Association of health literacy with adherence to screening mammography guidelines

Obstet Gynecol. 2015 Apr;125(4):852-859. doi: 10.1097/AOG.0000000000000708.


Objective: To investigate the relationship of health literacy and screening mammography.

Methods: All patients seen at a breast clinic underwent prospective assessment of health literacy from January 2010 to April 2013. All women at least 40 years of age were included. Men and women diagnosed with breast cancer before age 40 years were excluded. Routine health literacy assessment was performed using the Newest Vital Sign. Demographic data were also collected. Medical records were reviewed to determine if patients had undergone screening mammography: women aged 40-49 years were considered to have undergone screening if they had another mammogram within 2 years. Women 50 years or older were considered to have undergone screening mammography if they had another mammogram within 1 year.

Results: A total of 1,664 consecutive patients aged 40 years or older were seen. No patient declined the health literacy assessment. Only 516 (31%) patients had undergone screening mammography. Logistic regression analysis that included ethnicity, language, education, smoking status, insurance status, employment, income, and family history found that only three factors were associated with not obtaining a mammogram: low health literacy (odds ratio [OR] 0.27, 95% confidence interval [CI] 0.19-0.37; P<.001), smoking (OR 0.64, 95% CI 0.47-0.85; P=.002), and being uninsured (OR 0.66, 95% CI 0.51-0.85; P=.001).

Conclusion: Of all the sociodemographic variables examined, health literacy had the strongest relationship with use of screening mammography.

MeSH terms

  • Adult
  • Aged
  • Early Detection of Cancer / statistics & numerical data*
  • Female
  • Guideline Adherence / statistics & numerical data
  • Guidelines as Topic
  • Health Literacy / statistics & numerical data*
  • Humans
  • Mammography / statistics & numerical data*
  • Medically Uninsured / statistics & numerical data
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Prospective Studies
  • Smoking