Abstract B21: Patient health literacy may affect use of screening mammography in an underinsured patient population
Authors: Machado Lorenzo , Klemens Anne E. , Nodora Jesse , Hsu Chiu-Hsieh , Zenuk Rachel , Martinez Maria Elena , Borbon Luis , Bouton Marcia E. , Komenaka Ian K. 
Published: December 2010

Purpose of Study: Physician-patient communication is critical to patient decisions. In underinsured and racial/ethnic minority patients, the disparity in comprehension may be greater than among insured or non-Hispanic white populations. Previous studies have demonstrated that mammography is underutilized by disadvantaged populations. Previous studies have also demonstrated that minority patients are dissatisfied with the amount of information they receive from physicians. One potential explanation for both the seeming non-compliance by patients and the dissatisfaction experienced by patients may be lack of awareness by the physicians of limited health literacy. The current study examined the feasibility of assessing health literacy in a busy surgical practice in a teaching institution and evaluated the influence of patient health literacy on their use of screening mammography.

Experimental Procedures: Maricopa Medical Center, the county safety net hospital in Phoenix, Arizona, serves a patient base which is 34.5% non-English speaking. All patients who were seen at least once at the Maricopa Medical Center Breast Clinic from January 14, 2010 to June 17, 2010 were included. Using the Newest Vital Sign (NVS) instrument to assess health literacy, participants were classified into 3 groups: 1) high likelihood of limited health literacy (NVS score 0 or 1); 2) Possible limited health literacy (NVS score 2 or 3); and 3) adequate health literacy (NVS score 4-6).

Data Summary: After exclusions, 504 of 505 patients underwent health literacy assessment as part of the routine history and physical examination during their clinic visit. The majority of the participants were classified as having a high likelihood of limited health literacy (59.9%), while 21.8% and 18.3% were classified as having possible limited health literacy and adequate health literacy, respectively. The vast majority of respondents (97.6%) were underinsured or uninsured. Compared to women with adequate health literacy, those with limited literacy were more likely to be Hispanic (p&lt;0.001) and of lower educational level (p&lt;0.0o1). Although nearly half (49%) of the patients had less than a high school education, limited health literacy was not explained solely by education level. Fifty six percent (56%) of limited health literacy patients had graduated from high school and 30% of these had at least some college education. Among patients who were 40 years or older, only 47% had undergone screening mammography and among those 50 years of age and older, 54% had participated in screening mammography. Among women 40 years of and older, mammography screening was significantly associated with higher level of health literacy; 42%, 39%, and 70% had undergone screening mammography among those with limited health literacy, possible health literacy, and high health literacy, respectively (p&lt;0.0001). The prevalence of screening mammography for women 50 years of age and older also increased with level of health literacy; however, the results were not statistically significant (p=0.15).

Conclusions: Assessment of health literacy is feasible in a busy surgical practice at a teaching hospital. Although overall use of screening mammography was suboptimal in this underinsured population, health literacy assessment can help identify patients at increased risk for underutilization of this important screening tool.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B21.