Health literacy and pap testing in insured women

UMMS Affiliation

Meyers Primary Care Institute; Department of Medicine

Publication Date


Document Type



Adult; Aged; Early Detection of Cancer; Female; Follow-Up Studies; *Health Knowledge, Attitudes, Practice; *Health Literacy; Health Services Accessibility; Humans; *Insurance, Health; Middle Aged; Papanicolaou Test; Patient Acceptance of Health Care; Questionnaires; Uterine Cervical Neoplasms; *Vaginal Smears


Community Health and Preventive Medicine | Health Services Research | Neoplasms | Obstetrics and Gynecology | Oncology | Public Health Education and Promotion | Translational Medical Research | Women's Health


Several studies have found a link between health literacy and participation in cancer screening. Most, however, have relied on self-report to determine screening status. Further, until now, health literacy measures have assessed print literacy only. The purpose of this study was to examine the relationship between participation in cervical cancer screening (Papanicolaou [Pap] testing) and two forms of health literacy-reading and listening. A demographically diverse sample was recruited from a pool of insured women in Georgia, Massachusetts, Hawaii, and Colorado between June 2009 and April 2010. Health literacy was assessed using the Cancer Message Literacy Test-Listening and the Cancer Message Literacy Test-Reading. Adherence to cervical cancer screening was ascertained through electronic administrative data on Pap test utilization. The relationship between health literacy and adherence to evidence-based recommendations for Pap testing was examined using multivariate logistic regression models. Data from 527 women aged 40 to 65 were analyzed and are reported here. Of these 527 women, 397 (75 %) were up to date with Pap testing. Higher health literacy scores for listening but not reading predicted being up to date. The fact that health literacy listening was associated with screening behavior even in this insured population suggests that it has independent effects beyond those of access to care. Patients who have difficulty understanding spoken recommendations about cancer screening may be at risk for underutilizing screening as a result.


UMCCTS funding

DOI of Published Version



J Cancer Educ. 2014 Dec;29(4):698-701. doi: 10.1007/s13187-014-0629-7. Link to article on publisher's site

Journal/Book/Conference Title

Journal of cancer education : the official journal of the American Association for Cancer Education

Related Resources

Link to Article in PubMed

PubMed ID