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Low Health Literacy Prevents Cancer Screening for Many Hispanic Patients

A Regenstrief Institute report exposes gaps in cancer health literacy among Indiana Hispanics; despite the mixed understanding of guidelines, adherence to cancer screenings remained relatively high.

A new study out of the Regenstrief Institute and Indiana University presents a snapshot of cancer health literacy, revealing mixed knowledge of cancer adherence screening guidelines that persisted across societal factors. Despite this, Hispanic patients largely complied with screening adherence.

“Our findings could help guide both future research and public health outreach targeting high-risk groups, in this case, Hispanics,” Regenstrief Institute Center for Health Services Research Director David Haggstrom, MD, MAS, corresponding and senior author of the new study, said. “We want to reach all age groups in the Hispanic community with cancer screening approaches to reduce the burden of disease. Given that cancer is of greater incidence and prevalence among older individuals, this is an audience that we especially want to learn more about, so we can promote cancer screening among them.”

Cancer is the top cause of Hispanic deaths in the US and Indiana, accounting for 21 percent and 19 percent of deaths in 2016, respectively.

While cancer rates among Hispanic people are generally lower than non-Hispanic Whites, cervical cancer incidence among Hispanics is 40 percent higher than non-Hispanic Whites. Further, Hispanics face barriers to timely cancer screenings, leading to delayed diagnosis.

The study focused on whether health literacy affects cancer-related behaviors of Hispanics, a previously unexplored area, the researchers pointed out.

Researchers sought to examine recent cancer screening patterns, knowledge, beliefs, and behaviors among 980 Hispanic adults in Indiana, providing insights for tailored screening messaging and prevention strategies.

The study findings showed that most surveyed Hispanics lacked accurate knowledge about the age to begin cancer screenings. Only 4 percent of participants correctly identified the age for lung cancer screening adherence, while only 18 percent correctly identified the age for breast cancer screening adherence.

Interestingly, these low rates persisted across several traditional social determinants of health, including nationality, rurality, and income, which typically impact health literacy but did not in this case.

However, societal factors impacted cancer beliefs, with Hispanics with higher income and education more likely to believe they were at risk of developing cancer and to worry about the disease. In fact, 78 percent of Hispanics with an income higher than $75,000 reported being worried about cancer, while 29 percent of patients with lower income also expressed concern.

Concerning cancer fatalism, lower-income individuals were more likely to agree with cancer statements like “When I think about cancer, I think about death” and “You cannot lower your cancer risk much.” Both lower-income and lower-educated groups agreed more frequently with “I would rather not know my cancer risk.”

The findings also showed that although researchers linked education levels to greater screening knowledge,  it did not correlate with adherence to screening guidelines, except cervical cancer. Surprisingly, lower-income individuals reported higher screening adherence rates, with 77 percent of lower-income Hispanics receiving up-to-date colorectal screening, 61 percent for breast cancer, and 47 percent for cervical cancer.

The study also found that younger age and urban residency were linked with higher colorectal cancer screening adherence odds. At the same time, the study found a link between primarily Spanish language usage and lower adherence odds.

The researchers said they concentrated on study diversity and inclusion to ensure valid results.

Researchers conducted a cross-sectional survey from August to October 2021 targeting Indiana-based Hispanic adults aged 18 and older who could read/write English or Spanish. To recruit participants, researchers used TV, social media, and Hispanic community organizations’ Facebook pages. The survey examined knowledge, beliefs, and behaviors related to cancer screening and prevention.

“Using non-traditional approaches, we tapped into a lot of different groups that make up the Hispanic community including first- and second-generation immigrants, a wide distribution of income, education and ages as well as representatives of the approximately one fourth of the Hispanic population that does not appear in usual sampling frameworks like driver’s license lists,” said study co-author Gerardo Maupomé, BDS, MSc, PhD. “Conducting this survey was particularly challenging because we knew that many in the Hispanic community would not be easy to find unless you knew how to get ahold of them.”

“Collecting data from hard-to-reach populations within the Hispanic community, we expanded considerably the body of knowledge about what are the risk factors and the beliefs and the behaviors that modify cancer experience.”

Of the 1,520 respondents, roughly half completed the survey in Spanish. The majority identified the United States) as their nation of birth; 14 percent were from Mexico, 7 percent from Cuba, 6 percent from Puerto Rico, and 13 percent from other countries.

“Hispanics residing in Indiana are somewhat representative of Hispanics residing in the Midwest, although not necessarily representative of Hispanics residing in other areas of the United States due, in part, to variation in immigration patterns,” said Haggstrom. “To our knowledge, this is the only data collection and analysis of Hispanics residing in the Midwest that enables drilling down on the associations in this population of knowledge and beliefs with behaviors.”

Maupomé added, “the Midwest and the South have in the past 10 to 15 years become what is called a gateway destination. The number of recent Hispanic arrivals is noticeable because there were not that many to begin with. What we’ve seen in our study of Indiana is the fine-grained stages of the trajectory of integration that occur, distinct from the traditional Hispanic areas of the US – eg, Southern California, Texas , and Florida.”

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