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Patient Educ Couns. 2009 Jun;75(3):352-7. doi: 10.1016/j.pec.2009.03.015. Epub 2009 Apr 21.

Health literacy and self-efficacy for participating in colorectal cancer screening: The role of information processing.

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Epidemiology & Public Health, UCL, London, United Kingdom.



This study aimed to document the association between health literacy and willingness and ability to seek information about the new colorectal cancer (CRC) screening program in the UK.(1) We also assessed self-efficacy for screening to determine the impact of health literacy on perceived confidence to take part in screening.


Ninety-six participants aged 50-69 years completed the British version of the Test of Functional Health Literacy in Adults (TOFHLA) (UK-TOFHLA) and used an interactive information menu to select information on why and how to participate in CRC screening. We derived a measure of reading effort by calculating the average amount of time spent reading individual information links. Each participant also completed a measure of comprehension, and self-efficacy for participating in screening.


A multivariate analysis supported the hypothesis that lower health literacy would be associated with less information-seeking (b=.079, 95% confidence interval, .001-.157) greater effort in reading (b=-.965, 95% CI, -1.457 to -.473) and less self-efficacy for CRC screening (b=.61, 95% CI, .009-.131).


Lower health literacy had a direct impact on information-seeking. It was also independently associated with perceived confidence to participate in screening.


Reliance on printed communication when inviting low literate adults for screening can be problematic. The independent association between health literacy and self-efficacy further adds to the challenge of developing accessible and effective health promotion materials in this area.

[Indexed for MEDLINE]

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