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Open AccessArticle

The Role of Health Literacy in Explaining the Relation between Educational Level and Decision Making about Colorectal Cancer Screening

1
Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
3
Department of Methodology and Statistics, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(23), 4644; https://doi.org/10.3390/ijerph16234644
Received: 1 September 2019 / Revised: 8 October 2019 / Accepted: 15 November 2019 / Published: 22 November 2019
(This article belongs to the Special Issue Routes to Improve Health Literacy during the Life-Course)
Little is known about why educational inequalities exist in informed decision making in colorectal cancer (CRC) screening. Insight into the role and impact of health literacy is essential for intervention development. This study investigates associations between health literacy and informed decision making in CRC screening and explores to what extent health literacy mediates the association between education and informed decision making in CRC screening. In total, 696 individuals eligible for CRC screening (55–75 years of age) were recruited from online panels and filled in an online questionnaire at T0 (n = 696), T1 (n = 407) and T2 (n = 327). A hypothetical mediation model was tested using structural equation modelling. Outcomes included CRC knowledge, CRC screening knowledge, attitude, injunctive norm, descriptive norm, risk perception, self-efficacy, decisional conflict and decisional certainty. Health literacy domains included Comprehension, Application, Numeracy and Communication. Comprehension, Application and Numeracy, were found to mediate the association between education and knowledge about CRC and CRC screening, injunctive norm, descriptive norm, decisional conflict and decisional certainty. In light of these findings, targeting multiple health literacy domains in decision-support interventions is essential for facilitating informed decision making in CRC screening. View Full-Text
Keywords: education; health literacy; informed decision making; colorectal cancer screening; mediation analysis; structural equation modelling education; health literacy; informed decision making; colorectal cancer screening; mediation analysis; structural equation modelling
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Woudstra, A.J.; Smets, E.M.A.; Verdam, M.G.E.; Fransen, M.P. The Role of Health Literacy in Explaining the Relation between Educational Level and Decision Making about Colorectal Cancer Screening. Int. J. Environ. Res. Public Health 2019, 16, 4644.

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