title: The influence of health literacy on comprehension of a colonoscopy preparation information leaflet.
abstract: BACKGROUND
  Successful bowel preparation is important for safe, efficacious, cost-effective colonoscopy procedures; however, poor preparation is common.
  
  
  OBJECTIVE
  We sought to determine whether there was an association between health literacy and comprehension of typical written instructions on how to prepare for a colonoscopy to enable more targeted interventions in this area.
  
  
  METHODS
  This is a cross-sectional observational study.
  
  
  METHODS
  This study was performed at primary care clinics and federally qualified health centers in Chicago, Illinois.
  
  
  METHODS
  Seven hundred sixty-four participants (mean age, 63 years; SD, 5.42) were recruited. The sample was from a mixed sociodemographic background, and 71.9% of the participants were classified as having adequate health literacy scores.
  
  
  METHODS
  Seven hundred sixty-four participants were presented with an information leaflet outlining the bowel preparatory instructions for colonoscopy.
  
  
  METHODS
  Five questions were used to assess participants' comprehension of the instructions in an "open book" test.
  
  
  RESULTS
  Comprehension scores on the bowel preparation items were low. The mean number of items correctly answered was 3.2 (SD, 1.2) of a possible 5. Comprehension scores overall and for each individual item differed significantly by health literacy level (all p < 0.001). After controlling for sex, age, race, socioeconomic status, and previous colonoscopy experience in a multivariable model, health literacy was a significant predictor of comprehension (inadequate vs adequate: β = -0.2; p < 0.001; marginal vs adequate: β = -0.2; p < 0.001).
  
  
  CONCLUSIONS
  The outcome represents a simulated task and not actual comprehension of preparation instructions for participants' own recommended behavior.
  
  
  CONCLUSIONS
  Comprehension of a written colonoscopy preparation leaflet was generally low and significantly lower among people with low health literacy. Poor comprehension has implications for the safety and economic impact of gastroenterological procedures such as colonoscopy. Therefore, future interventions should aim to improve comprehension of complex medical information by reducing literacy-related barriers.
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom. Samuel.smith@ucl.ac.uk
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Smith
authors.forename: Christian
authors.initials: C
authors.lastname: von Wagner
authors.forename: Lesley M
authors.initials: LM
authors.lastname: McGregor
authors.forename: Laura M
authors.initials: LM
authors.lastname: Curtis
authors.forename: Elizabeth A H
authors.initials: EA
authors.lastname: Wilson
authors.forename: Marina
authors.initials: M
authors.lastname: Serper
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003113:Colonoscopy / Q000523:psychology*; D032882:Comprehension; D003430:Cross-Sectional Studies; D004521:Educational Measurement; D005260:Female; D057220:Health Literacy; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D011320:Primary Health Care