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. 2023 Jun;38(3):1023-1033.
doi: 10.1007/s13187-022-02227-y. Epub 2022 Nov 5.

Health Literacy, Health Numeracy, and Cancer Screening Patterns in the Zuni Pueblo: Insights from and Limitations of "Standard" Questions

Kate Cartwright  1 , Samantha Leekity  2 , Judith Sheche  2 , Deborah Kanda  2 , Mikaela Kosich  2 , Joseph Rodman  2 , Madison Gonya  3 , Keith Kelly  2 , Nicholas Edwardson  3 , V Shane Pankratz  2   4 , Shiraz I Mishra  2   5
Affiliations

Health Literacy, Health Numeracy, and Cancer Screening Patterns in the Zuni Pueblo: Insights from and Limitations of "Standard" Questions

Kate Cartwright et al. J Cancer Educ. 2023 Jun.

Abstract

American Indians experience disparities in cancer screening, stage at disease diagnoses, and 5-year cancer survival. This study investigates how health literacy and health numeracy may be linked to cancer screening behaviors of Zuni Pueblo members using a survey exploring screening behaviors related to breast, cervical, and colorectal cancers. As part of a larger community-based cancer prevention and control project, Zuni Health Initiative staff conducted surveys from October 2020 through April 2021 of 281 participants (men ages 50-75 and women ages 21-75) from the Zuni Pueblo. Bivariate and multivariable analyses investigated associations between health literacy/numeracy measures and cancer screening behaviors. Bivariate analyses showed some associations between distinct measures of health literacy/numeracy and colorectal cancer (CRC) screening, including both colonoscopy (health literacy) and fecal occult blood testing (FOBT) (health numeracy), as well as cervical cancer screening (health literacy). There were no statistically significant associations between health literacy/numeracy measures and mammogram screening for breast cancer. In multivariable analyses, there were no consistent patterns between health literacy/numeracy and screening for any cancer. There are some individual findings worth noting, such as statistically significant findings for health numeracy and FOBT (those reporting lower health numeracy were less likely to report FOBT). An important finding of this study is that questions used to assess health literacy/numeracy did not identify associations aligned with previous research. We reflect on the ways the "standard" questions may not be sufficiently tailored to the Zuni experience and may contribute to health equity barriers.

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Conflict of interest statement

The authors declare no competing interests.

References

    1. Bastani R, Maxwell AE, Bradford C, Das IP, Yan KX. Tailored risk notification for women with a family history of breast cancer. Prev Med. 1999;29(5):355–364. doi: 10.1006/pmed.1999.0556. - DOI - PubMed
    1. Bastani R, Gallardo NV, Maxwell AE. Barriers to colorectal cancer screening among ethnically diverse high-and average-risk individuals. J Psychosoc Oncol. 2001;19(3–4):65–84. doi: 10.1300/J077v19n03_06. - DOI
    1. Bastani R, Glenn BA, Taylor VM, Chen MS, Jr, Nguyen TT, Stewart SL, Maxwell AE. Integrating theory into community interventions to reduce liver cancer disparities: the Health Behavior Framework. Prev Med. 2010;50(1–2):63–67. doi: 10.1016/j.ypmed.2009.08.010. - DOI - PMC - PubMed
    1. Brega AG, Ang A, Vega W, Jiang L, Beals J, Mitchell CM, Moore K, Manson SM, Acton KJ, Roubideaux Y, Special Diabetes Program for Indians Healthy Heart Demonstration Project Mechanisms underlying the relationship between health literacy and glycemic control in American Indians and Alaska Natives. Patient educ couns. 2012;88(1):61–68. doi: 10.1016/j.pec.2012.03.008. - DOI - PubMed
    1. Carlson T (2019) Mana motuhake o Ngāti Porou: decolonising health literacy. Sites: a journal of social anthropology and cultural studies, 16(2).

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