Colorectal cancer screening knowledge, attitudes, and beliefs among persons of lower socioeconomic status: does literacy make a difference

Dolan N, Ferreira MR, Davis T, Fitzgibbon M, Rademaker AW, Liu D, Schmitt BP, Gorby NS, Wolf M, Bennett CL. Colorectal cancer screening knowledge, attitudes, and beliefs among persons of lower socioeconomic status: does literacy make a difference. Paper presented at: VA HSR&D National Meeting; 2004 Mar 1; Washington.

Objective: To evaluate whether lower literacy is associated with poorer knowledge and more negative attitudes and beliefs towards colorectal cancer screening. Participants and Methods: Three hundred seventy seven male veterans, age 50 and older, who had not undergone recent colorectal cancer screening, were surveyed about their knowledge, attitudes, and beliefs regarding colorectal cancer screening. Patients' literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine (REALM), an individually administered reading screening test. Results: Thirty-six percent of the 377 men had a literacy level < 8th grade. Men with lower literacy were 3.5 times as likely not to have heard about colorectal cancer (8.8% vs. 2.5%, p = 0.006), 1.5 times as likely not to know about screening tests (58.4% vs. 40.9%, p = 0.0001), and were more likely to have negative attitudes about fecal occult blood testing (FOBT) but not about flexible sigmoidoscopy. Specifically, men with lower literacy skills were 2 times as likely to be worried that FOBT was messy (26.7% vs. 13.3%, p = 0.008), 1.5 times as likely to feel that FOBT was inconvenient (28.7% vs. 18%, 0.05) and 4 times as likely to state they would not use an FOBT kit even if their physician recommended it (17.9% vs 4.0%, p = 0.02). Conclusions: Limited literacy may be an overlooked barrier to use of colorectal cancer screening, particularly FOBT, among low-income men. In a health care setting where resource constraints limit the availability of sigmoidoscopy as a screening test, development of a culturally sensitive, low literacy intervention should be considered.