Harsono Alfonsus Adrian H, Ruiz Rachel, Katta Meghna, Sheffer Hannah Ficarino, McLeod Marshall Chandler, Bhatia Smita, Chu Daniel I, Hollis Robert H
Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7 Ave S, BDB 561, Birmingham, AL, 35294-0016, USA.
School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
J Gastrointest Cancer. 2025 May 8;56(1):111. doi: 10.1007/s12029-025-01241-9.
Health literacy (HL) can impact health behaviors including colorectal cancer (CRC) screening. Prior findings using extensive measures of HL suggested that low HL is associated with lower CRC screening rates. We hypothesized that low HL, when measured using a clinically applicable three-question measure, would also be associated with low CRC screening rates.
Data collected from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) was utilized from 17 states that included a three-question HL measure. Participants ages 50-75 were included. The HL scores were categorized as adequate, marginal, or limited HL. The primary outcome was United States Preventative Services Task Force (USPSTF) recommendation-concordant CRC screening. The relationship between HL and CRC screening was examined using multivariable logistic regression.
Among 38,044 participants who met inclusion criteria, 47.2% (n = 17,950), 49.9% (n = 18,989), and 2.9% (n = 1105) had adequate, marginal, and limited HL, respectively. Lower HL levels were associated with lower adherence to USPSTF CRC screening recommendations: 73.3% for adequate, 68.0% for marginal, and 48.9% for limited HL (p < 0.01). Respondents with limited HL were 45% less likely to undergo CRC screening (OR = 0.55; 95%CI: 0.48-0.63). A significant interaction (p < 0.01) between health literacy and sex was identified. CRC screening difference among HL levels was more pronounced for male (OR = 0.48; 95% CI: 0.40-0.79) than female respondents (OR = 0.63; 95% CI: 0.52-0.76).
Limited health literacy is associated with significantly lower rates of appropriate CRC screening, particularly for males. This three-question HL measure provides a clinically applicable tool to identify people at risk for lack of CRC screening.
健康素养（HL）会影响包括结直肠癌（CRC）筛查在内的健康行为。先前使用广泛的健康素养测量方法得出的结果表明，低健康素养与较低的结直肠癌筛查率相关。我们假设，当使用一种临床适用的三个问题的测量方法时，低健康素养也会与低结直肠癌筛查率相关。
利用从2016年行为危险因素监测系统（BRFSS）收集的数据，该数据来自17个州，其中包括一项三个问题的健康素养测量。纳入年龄在50 - 75岁的参与者。健康素养得分被分为足够、边缘或有限健康素养。主要结局是美国预防服务工作组（USPSTF）推荐的符合标准的结直肠癌筛查。使用多变量逻辑回归分析健康素养与结直肠癌筛查之间的关系。
在38044名符合纳入标准的参与者中，分别有47.2%（n = 17950）、49.9%（n = 18989）和2.9%（n = 1105）具有足够、边缘和有限的健康素养。较低的健康素养水平与较低的USPSTF结直肠癌筛查建议依从性相关：足够健康素养者为73.3%，边缘健康素养者为68.0%，有限健康素养者为48.9%（p < 0.01）。健康素养有限的受访者接受结直肠癌筛查的可能性降低45%（OR = 0.55；95%CI：0.48 - 0.63）。确定了健康素养与性别之间存在显著交互作用（p < 0.01）。健康素养水平之间的结直肠癌筛查差异在男性（OR = 0.48；95%CI：0.40 - 0.79）中比女性受访者（OR = 0.63；95%CI：0.52 - 0.76）更明显。
有限的健康素养与显著较低的适当结直肠癌筛查率相关，尤其是在男性中。这种三个问题的健康素养测量提供了一种临床适用的工具，以识别有缺乏结直肠癌筛查风险的人群。
