Health literacy and informed decision making regarding colorectal cancer screening: a systematic review.
Making an informed decision about participation in colorectal cancer (CRC) screening may be challenging for invitees with lower health literacy skills. The aim of this systematic review is to explore to what extent the level of a person's health literacy is related to their informed decision making concerning CRC screening. We searched for peer-reviewed studies published between 1950 and May 2013 in MEDLINE, EMBASE, SciSearch and PsycINFO. Studies were included when health literacy was studied in relation to concepts underpinning informed decision making (awareness, risk perception, perceived barriers and benefits, knowledge, attitude, deliberation). The quality of the studies was determined and related to the study results. The search returned 2254 papers. Eight studies in total were included, among which seven focused on knowledge, four focused on attitudes or beliefs concerning CRC screening, and one focused on risk perception. The studies found either no association or a positive association between health literacy and concepts underpinning informed decision making. Some studies showed that higher health literacy was associated with more CRC screening knowledge and a more positive attitude toward CRC screening. The results of studies that obtained a lower quality score were no different than studies that obtained a higher quality score. In order to obtain more insight into the association between health literacy and informed decision making in CRC cancer screening, future research should study the multiple aspects of informed decision making in conjunction instead of single aspects.
1 Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands 2 NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands Iris.van.der.Heide@rivm.nl.
Iris
I
van der Heide
1 Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
Ellen
E
Uiters
1 Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands 3 Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Netherlands.
A
A
Jantine Schuit
2 NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands.
Jany
J
Rademakers
4 Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
Mirjam
M
Fransen
D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003657:Decision Making; D055088:Early Detection of Cancer / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D010358:Patient Participation / Q000523:psychology*