Limited health literacy is a barrier to colorectal cancer screening in England: Evidence from the English Longitudinal Study of Ageing()

OBJECTIVE: To determine the association between health literacy and participation in publicly available colorectal cancer (CRC) screening in England using data from the English Longitudinal Study of Ageing (ELSA). METHODS: ELSA is a population-based study of English adults aged ≥ 50 years. Health literacy, participation in the national CRC screening programme, and covariates were interview-assessed in 2010–11. All those age-eligible for screening from 2006 to 11 were included in the present analysis (n = 3087). The association between health literacy and screening was estimated using multivariable-adjusted logistic regression. RESULTS: 73% of participants had adequate health literacy skills. Screening uptake was 58% among those with adequate and 48% among those with limited health literacy skills. Having adequate health literacy was associated with greater odds of CRC screening (multivariable adjusted OR = 1.20; 95% CI: 1.00–1.44), independent of other predictors of screening: age (OR = 0.92; 95% CI: 0.91–0.94 per one year increase), female sex (OR = 1.31; 95% CI: 1.11–1.54), and being in a higher wealth quintile (OR = 1.88; 95% CI: 1.43–2.49). CONCLUSIONS: Limited health literacy is a barrier to participation in England's national, publicly available CRC screening programme. Interventions should include appropriate design of information materials, provision of alternative support, and increased one-on-one interaction with health care professionals.