The role of health literacy and communication habits on previous colorectal cancer screening among low-income and uninsured patients

• Lower educational attainment was associated with no prior colorectal cancer (CRC) screening.
• Inadequate health literacy was associated with not having a prior CRC screening.
• Health literacy eliminated the association between education and previous CRC screening.
• Health literacy level had no association with adhering to CRC screening guidelines.
• Patients' communication habits had no association with prior colorectal cancer screening.

ObjectiveTo determine the association between health literacy, communication habits and colorectal cancer (CRC) screening among low-income patients.MethodsSurvey 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.ResultsOver 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.ConclusionLimited 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.