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

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Abstract
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.