title: Potential links between health literacy and cervical cancer screening behaviors: a systematic review.
abstract: OBJECTIVE
  The objective of this study is to critically appraise empirical evidence investigating pathways between health literacy (HL) and cervical cancer screening.
  
  
  METHODS
  A comprehensive search was undertaken to identify English-language studies published before May 2014 that measured HL and cervical cancer screening. After screening for eligibility, we identified 12 articles that met inclusion criteria.
  
  
  RESULTS
  Nine studies yielded a positive association between HL and cervical cancer screening. Five studies investigated the relationships between HL, psychosocial variables, and cervical cancer screening and found that HL was associated with cervical cancer knowledge (n = 4) and cancer worry (n = 2). Separately, cancer knowledge (n = 2) and perceived barriers (n = 1) were correlated with cervical cancer screening. One study investigated an indirect pathway of HL to cervical cancer screening through health knowledge, although the indirect pathway was non-significant. Overall, the investigations tended to focus on print-related HL domain only and included only English-speaking or Spanish-speaking women. In addition, the studies were limited by lack of theoretical basis (n = 10) or temporality (n = 10) and use of self-reported screening status (n = 7).
  
  
  CONCLUSIONS
  Evidence supports a positive link between HL and cervical cancer screening. There is only limited evidence to delineate indirect pathways linking HL and cervical cancer screening. Studies using a multidimensional validated measure of HL are needed in diverse groups of women, particularly those with a heightened burden of cervical cancer. With continuing cervical cancer disparities among culturally and linguistically diverse women, delineating how HL influences cervical cancer screening may help develop effective intervention strategies to reduce the disparities experienced by these women.
authors.affiliation: School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Kyounghae
authors.initials: K
authors.lastname: Kim
authors.affiliation: School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Hae-Ra
authors.initials: HR
authors.lastname: Han
mesh_terms: D000328:Adult; D001294:Attitude to Health / Q000208:ethnology*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D057220:Health Literacy; D006801:Humans; D007802:Language; D057566:Self Report; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000523:psychology*