The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women

Objective: Our purpose was to describe the relationship between health literacy, ethnicity, and cervical cancer screening practices and to evaluate physician recognition of low literacy. Study Design: We studied a prospective cohort of English-speaking patients ≥18 years (n = 529) in ambulatory womenʹs clinics. Univariate and multivariate analyses were used to evaluate demographics, health practices and beliefs, and knowledge regarding cervical cancer screening and prevention. Physiciansʹ assessments of patient reading skills were obtained. Results: Low health literacy (<9th grade) was found among 40% of participants. Minority women were half as likely to know the purpose of the Papanicolaou test (9% vs 21%; P < .03) and were significantly more likely to have low literacy levels compared with white women (46% vs 15%; P < .05). Literacy was the only factor independently associated with knowledge related to cervical cancer screening (adjusted odds ratio, 2.25; 95% CI, 1.05-4.80). Physicians detected only 20% of the lowest readers. Conclusion: Poor health literacy was a better predictor of cervical cancer screening knowledge than ethnicity or education, yet physicians infrequently recognized low literacy. Improved physician awareness and development of low literacy interventions may improve cervical cancer screening, particularly for the most vulnerable women. (Am J Obstet Gynecol 2002;186:938-43.)