Health literacy and cancer screening: A systematic review

ObjectiveTo evaluate published evidence about health literacy and cancer screening.MethodsSeven databases were searched for English language articles measuring health literacy and cancer screening published in 1990–2011. Articles meeting inclusion criteria were independently reviewed by two investigators using a standardized data abstraction form. Abstracts (n = 932) were reviewed and full text retrieved for 83 articles. Ten articles with 14 comparisons of health literacy and cancer screening according to recommended medical guidelines were included in the analysis.ResultsMost articles measured health literacy using the S-TOFHLA instrument and documented cancer screening by self-report. There is a trend for an association of inadequate health literacy and lower cancer screening rates, however, the evidence is mixed and limited by study design and measurement issues.ConclusionA patient's health literacy may be a contributing factor to being within recommended cancer screening guidelines.Practice implicationsFuture research should: be conducted using validated health literacy instruments; describe the population included in the study; document cancer screening test completion according to recommended guidelines; verify the completion of cancer screening tests by medical record review; adjust for confounding factors; and report effect size of the association of health literacy and cancer screening.