AHRQ: Health illiteracy an obstacle to mammo screening

Women with poor health literacy are less likely to undergo mammography screening, confirming similar findings from 2004, according to a report published by the Agency for Healthcare Research and Quality (AHRQ).

Defining health literacy as "the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions," AHRQ preformed a systematic review of clinical studies to determine the effect of health literacy on individuals’ use of healthcare services and on outcomes. The report comprised an update to a similar AHRQ investigation, conducted in 2004, with the present study examining whether any previous findings regarding the relationship between health illiteracy and poor access to healthcare services and inferior outcomes had changed.

AHRQ identified four cross-sectional studies that investigated the relationship between health literacy and breast cancer screening. “All studies found a lower use of mammography in the lower health literacy group compared with the adequate group,” the report noted.

The studies’ findings were not uniform, however. One study, conducted by White et al and including a sample of 18,100 participants, found that among health illiterate women, only those over the age of 65 were less likely to undergo screening than literate women of the same age group.

In another study that included 97 female patients of Philadelphia community health clinics, researchers reported that health illiterate women were less likely to have ever undergone mammography screening, though when determining the likelihood of screening within the last year or three years, health illiteracy was not observed to have any effect.

The study also noted that one nonrandomized trial showed that an intervention consisting of a brochure, video and verbal recommendation improved screening rates among illiterate women. This study was part of broader and mixed evidence that AHRQ deemed ‘insufficient’ to establish a relationship between interventions and smoother access to health services and improved outcomes.

AHRQ called the evidence that health illiteracy leads to a lower likelihood of mammography screening “moderate.”

Overall, AHRQ concluded that lower health literacy was “consistently” associated with worse health outcomes, including increased hospitalizations, greater ER use, lower influenza vaccination rates, poorer compliance with medications and a diminished ability to interpret labels and health messages. Moreover, among seniors, poor health literacy was correlated with worse overall health status and higher mortality.

To read AHRQ’s  “Health Literacy Interventions and Outcomes: An Updated Systematic Review,” click here.