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

Prev Med. 2014 Apr;61(100):100-5. doi: 10.1016/j.ypmed.2013.11.012. Epub 2013 Nov 25.


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.

Keywords: Colorectal cancer screening; Communication; Early detection; Faecal occult blood test; Health equity; Health literacy; Organised Screening.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aging*
  • Cohort Studies
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / prevention & control
  • England
  • Female
  • Health Knowledge, Attitudes, Practice
  • Health Literacy / statistics & numerical data*
  • Health Promotion / methods
  • Health Status Disparities
  • Humans
  • Interviews as Topic
  • Longitudinal Studies
  • Male
  • Mass Screening / psychology*
  • Middle Aged
  • National Health Programs
  • Population Surveillance
  • Refusal to Participate
  • Regression Analysis
  • Self Report
  • Socioeconomic Factors
  • Surveys and Questionnaires