Literacy Barriers to Colorectal Cancer Screening in Community Clinics

Figures & data

Table 1. Demographics, by literacy level

Variable	Low literacy (n = 506)	Adequate literacy (n = 469)	Total (n = 975)
Gender (p < .0001)
Female	359 (71.4%)	392 (83.6%)	751 (77.1%)
Male	144 (28.6%)	77 (16.4%)	221 (22.9%)
Race (p < .0001)
African American	415 (82.5%)	239 (51.0%)	654 (67.3%)
White	86 (17.1%)	229 (48.8%)	315 (32.4%)
Hispanic	2 (0.4%)	1 (0.2%)	3 (0.3%)
Age (p < .0001)
50–59 years	297 (58.7%)	323 (68.9%)	620 (63.6%)
60–69 years	144 (28.5%)	123(26.2%)	267 (27.3%)
70 + years	65 (13.0%)	23 (4.9%)	88 (9.1%)
Marital status (p < .0001)
Single	166 (33.0%)	116 (24.7%)	282 (29.1%)
Married	140 (27.8%)	193 (41.2%)	333 (34.3%)
Separated	34 (6.8%)	32 (6.8%)	66 (6.7%)
Divorced	81 (16.1%)	76 (16.2%)	157 (16.1%)
Widowed	82 (16.3%)	52 (11.1%)	134 (13.8%)
Last grade completed (p < .0001)
Less than high school	226 (45.0%)	92 (19.6%)	318 (32.7%)
High school graduate	210 (41.8%)	229 (48.8%)	439 (45.3%)
Some college	52 (10.7%)	107 (22.8%)	161 (16.4%)
College grad and above	13 (2.6%)	41 (8.7%)	54 (5.6%)
Location (p < .0001)
Rural	337 (66.6%)	364 (77.6%)	701 (72.0%)
Urban	169 (33.4%)	105 (22.4%)	274 (28.0%)

Table 2. Knowledge and awareness, by literacy level

Variable	Low literacy, n (%)	Adequate literacy, n (%)
Have you ever heard of CRC? (p = .49)
Yes	462 (95.7%)	443 (96.5%)
No	21 (4.4%)	16 (3.5%)
Do you know anyone who has had CRC? (p < .0001, multivariate p < .0001)
Yes	197 (40.9%)	262 (57.1%)
No	275 (57.1%)	194 (42.3%)
Don't know	10 (1.9%)	3 (0.7%)
Have you ever heard of any tests to find CRC? (p < .0001, multivariate p = .0016)
Yes	226 (46.9%)	304 (66.2%)
No	245 (50.8%)	148 (32.2%)
Don't know	11 (2.3%)	7 (1.5%)
If yes, which tests (name all that you have heard of)?
FOBT (p < .0001, multivariate p = .0018)	115 (50.9%)	104 (34.2%)
Colonoscopy (p < .0001, multivariate p = .0007)	173 (76.6%)	282 (92.8%)
Sigmoidoscopy (p = .0003, multivariate p = .0035)	3 (1.3%)	26 (8.6%)
Have you ever seen one of these FOBTs? [stool and tissue tests are shown] (p = .051, multivariate p = .039)
Yes	185 (38.4%)	192 (41.8%)
No	289 (60.0%)	266 (58.0%)
Don't know	8 (1.7%)	1 (0.2%)
Have you ever seen or heard an advertisement that encouraged you to get tested for CRC? (p < .0001, multivariate p < .0001)
Yes	283 (58.7%)	350 (76.3%)
No	187 (38.8%)	106 (23.1%)
Don't know	12 (2.5%)	3 (0.7%)
How helpful do you think it is to find CRC early? (p < .0001, multivariate p < .0001)
Very helpful	359 (74.5%)	422 (91.9%)
Helpful	92 (19.1%)	33 (7.2%)
Not very helpful	2 (0.4%)	0 (0.0%)
Not helpful at all	4 (0.8%)	0 (0.0%)
Don't know	25 (5.2%)	4 (0.9%)

Table 3. Beliefs, by literacy level

Variable	Low literacy, n (%)	Adequate literacy, n (%)
If you had CRC, would you want to know about it? (p = .022)
Yes	424 (88.0%)	426 (92.8%)
No	39 (8.1%)	18 (3.9%)
Don't know	19 (4.0%)	15 (3.3%)
How worried are you that you might find out you have CRC? (p = .36)
Very worried	21 (4.4%)	23 (5.0%)
Somewhat worried	80 (16.6%)	91 (19.8%)
Not worried	185 (38.4%)	170 (37.0%)
Not worried at all	182 (37.8%)	163 (35.5%)
Don't know	14 (2.9%)	12 (2.6%)
I feel I will get CRC sometime during my life (p = .013)
Strongly agree	8 (1.7%)	6 (1.3%)
Agree	138 (28.6%)	112 (24.4%)
Disagree	194 (40.3%)	215 (46.8%)
Strongly disagree	44 (9.1%)	55 (12.0%)
Don't know	98 (20.3%)	71 (15.5%)
Having an FOBT will help me find colon and rectal problems early (p = .0027, multivariate p = .0003)
Strongly agree	72 (14.9%)	121 (26.4%)
Agree	379 (78.6%)	329 (71.7%)
Disagree	5 (1.0%)	3 (0.7%)
Strongly disagree	2 (0.4%)	0 (0.0%)
Don't know	24 (4.6%)	6 (1.3%)
Having an FOBT will decrease my chances of dying from CRC (p = .0156, multivariate p = .015)
Strongly agree	45 (9.3%)	88 (19.2%)
Agree	327 (67.8%)	296 (64.5%)
Disagree	54 (11.2%)	44 (9.6%)
Strongly disagree	6 (1.2%)	5 (1.1%)
Don't know	50 (10.4%)	26 (5.7%)
I am afraid to do an FOBT because I am afraid of finding out that something is wrong (p = .49)
Strongly agree	10 (2.1%)	16 (3.5%)
Agree	79 (16.4%)	56 (12.2%)
Disagree	315 (65.4%)	266 (58.0%)
Strongly disagree	65 (13.5%)	110 (24.0%)
Don't know	13 (2.7%)	11 (2.4%)

Table 4. Self-efficacy, by literacy level

Variable	Low literacy, n (%)	Adequate literacy, n (%)
I know for sure I can get an FOBT kit (p = .20, multivariate p = .04)
Strongly agree	30 (6.2%)	81 (17.7%)
Agree	403 (83.6%)	346 (75.4%)
Disagree	16 (3.3%)	9 (2.0%)
Strongly disagree	0 (0.0%)	3 (0.7%)
Don't know	33 (6.9%)	20 (4.4%)
I know for sure I can find out how to correctly complete an FOBT kit at home (p = .081)
Strongly agree	30 (6.2%)	87 (19.0%)
Agree	424 (88.0%)	359 (78.2%)
Disagree	8 (1.7%)	4 (0.9%)
Strongly disagree	0 (0.0%)	0 (0.0%)
Don't know	20 (4.2%)	9 (2.0%)
I know for sure I will mail the card with the results on it back to the clinic (p = .59)
Strongly agree	46 (9.5%)	129 (28.1%)
Agree	429 (89.0%)	324 (70.6%)
Disagree	3 (0.6%)	1 (0.2%)
Strongly disagree	0 (0.0%)	0 (0.0%)
Don't know	4 (0.8%)	5 (1.1%)

Table 5. Barriers, by literacy level

Variable	Low literacy, n (%)	Adequate literacy, n (%)
I am afraid the FOBT instructions will be confusing (p < .0001)
Strongly agree	2 (0.4%)	1 (0.2%)
Agree	56 (11.6%)	22 (4.8%)
Disagree	366 (75.9%)	341 (74.3%)
Strongly disagree	19 (3.9%)	75 (16.3%)
Don't know	39 (8.1%)	20 (4.4%)
Doing FOBT is embarrassing (p < .0001)
Strongly agree	3 (0.6%)	2 (0.4%)
Agree	77 (16.0%)	37 (8.1%)
Disagree	357 (74.1%)	345 (75.2%)
Strongly disagree	23 (4.8%)	65 (14.2%)
Don't know	22 (4.6%)	10 (2.2%)
Doing an FOBT is a lot of trouble (p = .0031)
Strongly agree	3 (0.6%)	1 (0.2%)
Agree	45 (9.3%)	27 (5.9%)
Disagree	359 (74.5%)	340 (74.1%)
Strongly disagree	26 (5.4%)	64 (13.9%)
Don't know	49 (10.3%)	27 (5.9%)
Doing an FOBT is messy (p = .013)
Strongly agree	5 (1.0%)	5 (1.1%)
Agree	107 (22.2%)	79 (17.2%)
Disagree	278 (57.7%)	272 (59.3%)
Strongly disagree	15 (3.1%)	49 (10.7%)
Don't know	77 (16.0%)	54 (11.8%)

Table 6. Recommendation and behavior, by literacy level

	Low literacy, n (%)	Adequate literacy, n (%)
Has a doctor ever recommended that you get tested/screened for colon cancer? (p = .79)
Yes	185 (38.4%)	179 (39.0%)
No	291 (60.4%)	272 (59.3%)
Don't know	6 (1.2%)	8 (1.7%)
Have you ever been given information or education on either of the FOBT tests? (p = .013)
Yes	78 (16.2%)	103 (22.4%)
No	391 (81.1%)	351 (76.5%)
Don't know	13 (2.7%)	5 (1.1%)
Has a doctor ever given you one of the FOBT kits or stool tests? (p = .17)
Yes	152 (31.5%)	125 (27.2%)
No	322 (66.7%)	330 (71.9%)
Don't know	8 (1.7%)	4 (0.9%)
Have you ever done an FOBT kit or stool test? (p = .073, multivariate p = .036)
Yes	134 (27.8%)	133 (29.0%)
No	340 (70.5%)	325 (70.8%)
Don't know	8 (1.7%)	1 (0.2%)