Health literacy, cervical cancer risk factors, and distress in low-income African-American women seeking colposcopy.

Abstract

OBJECTIVES: To describe the relationship between health literacy, distress, and cervical cancer risk factors in women at high risk for developing cervical cancer. DESIGN: Cross-sectional, prospective cohort design. SETTING: Two university-based gynecological oncology colposcopy clinics and 3 Planned Parenthood community dinics. PATIENTS/PARTICIPANTS: One hundred-thirty English-speaking African-American women > or = 18 years referred for colposcopy following abnormal Pap testing. MAIN OUTCOME MEASURES: Avoidance and Intrusion subscales of the Impact of Events Scale (IES), Rapid Estimate of Adult Literacy in Medicine (REALM), and demographics. RESULTS: Forty-five percent of women had a low level of health literacy (< 9th grade). Low health literacy was related to fewer risk factors (P < .01) and higher levels of distress on the Impact of Events avoidance subscale (P < .05) after controlling for covariates. Forty-three percent of women with low literacy had excessive levels of distress as compared to 25% in women with high literacy (P < .05). CONCLUSIONS: A low level of health literacy is associated with increased levels of distress among women at high risk for developing cervical cancer. To the extent that distress serves as a barrier to treatment, culturally informed, effective interventions are needed.