title: Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: does literacy make a difference?
abstract: OBJECTIVE
  To evaluate whether lower literacy is associated with poorer knowledge and more negative attitudes and beliefs toward colorectal cancer screening among veterans without recent colorectal cancer screening.
  
  
  METHODS
  Three hundred seventy-seven male veterans, age 50 years 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, an individually administered screening test for reading.
  
  
  RESULTS
  Thirty-six percent of the 377 men had an eighth grade literacy level or higher. Men with lower literacy were 3.5 times as likely not to have heard about colorectal cancer (8.8% v 2.5%; P =.006), 1.5 times as likely not to know about screening tests (58.4% v 40.9%; P =.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 two times as likely to be worried that FOBT was messy (26.7% v 13.3%; P =.008), 1.5 times as likely to feel that FOBT was inconvenient (28.7% v 18%; P =.05), and four times as likely to state they would not use an FOBT kit even if their physician recommended it (17.9% v 4.0%; P =.02).
  
  
  CONCLUSIONS
  Limited literacy may be an overlooked barrier in colorectal cancer screening among veterans.
authors.affiliation: Midwest Center for Health Services and Policy Research, VA Chicago Healthcare System, Department of Medicine, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA. ndo428@northwestern.edu
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Dolan
authors.forename: M Rosario
authors.initials: MR
authors.lastname: Ferreira
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Marian L
authors.initials: ML
authors.lastname: Fitzgibbon
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Dachao
authors.initials: D
authors.lastname: Liu
authors.forename: Brian P
authors.initials: BP
authors.lastname: Schmitt
authors.forename: Nicolle
authors.initials: N
authors.lastname: Gorby
authors.forename: Michael
authors.initials: M
authors.lastname: Wolf
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D004522:Educational Status; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D012812:Sigmoidoscopy; D014728:Veterans / Q000523:psychology*