title: The influence of health literacy on colorectal cancer screening knowledge, beliefs and behavior.
abstract: OBJECTIVE
  To determine if health literacy is associated with knowledge of colorectal cancer (CRC) and CRC screening tests, with perceived benefits and barriers to CRC screening, with perceived risk of CRC, with reported self-efficacy for completing CRC screening and with receipt of CRC tests.
  
  
  METHODS
  A convenience sample of 99 subjects completed a health literacy assessment, the Rapid Estimate of Adult Literacy in Medicine (REALM) and a structured interview.
  
  
  RESULTS
  Limited or inadequate health literacy was significantly associated with less knowledge about CRC and CRC screening and with more reported barriers to completing fecal occult blood testing (FOBT) and colonoscopy in multivariate analysis. Health literacy was not associated with perceived benefits or reported self-efficacy for completing FOBT or colonoscopy, with perceived risk of developing CRC or with completing CRC tests. However, our small sample size limited our power to detect differences.
  
  
  CONCLUSIONS
  Patients with limited health literacy have less knowledge about CRC and CRC screening and report more barriers to completing FOBT and colonoscopy. Interventions to improve CRC screening should consider the health literacy of patients, especially when addressing barriers to screening. Future studies are needed to better define the role of health literacy in CRC screening.
authors.affiliation: Center for Health Services Research, Division of General Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. neeraja.peterson@vanderbilt.edu
authors.forename: Neeraja B
authors.initials: NB
authors.lastname: Peterson
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Dwyer
authors.forename: Shelagh A
authors.initials: SA
authors.lastname: Mulvaney
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Russell L
authors.initials: RL
authors.lastname: Rothman
mesh_terms: D001294:Attitude to Health; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D003469:Culture; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology