Health literacy, cervical cancer risk factors, and distress in low-income African-American women seeking colposcopy.

OBJECTIVES To describe the relationship between health literacy, distress, and cervical cancer risk factors in women at high risk for developing cervical cancer. DESIGN Cross-sectional, prospective cohort design. SETTING Two university-based gynecological oncology colposcopy clinics and 3 Planned Parenthood community dinics. PATIENTS/PARTICIPANTS One hundred-thirty English-speaking African-American women > or = 18 years referred for colposcopy following abnormal Pap testing. MAIN OUTCOME MEASURES Avoidance and Intrusion subscales of the Impact of Events Scale (IES), Rapid Estimate of Adult Literacy in Medicine (REALM), and demographics. RESULTS Forty-five percent of women had a low level of health literacy (< 9th grade). Low health literacy was related to fewer risk factors (P < .01) and higher levels of distress on the Impact of Events avoidance subscale (P < .05) after controlling for covariates. Forty-three percent of women with low literacy had excessive levels of distress as compared to 25% in women with high literacy (P < .05). CONCLUSIONS A low level of health literacy is associated with increased levels of distress among women at high risk for developing cervical cancer. To the extent that distress serves as a barrier to treatment, culturally informed, effective interventions are needed.