Internet first for such information. Those with lower health literacy reported reading on fewer days and using the computer on fewer days than did other participants. The authors assessed the association of low health literacy with colorectal cancer screening in an age-appropriate subgroup for which colorectal cancer screening is recommended. In these insured subjects receiving care in integrated health care delivery systems, those with low health literacy were less likely to be up to date on screening for colorectal cancer, but the difference was not statistically significant.

Acknowledgments

The study was a core project of the HMO Cancer Research Network, the “Health Literacy and Cancer Prevention: Do People Understand What They Hear?” funded by the National Cancer Institute (grant name: Cancer Research Network Across Health Care Systems; grant no. U19 CA 79689). Additional funding for participation of a fourth Cancer Research Network site was provided by a pilot grant through the Cancer Research Network Cancer Communication Research Center, also funded by the National Cancer Institute (P20 CA137219). The funding agency did not contribute to the study design, data collection, analysis, or interpretation; or to the decision to submit the manuscript for publication.

S. L. Cutrona is supported by Award Number KL2TR000160 from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.