title: The role of health literacy and communication habits on previous colorectal cancer screening among low-income and uninsured patients.
abstract: OBJECTIVE
  To determine the association between health literacy, communication habits and colorectal cancer (CRC) screening among low-income patients.
  
  
  METHODS
  Survey responses of patients who received financial assistance for colonoscopy between 2011 and 2014 at a family medicine residency clinic were analyzed using multivariate logistic regression (n = 456). There were two dependent variables: (1) previous CRC screening and (2) CRC screening adherence. Our independent variables of interest were health literacy and communication habits.
  
  
  RESULTS
  Over two-thirds (67.13%) of respondents had not been previously screened for CRC. Multivariate analysis showed a decreased likelihood of previous CRC screening among those who had marginal (OR = 0.52; 95% CI = 0.29-0.92) or inadequate health literacy (OR = 0.49; 95% CI = 0.27-0.87) compared to those with adequate health literacy. Controlling for health literacy, the significant association between educational attainment and previous CRC screening was eliminated. Thus, health literacy mediated the relationship between educational attainment and previous CRC screening. There was no significant association between communication habits and previous CRC screening. There was no significant association between screening guideline adherence, and health literacy or communication.
  
  
  CONCLUSIONS
  Limited health literacy is a potential barrier to CRC screening. Suboptimal CRC screening rates reported among those with lower educational attainment may be mediated by limited health literacy.
authors: Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, TX 77843-1266, USA.
authors: Chinedum O
authors: CO
authors: Ojinnaka
authors: Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, TX 77843-1266, USA.
authors: Jane N
authors: JN
authors: Bolin
authors: Department of Family and Community Medicine, College of Medicine, Texas A&M Physicians Family Medicine Residency, Texas A&M Health Science Center, 2900 E.29TH Street, Bryan, TX 77803, USA; Texas A&M Physicians Family Residency, Texas A&M Health Science Center, 2900 E.29 Street, Bryan, TX 77803, USA.
authors: David A
authors: DA
authors: McClellan
authors: Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, TX 77843-1266, USA.
authors: Janet W
authors: JW
authors: Helduser
authors: Texas A&M Physicians Family Residency, Texas A&M Health Science Center, 2900 E.29 Street, Bryan, TX 77803, USA.
authors: Philip
authors: P
authors: Nash
authors: Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health, College Station, TX 77843-1266, USA.
authors: Marcia G
authors: MG
authors: Ory
keywords: Colorectal cancer; Health literacy; Screening