Poor health literacy associated with stronger perceived barriers to breast cancer screening and overestimated breast cancer risk

Abstract

BackgroundLow health literacy (HL) is negatively associated with mammography screening uptake. However, evidence of the links between poor HL and low mammography screening participation is scarce.MethodsWe conducted a cross-sectional questionnaire survey among participants of a cancer screening program. We measured HL using a validated Chinese instrument. We assessed breast cancer screening-related beliefs using the Health Belief Model and the accuracy of risk perception. We used multivariable regression models to estimate the relationship between HL and the outcomes.ResultsA total of 821 females were included. 264 (32.2%) had excellent or sufficient, 353 (43.0%) had problematic, and 204 (24.8%) had inadequate health literacy (IHL). Women with IHL were more likely to agree that high price (β = -0.211, 95% CI -0.354 to -0.069), lack of time (β = -0.219, 95% CI -0.351 to -0.088), inconvenient service time (β = -0.291, 95% CI -0.421 to -0.160), long waiting time (β = -0.305, 95% CI -0.447 to -0.164), fear of positive results (β = -0.200, 95% CI -0.342 to -0.058), embarrassment (β = -0.225, 95% CI -0.364 to -0.086), fear of pain (β = -0.154, 95% CI -0.298 to -0.010), fear of radiation (β = -0.177, 95% CI -0.298 to -0.056), lack of knowledge on service location (β = -0.475, 95% CI -0.615 to -0.335), and lack of knowledge on mammography (β = -0.360, 95% CI -0.492 to -0.228) were barriers. They were also less likely to have an accurate breast cancer risk perception (aOR 0.572, 95% CI 0.341 to 0.956).ConclusionWomen with lower HL could have stronger perceived barriers to BC screening and an over-estimation of their breast cancer risk. Tackling emotional and knowledge barriers, financial and logistical assistance, and guidance on risk perception are needed to increase their breast cancer screening uptake.

Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach

“…Furthermore, classifying participants into health literacy categories (“adequate,” “inadequate,” and “borderline”) underscores the diversity within the older adult population. This variability in health literacy levels has been consistently observed in previous studies [ 36 , 37 ] and reinforces the need for public health approaches that consider the different needs of specific groups based on their health literacy. However, it is important to emphasize that identifying individuals with “inadequate” and “borderline” health literacy underscores the importance of targeted educational strategies and specific interventions for these groups.…”

“For and against” factors influencing participation in personalized breast cancer screening programs: a qualitative systematic review until March 2022

“…Despite the acceptance of the strategy, women’s own factors that do not favor participation show a greater weight among all the findings identified. Aspects such as low knowledge about the strategy, fatalistic beliefs about breast cancer, negative influences from other women, and negative psychological reactions and attitudes towards risk estimation are consistent with other studies on breast cancer personalization [ 39 , 45 , 46 ], and have been widely documented as strong barriers to participation breast cancer screening [ 47 – 49 ], particularly for women with low health literacy [ 50 ]. Therefore, these factors could be thought of as “inherited” from the current “one-size-fits-all” model of early detection.…”

The Association of Context with Reported Self-Efficacy for Cancer-Preventive Behaviors and Perceived Cancer Risk in U.S. Adults from the Midlife in the United States (MIDUS) Study

“…For example, individuals who tend to be pessimistic are more likely to have negative perceptions about their neighborhoods as well as their health [28]. Additionally, other individual-level factors such as emotional responses (e.g., cancer worry, anxiety, fear of positive screening findings), racial and ethnic background, acculturation, having a cancer-related symptom (e.g., a benign breast symptom), general cancer beliefs (causes, information overload), general health literacy, cancer information seeking, risk behaviors and self-reported health [13,59] have also been documented in the literature, and may be worth examination in future studies along with context. It should be noted that the associations observed in this study controlled for establishment of quality ties to others using the positive relations scale, which is a factor that may affect perceptions of both neighborhood environment and cancer risk or self-efficacy.…”