Screening & Prevention
Women With Low Literacy Levels Less Likely to Understand Results of Pap Tests, Study Says
Women who read below a ninth-grade level are less likely to understand the purpose of annual Pap test exams and may not be able to properly interpret their test results or seek proper follow-up care in instances of abnormal results indicating possible cervical cancer, according to a study appearing in a recent issue of the American Journal of Obstetrics and Gynecology, Reuters Health reports (McKinney, Reuters Health, 6/10). Dr. Stacy Lindau of the University of Chicago and colleagues surveyed 529 English-speaking adult women who sought care at ambulatory OB/GYN and women's HIV clinics at a Chicago academic medical center between January 1999 and December 1999. Before seeing a physician, the women participated in a 10-minute interview during which they were asked about their demographics, health practices history, knowledge of cervical cancer screening and prevention, history of cervical cancer screening and perception of previous doctor-patient interaction regarding cervical cancer screening. They were also given a three-minute literacy assessment using the Rapid Estimate of Adult Literacy in Medicine tool. Thirty-two physicians also completed self-administered questionnaires regarding their perceptions of the patient's literacy immediately after each patient visit.
Results
Nearly all of the women surveyed had been given a Pap test on a previous occasion. However, 87% did not associate the Pap test with cervical cancer screening or prevention, and more than 50% could not identify any risk-reduction strategies for cervical cancer, such as the use of condoms, the limiting of sexual partners or the avoidance of tobacco. The researchers conducted a multivariate analysis of variables including ethnicity, socioeconomic background, insurance status, age, employment and literacy and determined that health literacy was the "only variable" independently associated with knowledge about the Pap test. Of the 529 women surveyed, one third demonstrated "marginal" health literacy, reading on a seventh- or eighth-grade level, while nearly 10% read at the level of a sixth-grade student or below. Complicating patient comprehension was the fact that physicians tended to overestimate patient literacy, judging 70% of the women to be "literate," reading at a ninth-grade level or above. The authors note that this finding "raise[s] concern about the potential for adequate follow-up after an abnormal screening result, because adherence to health care recommendations is independently related to both understanding of disease and health literacy" (Lindau et al., American Journal of Obstetrics and Gynecology, May 2002). Lindau told Reuters Health that low literacy presents an "overlooked barrier" to efficient physician-patient communication that leaves many women in a "precarious limbo between diagnosis and treatment," as they may not be sure of how to interpret their test results, which are often mailed to them days after their doctor visits. Lindau suggested that physicians discuss cervical cancer screenings with their patients instead of relying on printed materials, and she added that researchers need to develop new methods of detecting low literacy levels in patients. She also noted that same-day test results may be helpful to women who have difficulty reading (Reuters Health, 6/10).
