title: Limited health literacy is a barrier to colorectal cancer screening in England: evidence from the English Longitudinal Study of Ageing.
abstract: OBJECTIVE
  To determine the association between health literacy and participation in publicly available colorectal cancer (CRC) screening in England using data from the English Longitudinal Study of Ageing (ELSA).
  
  
  METHODS
  ELSA is a population-based study of English adults aged ≥ 50 years. Health literacy, participation in the national CRC screening programme, and covariates were interview-assessed in 2010-11. All those age-eligible for screening from 2006 to 11 were included in the present analysis (n=3087). The association between health literacy and screening was estimated using multivariable-adjusted logistic regression.
  
  
  RESULTS
  73% of participants had adequate health literacy skills. Screening uptake was 58% among those with adequate and 48% among those with limited health literacy skills. Having adequate health literacy was associated with greater odds of CRC screening (multivariable adjusted OR=1.20; 95% CI: 1.00-1.44), independent of other predictors of screening: age (OR=0.92; 95% CI: 0.91-0.94 per one year increase), female sex (OR=1.31; 95% CI: 1.11-1.54), and being in a higher wealth quintile (OR=1.88; 95% CI: 1.43-2.49).
  
  
  CONCLUSIONS
  Limited health literacy is a barrier to participation in England's national, publicly available CRC screening programme. Interventions should include appropriate design of information materials, provision of alternative support, and increased one-on-one interaction with health care professionals.
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK. Electronic address: l.kobayashi.12@ucl.ac.uk.
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Kobayashi
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK. Electronic address: j.wardle@ucl.ac.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK. Electronic address: c.wagner@ucl.ac.uk.
authors.forename: Christian
authors.initials: C
authors.lastname: von Wagner
mesh_terms: D000368:Aged; D000375:Aging; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data*; D006293:Health Promotion / Q000379:methods; D054624:Health Status Disparities; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D009313:National Health Programs; D011159:Population Surveillance; D045808:Refusal to Participate; D012044:Regression Analysis; D057566:Self Report; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Colorectal cancer screening; Communication; Early detection; Faecal occult blood test; Health equity; Health literacy; Organised Screening