Table 9Summary of studies of the relationship between health literacy and colon cancer screening (KQ 1a)

Authors, Year, Study Design, Literacy tool, Sample Size, QualityPopulation and Setting, Health Literacy LevelVariables Used in Multivariate AnalysisOutcome Measure

Results By Health Literacy Skill Level
Differences in Results Between Health Literacy Skill Levels
Miller et al., 200789

Cross-sectional

N= 50

Fair
University community-based internal medicine clinic

REALM
Limited: 48%
Adequate: 52%
AgeSelf-report of last time received colon screening

Limited: 54%
Adequate: 58%
No difference between limited and adequate groups: RR, 0.99; 95% CI, 0.64 -1.55
Cho et al., 200881

Cross-sectional

N = 489

Fair
Elderly outpatients at Hospital and an FQHC in Chicago

S-TOFHLA
Inadequate:50.9%
Adequate: 49.1%
Race
Ethnicity
Gender
Education
Self-report FOBT: NRDecreased probability in inadequate compared with adequate group; P < 0.05
Peterson et al., 200787

Cross-sectional

N = 99

Fair
Community health clinic in Nashville, TN

REALM
Limited: 29.3%
Adequate 70.7%
Age
Sex
Race
Insurance
Self-report of colon screening

Inadequate: 51.7%
Adequate: 65.7%
No difference between limited and adequate groups: OR, 0.67; 95% CI, 0.24-1.83
Guerra et al., 200588

Cross-sectional

N = 136

Fair
4 community clinics, 2 university practices in PA

S-TOFHLA
Inadequate:36%
Marginal: 6%
Adequate:58%
Ethnicity
Medicaid
Education
Income
Self-report FOBT
Inadequate/Marginal: 39%
Adequate: 64%

Sigmoidoscopy or Colonoscopy
Inadequate/Marginal: 30%
Adequate: 72%
No differences between inadequate/marginal and adequate groups: FOBT; P = 0.66 Sigmoidoscopy or Colonoscopy; P = 0.52
White et al., 200886

Cross-sectional

N = 18,100

Fair
Nationally representative US sample living in households

NAAL
Basic/below basic: 36%
Intermediate: 56%
Proficient: 12%
Age
Gender
Race
Poverty level
Insurance
Health status
Oral reading fluency
Self-report of colon screen

Below basic: 38%
Basic: 41%
Intermediate: 41%
Proficient: 36%
Adults over 65 years:
Decreased probability of having colon cancer screening basic/below basic groups; P < 0.05

CI=confidence interval; FOBT=fecal occult blood test; FQHC=federally qualified health center; N=number; NAAL=national assessment of adult literacy; NR=not reported; OR=odds ratio; REALM=Rapid Estimate of Adult Literacy in Medicine; RR=relative risk; S-TOFHLA=Short Test of Functional Health Literacy in Adults.

From: Results: Relationship of Health Literacy to Outcomes and Disparities

Cover of Health Literacy Interventions and Outcomes: An Updated Systematic Review
Health Literacy Interventions and Outcomes: An Updated Systematic Review.
Evidence Reports/Technology Assessments, No. 199.
Berkman ND, Sheridan SL, Donahue KE, et al.

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