Introduction
Health literacy affects how patients behave within the healthcare system. Overutilization
of screening procedures inconsistent with the U.S. Preventive Services Task Force
guidelines contributes to the high cost of health care. The authors hypothesize that
higher health literacy supports guideline-concordant screening. This study assesses
the effect of health literacy on nonrecommended prostate, breast, and cervical cancer
screening in patients older than the recommended screening age limit.
Methods
The 2016 Behavioral Risk Factor Surveillance System included health literacy modules.
Respondents self-reported their ability to obtain and understand health information,
resulting in 4 health literacy rankings. The authors calculated the population-weighted
proportion of respondents in each health literacy category who underwent screening
past the Task Force‒recommended age limit. The ORs of nonrecommended screening for
each malignancy were calculated, with low health literacy as the ref category.
Results
Individuals with higher health literacy underwent more nonrecommended screening. Nonrecommended
prostate cancer screening was performed in 27.4% (95% CI=23.7%, 31.4%) and 47.7% (95%
CI=44.1%, 51.3%) of respondents with low and high health literacy, respectively (p<0.001). Nonrecommended breast cancer screening was performed in 46.8% (95% CI=42.6%,
51.1%) and 67.7% (95% CI=64.2%, 71.1%) of respondents with low and high health literacy,
respectively (p=0.002). Nonrecommended cervical cancer screening was performed in 33.8% (95% CI=31.1%,
36.5%) and 48.4% (95% CI=46.3%, 50.5%) of respondents with low and high health literacy,
respectively (p<0.001). Individuals with high health literacy were significantly more likely than
those with low health literacy to screen against the recommendations for prostate
(OR=1.73, 95% CI=1.34, 2.23, p<0.001), cervical (OR=1.533, 95% CI=1.31, 1.80, p<0.001), and breast (OR=8.213, 95% CI=4.90, 13.76, p<0.001) cancer.
Conclusions
Higher health literacy correlates with increased rates of screening beyond the recommended
age, contrary to the study hypothesis. Breast cancer demonstrated the highest rates
of nonrecommended screening.
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REFERENCES
Behavioral Risk Factor Surveillance System: 2016 BRFSS survey data and documentation. Centers for Disease Control and Prevention. https://www.cdc.gov/brfss/annual_data/annual_2016.html. Updated February 20, 2019. Accessed September 15, 2020.
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Article Info
Publication History
Published online: December 17, 2020
Identification
Copyright
© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
