Health literacy and self-efficacy for participating in colorectal cancer screening: The role of information processing

Wagner, Christian von; Semmler, Claudia; Good, Anna; Wardle, Jane

doi:10.1016/j.pec.2009.03.015

Cited by 209 publications

(199 citation statements)

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“…Low health literacy is postulated to result in lower screening attendance through causing limited knowledge of health services and diseases, difficulty in understanding abstract concepts such as risk, a preference for emotional over factual information, and lower decision-making skills(von Wagner, Steptoe, et al, 2009). In the context of CRC screening, previous studies have shown that individuals with low levels of health literacy report more problems in seeking and processing health-related information (von Wagner, Semmler, Good, & Wardle, 2009), as well as barriers in understanding (Arnold et al, 2012;Peterson, Dwyer, Mulvaney, Dietrich, & Rothman, 2007) or completing screening (Kobayashi et al, 2014). In line with these hypotheses, we found that inadequate health literacy was associated with lower probability of screening uptake in univariate and multivariate models, and it contributed to nearly 8% of inequality.…”

Section: Discussionmentioning

confidence: 99%

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Solmi

Wagner

Kobayashi

et al. 2015

Social Science & Medicine

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Colorectal cancer (CRC) is the second largest cause of cancer death in the UK. Since 2010, CRC screening based on Faecal Occult Blood testing has been offered by the NHS in England biennially to all persons age 60 to 69 years. Several studies have demonstrated a gradient in uptake using area-level markers of socio-economic status (SES), but few have examined the individual-level contributors to the gradient. We aimed to quantify the extent of SES inequality in CRC screening uptake in England using individual-level data, and to identify individual factors associated with this inequality.We used data from 1,833 participants (aged 61-69) in Wave 5 (collected in years 2010/11) of the English Longitudinal Study of Ageing (ELSA) eligible for having been sent at least one CRC screening invitation. Uptake was defined by self-report of ever having been screened as part of the National Screening Programme. We assessed socio-economic inequality using the corrected concentration index of uptake against SES rank, which was derived by regressing a range of SES markers against net non-pension household wealth. Other demographic and health-related variables were included in the analysis. Factors associated with inequality were measured using concentration index decomposition.There was a significant pro-rich gradient in screening uptake (concentration index: 0.16, 95% CI:0.11-0.22), mostly explained within our model by differences in non-pension wealth (38.7%), partner screening status (15.9%), sickness/disability (13.5%), and health literacy (8.5%).Interventions aimed at reducing inequalities in CRC screening uptake should focus on improving acceptability of screening in populations with low levels of education and literacy barriers.

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Section: Discussionmentioning

confidence: 99%

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Solmi

Wagner

Kobayashi

et al. 2015

Social Science & Medicine

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“…The mediating roles of cognitive load, imagination ease, and involvement with the information are tested. These mechanisms have been suggested in the literature (Meppelink, Smit, Buurman, & Van Weert, 2015;Von Wagner, Semmler, Good, & Wardle, 2009;Wilson & Wolf, 2009) but have not, to our knowledge, been tested empirically or in combination. Through this testing, our article responds to the call for theory-driven studies on health literacy and e-health (Mackert, Champlin, Holton, Muñoz, This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http:// creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.…”

Section: Disclaimer/complaints Regulationsmentioning

confidence: 94%

“…This means that if reading a message and deriving meaning from its content (information encoding) require much cognitive capacity, there will be less capacity left for message storage and ultimately retrieval. Lower health literacy was found to be associated with greater effort in reading (Von Wagner, Semmler, et al, 2009), which could possibly increase people's risk of experiencing cognitive overload when processing health information (Wilson & Wolf, 2009). For people with higher health literacy, processing health information might require relatively less cognitive capacity (Chin et al, 2011).…”

Section: Cognitive Load Imagination Ease and Website Involvementmentioning

confidence: 99%

“…The mediating roles of cognitive load, imagination ease, and involvement with the information are tested. These mechanisms have been suggested in the literature (Meppelink, Smit, Buurman, & Van Weert, 2015;Von Wagner, Semmler, Good, & Wardle, 2009;Wilson & Wolf, 2009) but have not, to our knowledge, been tested empirically or in combination. Through this testing, our article responds to the call for theory-driven studies on health literacy and e-health (Mackert, Champlin, Holton, Muñoz, & Damásio, 2014) and adds to the body of European health literacy studies, which is currently limited (Barry, D'Eath, & Sixsmith, 2013).…”

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confidence: 94%

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Health Literacy and Online Health Information Processing: Unraveling the Underlying Mechanisms

Meppelink

Smit

Diviani

et al. 2016

Journal of Health Communication

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Health literacy and online health information processing: Unraveling the underlying mechanisms Meppelink, C.S.; Smit, E.G.; Diviani, N.; van Weert, J.C.M. General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. The usefulness of the Internet as a health information source largely depends on the receiver's health literacy. This study investigates the mechanisms through which health literacy affects information recall and website attitudes. Using 2 independent surveys addressing different Dutch health websites (N = 423 and N = 395), we tested the mediating role of cognitive load, imagination ease, and website involvement. The results showed that the influence of health literacy on information recall and website attitudes was mediated by cognitive load and imagination ease but only marginally by website involvement. Thus, to improve recall and attitudes among people with lower health literacy, online health communication should consist of information that is not cognitively demanding and that is easy to imagine.The Internet is a powerful source of information that makes an unlimited amount of information available to everyone. In the United States 84% of adults use the Internet (Perrin & Duggan, 2015), and in The Netherlands 97% of the adult population has Internet access (Statistics Netherlands, 2014). Moreover, more than two thirds of the U.S. adult population currently owns a smartphone (Smith, 2015). Because nearly anything can be found online, this suggests that access to information no longer divides groups in society. Smartphones in particular are expected to decrease the digital divide created by the Internet, as they offer opportunities to reach population groups that were difficult to reach before (Fiordelli, Diviani, & Schulz, 2013). Equal physical access to the Internet, however, does not necessarily correspond to an equal ability to understand and use online information. For some population groups, finding, evaluating, and understanding information is more difficult than it is for others.Information is a valuable asset in many domains, including health. The extent to which people are able to benefit from online information largely depends on their level of health literacy, defined as the "ability to obtain, process, understand, and communicate about health-rel...

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“…embarrassment, contact with faecal material). 32,33 Health literacy limitations are also implicated in comprehension of the screening information materials 34 and recognition of the organisation that sends the screening invitations. All these factors may have their upstream roots in the more stressful, constrained lives of people with fewer social and economic resources.…”

Section: Relevance To Priorities and Needs Of The Nhsmentioning

confidence: 99%

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Raine

Atkin

Wagner

et al. 2017

Programme Grants Appl Res

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Objective: To reduce socioeconomic inequalities in uptake of the NHS BCSP ’ s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group. Design: Workstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘ gist ’ information, (2) a ‘ narrative ’ leaflet, (3) ‘ general practice endorsement ’ (GPE) and (4) an ‘ enhanced reminder ’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention. Methods: Interventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘ usual care ’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘ gist ’ leaflet ( n = 163,525), (2) ‘ narrative ’ leaflet ( n = 150,417), (3) GPE on the invitation letter ( n = 265,434) and (4) ER ( n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual ’ s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘ definitive ’ test result of either ‘ normal ’ (i.e. no further investigation required) or ‘ abnormal ’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome. Results: The gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; all p -values > 0.05). GPE showed no effect on the gradient ( p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10; p < 0.0001]. ER showed a significant interaction with SECs ( p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20; p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06; p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11; p = 0.001). All interventions were inexpensive to provide. Limitations: In line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect. Conclusions: Enhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results hig...

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Health literacy and self-efficacy for participating in colorectal cancer screening: The role of information processing

Cited by 209 publications

References 29 publications

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Health Literacy and Online Health Information Processing: Unraveling the Underlying Mechanisms

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

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