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Colorectal Cancer Screening Knowledge, Attitudes, and Beliefs Among Veterans: Does Literacy Make a Difference?

From the VA Midwest Center for Health Services and Policy Research, VA Chicago Healthcare System; the Divisions of Gastroenterolgy, General Internal Medicine, and Hematology/Oncology of the Department of Medicine, Department of Preventive Medicine, and the Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, the Robert H. Lurie Comprehensive Cancer Center; the Center for Healthcare Studies, Northwestern University, Chicago, IL; and the Department of Family Medicine, Louisiana State University Health Sciences Center, Shreveport, LA

Address reprint requests to Nancy C. Dolan, MD, Northwestern University, Feinberg School of Medicine, 675 N St Clair St, Suite 18-200, Chicago, IL 60611; e-mail:ndo428{at}northwestern.edu

PURPOSE: To evaluate whether lower literacy is associated with poorer knowledge and more negative attitudes and beliefs toward colorectal cancer screening among veterans without recent colorectal cancer screening.

PATIENTS AND METHODS: Three hundred seventy-seven male veterans, age 50 years and older, who had not undergone recent colorectal cancer screening, were surveyed about their knowledge, attitudes, and beliefs regarding colorectal cancer screening. Patients' literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine, an individually administered screening test for reading.

RESULTS: Thirty-six percent of the 377 men had an eighth grade literacy level or higher. Men with lower literacy were 3.5 times as likely not to have heard about colorectal cancer (8.8% v 2.5%; P = .006), 1.5 times as likely not to know about screening tests (58.4% v 40.9%; P = .0001), and were more likely to have negative attitudes about fecal occult blood testing (FOBT), but not about flexible sigmoidoscopy. Specifically, men with lower literacy skills were two times as likely to be worried that FOBT was messy (26.7% v 13.3%; P = .008), 1.5 times as likely to feel that FOBT was inconvenient (28.7% v 18%; P = .05), and four times as likely to state they would not use an FOBT kit even if their physician recommended it (17.9% v 4.0%; P = .02).

CONCLUSION: Limited literacy may be an overlooked barrier in colorectal cancer screening among veterans.

Supported by the Department of Veterans Affairs (PCI 99-158) and the National Institute of Health (R01CA86424-01A2).

Presented at the VA Health Services and Research Development Services National Meeting, March 10, 2004, Washington, DC, and the 28th Annual Meeting of the American Society of Preventive Oncology, Bethesda, MD, March 15, 2004.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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