Elsevier

Preventive Medicine

Volume 61, April 2014, Pages 100-105
Preventive Medicine

Limited health literacy is a barrier to colorectal cancer screening in England: Evidence from the English Longitudinal Study of Ageing

https://doi.org/10.1016/j.ypmed.2013.11.012Get rights and content
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open access

Highlights

  • We examine the role of health literacy in colorectal cancer screening in England.

  • Almost one in three English adults aged 60–75 have limited health literacy skills.

  • Low literacy is a barrier to colorectal cancer screening participation in England.

  • Interventions are needed to reduce literacy-based screening inequalities.

Abstract

Objective

To determine the association between health literacy and participation in publicly available colorectal cancer (CRC) screening in England using data from the English Longitudinal Study of Ageing (ELSA).

Methods

ELSA is a population-based study of English adults aged ≥ 50 years. Health literacy, participation in the national CRC screening programme, and covariates were interview-assessed in 2010–11. All those age-eligible for screening from 2006 to 11 were included in the present analysis (n = 3087). The association between health literacy and screening was estimated using multivariable-adjusted logistic regression.

Results

73% of participants had adequate health literacy skills. Screening uptake was 58% among those with adequate and 48% among those with limited health literacy skills. Having adequate health literacy was associated with greater odds of CRC screening (multivariable adjusted OR = 1.20; 95% CI: 1.00–1.44), independent of other predictors of screening: age (OR = 0.92; 95% CI: 0.91–0.94 per one year increase), female sex (OR = 1.31; 95% CI: 1.11–1.54), and being in a higher wealth quintile (OR = 1.88; 95% CI: 1.43–2.49).

Conclusions

Limited health literacy is a barrier to participation in England's national, publicly available CRC screening programme. Interventions should include appropriate design of information materials, provision of alternative support, and increased one-on-one interaction with health care professionals.

Keywords

Colorectal cancer screening
Early detection
Faecal occult blood test
Health equity
Organised Screening
Health literacy
Communication

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