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At least 127 records · Page 7Linked to original sources
PubMed2006

Physician overestimation of patient literacy: a potential source of health care disparities.

OBJECTIVE: To investigate physician overestimation of patient literacy level in a primary care setting. METHODS: The study sample consisted of 12 non-academic primary care physicians and 100 patients from a U.S. Department of Veterans Affairs Hospital in Houston, Texas. Patient literacy level was measured on a 1-4 scale using the Rapid Estimate of Adult Literacy in Medicine (REALM). Physicians rated each patient's literacy level on a corresponding scale. Chi-square was used to test for association of patient race/ethnicity and gender with: (1) patient REALM level and (2) discrepancy between patient REALM level and physician rating of patient literacy level. RESULTS: Patient REALM level was not statistically significantly associated with patient race/ethnicity or gender. Physicians overestimated the REALM level for 54% of African American, 11% of white non-Hispanic, and 36% of other race/ethnicity patients (p<.01). CONCLUSION: Physicians commonly overestimate patients' literacy levels, and this apparently occurs more often with minority patients, and particularly with African Americans, than with white non-Hispanic patients. This discordance in estimation of patient's literacy level may be a source of disparities in health care.

Black or African American↗
PubMed2006

Literacy, race, and PSA level among low-income men newly diagnosed with prostate cancer.

OBJECTIVES: Among men with newly diagnosed prostate cancer, prostate-specific antigen (PSA) levels are higher and the cancer stage more advanced for African Americans than for whites. An earlier study found that after adjustment for literacy, race was no longer a significant predictor of advanced stage at presentation. We investigated whether, after adjusting for literacy, race was a significant independent predictor of greater PSA levels among men with newly diagnosed prostate cancer. METHODS: Consecutive patients with newly diagnosed prostate cancer from four outpatient care facilities in Chicago were interviewed and given a literacy assessment (n = 308). The PSA level at diagnosis was obtained from the medical charts. Logistic regression models were used to identify predictors of high PSA levels (greater than 20 ng/mL) at presentation. RESULTS: African-American men were three times more likely to have low literacy skills (sixth grade or less: 22.9% versus 7.1%; P <0.001) than were white men. In turn, men with low literacy skills were more than twice as likely to have a PSA level greater than 20 ng/mL at diagnosis (33.3% versus 13.5%; P = 0.009). On multivariate analyses, significant predictors of high PSA levels included low literacy (adjusted odds ratio 2.5, 95% confidence interval 1.5 to 4.2) and older age (age 65 to 74 years, adjusted odds ratio 2.6, 95% confidence interval 2.1 to 3.1 versus older than 74 years, adjusted odds ratio 3.4, 95% confidence interval 1.8 to 6.6), but not African-American race. CONCLUSIONS: In the current era in which PSA testing is common, low literacy may be an important and potentially overlooked factor associated with higher PSA levels at prostate cancer diagnosis among African-American and white men.

Aged↗
PubMed1993

Does reading make you smarter? Literacy and the development of verbal intelligence.

The studies reported here represent the first steps in the development of a new research paradigm for studying the unique cognitive correlates of literacy. Reading experience exhibits enough isolable variance within a generally literate society to be reliably linked with cognitive differences. Research on such links is therefore facilitated because the consequences of engaging in literacy activities can be studied without necessarily obtaining totally illiterate samples or setting up cross-cultural comparisons. Issues that are at least analogous issues to those raised in cross-cultural research can be studied within literate societies with a paradigm such as this, and therefore the speed with which we can answer questions about the cognitive consequences of literacy may be greatly increased because more studies can be carried out, larger samples can be studied, and the range of the cognitive domains tapped can be widened. Research in this area appears to have been stifled because of the widespread acceptance of the most extreme interpretations of the outcome of Scribner and Cole's (1981) investigation--interpretations that have slowly diffused throughout the literature without being accompanied by any new data. These conclusions are fueled by a powerful social critique that advances the argument that the positive cultural and economic effects of literacy have been overstated--indeed, that literacy is, if anything, a repressive force (Auerbach, 1992; Street, 1984, 1988; Stuckey, 1991). Educational theorists such as Frank Smith accused the educational establishment of "overselling" literacy and have argued that "Literacy doesn't generate finer feelings or higher values. It doesn't even make anyone smarter" (1989, p. 354). The data reported herein appear to indicate that these theorists could well be wrong in this conclusion. If "smarter" means having a larger vocabulary and more world knowledge in addition to the abstract reasoning skills encompassed within the concept of intelligence, as it does in most laymen's definitions of intelligence (Stanovich, 1989; Sternberg, 1990), then reading may well make people smarter. Certainly our data demonstrate time and again that print exposure is associated with vocabulary, general knowledge, and verbal skills even after controlling for abstract reasoning abilities (as measured by such indicators as the Raven).(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed2000

All children are ready to learn: an emergent versus readiness perspective in early literacy assessment.

Assessment of emergent literacy is relatively new to the field of communication disorders. Traditional approaches to reading assessment evaluated mastery of reading readiness skills. By contrast, emergent literacy assessment evaluates the increased awareness and understanding of print that begin early in development. One of the most influential figures in emergent literacy assessment has been Marie M. Clay. She has defined critical components of emergent literacy and, in so doing, has played an integral role in the paradigm shift from a reading readiness to an emergent literacy perspective. This article is intended to distinguish emergent literacy from reading readiness, explicate Marie Clay's contribution to our current understanding of effective emergent literacy assessment, and provide some guidance in using her assessment techniques with children with significant disabilities.

Age Factors↗
PubMedDate not supplied

Rethinking literacy and women's health: a Bangladesh case study.

Health and literacy are two major areas of women's development in the Third World. Although health and literacy have been recognized as essential elements for improving the quality of women's lives, questions emerge from Eurocentric and colonial assumptions about development, including the following: Does literacy have an impact on women's health? If it does, what are the mechanisms whereby literacy could have an impact on women's health? Using Bangladesh as a case study, I question the Eurocentric and colonial nature of dominant discourses in the answers to questions about literacy and women's health. I argue that literacy and women's health need to be reconsidered from the local women's standpoint since dominant discourses fail to take into consideration local women's worldviews, indigenous knowledge, and oral traditions. Finally, I make some recommendations for future research and programming in literacy and women's health in Bangladesh and in health care in Third World contexts.

Bangladesh↗
PubMedDate not supplied

Speech, language and literacy skills 3 years later: a follow-up study of early phonological and metaphonological intervention.

BACKGROUND: Three years before the present study, 19 preschool children participated in a phonological and metaphonological intervention programme. The phonological intervention programme was based on non-linear phonological analyses. The metaphonological intervention programme included both rhyming and alliteration tasks and was directly targeted during the last section of the programme. All children made significant gains in phonology, and many in metaphonology. However, the literature notes a tendency for children with history of early speech or language impairments to have difficulty acquiring literacy skills or to show residual speech impairment. The participants of the 1998 study were therefore considered at risk for continuing speech impairment and/or academic performance. AIMS: The primary objectives were to document the children's later speech, language and literacy skills, and to determine potential relationships between previous and concurrent child factors. METHODS & PROCEDURES: Twelve children from the original cohort (aged 6;1-8;5) received a comprehensive battery of speech, language, cognitive and academic tasks 3 years after the original study. Data were evaluated both concurrently and in terms of the children's preschool performance. OUTCOMES & RESULTS: Five of the children had residual phonological impairment. Only two children showed below average reading (decoding and comprehension), although five also showed below average spelling performance. Children with limitations in verbal memory, language production and metaphonology at the follow-up point were more likely to show delays in literacy. Language production skills at the follow-up point were most strongly correlated with literacy development. In terms of the early study, the strongest predictor for literacy development was performance on metaphonology tasks at the end of the early intervention study. The strongest predictor for ongoing speech impairment was phonological skill at the end of the early study. CONCLUSIONS: Results suggest that early phonological and metaphonological intervention can promote normalization of speech development and normal acquisition of literacy skills for at least some children with a history of severe phonological impairment. In the earlier study, the component structure of words (onsets, rhymes, codas) was emphasized through both metaphonological and non-linear phonological intervention. Risk for literacy and ongoing speech impairment can be reduced through early intervention that draws attention to the structure of words.

Child↗
PubMed2004

The relationship between literacy and cognition in well-educated elders.

BACKGROUND: Literacy is correlated with general intelligence and is often used to estimate premorbid intelligence in persons with dementia. However, little is known about the relationship between literacy and specific cognitive domains. METHODS: Study participants were 664 community-living adults aged 65 years or older who were participating in a community-based study of health and function in Sonoma, California. Literacy was measured using the North American Adult Reading Test, which evaluates the ability to pronounce words with irregular spellings (such as indict). Cognitive function was assessed using a neuropsychological test battery that included the Mini-Mental State Examination and measures of attention and executive function (Trails B, Stroop, Digit Symbol), verbal learning and memory (California Verbal Learning Test), and verbal fluency (letter "s," animals). RESULTS: The mean age of the participants was 76 years, 50% were women, 97% were white, and 92% had 12 or more years of education. A strong, linear association was observed between literacy and all cognitive measures (all p <.001). Results were similar after adjustment for age, sex, education, and health-related covariates and were consistent in subgroups of the study population (e.g., women vs men; English vs other native languages). Education was not associated with most cognitive measures after adjustment for literacy. CONCLUSIONS: Literacy is strongly associated with cognitive function across all cognitive domains in well-educated, elderly white persons. Future studies should determine whether interventions to improve lifetime literacy may help prevent cognitive deterioration with age.

Aged↗
PubMed2001

Health literacy: communication for the public good.

This article builds upon a presentation at the Fifth Global Health Conference on Health Promotion (Mexico City, 9 June 2000), seeking to advance the development of health literacy through effective communication. First, it offers a timely reflection for health promotion epistemology in particular, and the potential approach to framing health promotion activities in general, with health literacy as a bridging concept. The concept of health literacy is briefly explained and defined, followed by identification of some promising communication interventions to diffuse health literacy. Four predominant areas within the communication field are described that shed light on approaches for developing health literacy: integrated marketing communication, education, negotiation and social capital. Each component can contribute to strategic science-based communication. Finally, the article elucidates that communication and developing health literacy are not simple solutions. Communication is not simply message repetition, but includes the development of an environment for community involvement to espouse common values of humankind. With effective communication, worldwide health literacy can become a reality in the 21st century, embodying health as a central tenet of human life.

Educational Status↗
PubMed2003

Exploring the language and literacy outcomes of pediatric cochlear implant users.

OBJECTIVE: The principal goal of this study was to investigate the relationship between language and literacy (i.e., reading and writing) skills in pediatric cochlear implant users. A peripheral objective was to identify the children's skills that were in need of remediation and subsequently to provide suggestions for remedial programming. It was predicted that the robust language skills often associated with children who have cochlear implant experience would facilitate the development of literacy skills. It was further proposed that the language and literacy skills of pediatric cochlear implant users would approximate the language and literacy skills of children with normal hearing. DESIGN: Sixteen pediatric cochlear implant users' language and literacy skills were evaluated and then compared with a reference group of 16 age-matched, normal-hearing children. All 32 participants were educated in mainstream classes within the public school system in the Midwest. The "Sentence Formulation" and "Concepts and Directions" subtests of the Clinical Evaluation of Language Fundamentals-3 test were used to evaluate receptive and expressive language skills. Reading comprehension was evaluated with the "Paragraph Comprehension" subtest of the Woodcock Reading Mastery Test. Performance measures for the writing analyses included productivity, complexity and grammaticality measures. RESULTS: Children with cochlear implants performed within 1 SD of the normal-hearing, age-matched children on measures of language comprehension, reading comprehension and writing accuracy. However, the children with cochlear implants performed significantly poorer than the children with normal hearing on the expressive "Sentence Formulation" subtest. The cochlear implant users also produced fewer words on the written narrative task than did the normal-hearing children, although there was not a significant difference between groups with respect to total words per clause. Furthermore there was a strong correlation between language performance and reading performance, as well as language performance and total words produced on the written performance measure for the children using cochlear implants. CONCLUSIONS: The results of this study suggest that the language skills of pediatric cochlear implant users are related to and correlated with the development of literacy skills within these children. Consequently, the performance of the cochlear implant users, on various language and literacy measures, compared favorably to an age-matched group of children with normal hearing. There were significant differences in the ability of the cochlear implant users to correctly utilize grammatical structures such as conjunctions and correct verb forms when they were required to formulate written and oral sentences. Given this information, it would be appropriate for their educational or remedial language programs to emphasize the use and development of these structures.

Child↗
PubMed2006

Literacy achievement of children with intellectual disabilities and differing linguistic backgrounds.

BACKGROUND: The aim of the present study was to examine the literacy achievement of 10- to 12-year-old native and non-native children with intellectual disabilities (ID) living in the Netherlands. An intriguing question within this context was whether the second language learning non-native children with ID would show a double disadvantage when compared with their monolingual Dutch peers with no ID. METHODS: Dutch literacy scores in the domains of word decoding, vocabulary, syntax and text were therefore compared for: (1) intellectually disabled native Dutch children; (2) intellectually disabled non-native children; (3) normally developing native Dutch children; and (4) normally developing non-native children. The interrelations between literacy subskills were also compared for native vs. non-native children with ID. RESULTS: The native and non-native students diagnosed as intellectually disabled produced substantially lower literacy scores than their non-disabled peers. The differences between the native (L1) and non-native (L2) children in regular vs. special education were found to depend on the aspect of literacy considered. Word decoding and language skills turned out to significantly predict the children's reading comprehension, although some differences in the strength of relationships could also be evidenced. CONCLUSIONS: The literacy achievement of intellectually disabled children with differing linguistic backgrounds generally falls behind that of their non-disabled peers. For word decoding, the non-native children in regular and special education were generally able to keep up with their native peers. For higher-order literacy abilities closely related to the mental lexicon, sentence processing and text processing, however, significant differences in the performances of the native (L1) and non-native (L2) children in regular vs. special education were found, suggesting a double disadvantage for the non-native children in special education.

Achievement↗
PubMed2005

Literacy difficulties and psychiatric disorders: evidence for comorbidity.

BACKGROUND: Literacy difficulties show high levels of comorbidity with both disruptive and emotional disorders, but questions remain over the nature and specificity of these links. METHOD: Relationships between specific literacy difficulties and psychiatric disorder were investigated in a large-scale national sample of children aged 9 to 15 years. RESULTS: Specific literacy difficulties were more common in children from lower socio-economic backgrounds, and were significantly associated with increased risks of Attention-Deficit Hyperactivity Disorder (especially inattentive symptomatology), Conduct Disorder and anxiety disorders in both girls and boys, and with self-reports of depressed mood in boys. Associations between literacy difficulties and diagnoses of both Attention-Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) were mediated by inattentiveness, as were links with low mood. Links between specific literacy difficulties and anxiety were of a different nature, suggestive of a direct impact of literacy problems on risk for anxiety disorders. CONCLUSIONS: Literacy difficulties are significantly associated with externalizing disorders via inattention, but may constitute a more immediate risk factor for naturally anxious children to develop clinically significant levels of anxiety.

Adolescent↗
PubMed2005

Brief report: Resident recognition of low literacy as a risk factor in hospital readmission.

BACKGROUND: Low literacy is associated with poor self-management of disease and increased hospitalization, yet few studies have explored the extent to which physicians consider literacy in their patient care. OBJECTIVE: To examine trainee recognition of low literacy as a potential factor in patient adherence and hospital readmission. DESIGN AND PARTICIPANTS: Randomized study of 98 Internal Medicine residents and medical students. Trainees reviewed a case history and completed a questionnaire pertaining to a fictional patient's hospital readmission. Case version A contained clues to suggest limited patient literacy skills, while version B did not. Responses were reviewed for mention of low literacy and educational strategies recommended for low-literate patients. RESULTS: Few trainees raised the possibility of low patient literacy, even when provided clues (25% in Group A vs 4% in Group B, P=.003). Furthermore, while most trainees listed patient education as an important means of preventing another readmission, only 16% suggested using a strategy recommended for low-literate adults. CONCLUSION: Few trainees recognized low literacy as a potential factor in patient nonadherence and hospital readmission, and few recommended low-literate educational strategies. Medical residents and students may benefit from additional training in the recognition and counseling of low-literate patients.

Academic Medical Centers↗
PubMed2005

Interventions to improve health outcomes for patients with low literacy. A systematic review.

OBJECTIVE: To perform a systematic review of interventions designed to improve health outcomes for persons with low literacy skills. DATA SOURCES: We searched MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resources Information Center (ERIC), Public Affairs Information Service (PAIS), Industrial and Labor Relations Review (ILLR), PsycInfo, and Ageline from 1980 to 2003. STUDY SELECTION: We included controlled and uncontrolled trials that measured literacy and examined the effect of interventions for people with low literacy on health outcomes, including health knowledge, health behaviors, use of health care resources, intermediate markers of disease status, and measures of morbidity or mortality. Two abstractors reviewed each study for inclusion. Disagreements were resolved by consensus among the research team. DATA EXTRACTION: One reviewer abstracted data from each article into an evidence table; the second reviewer checked each entry. Disagreements about information in evidence tables were resolved by team consensus. Both data extractors independently completed an 11-item quality scale for each article; scores were averaged to give a final measure of article quality. DATA SYNTHESIS: We identified 20 articles examining interventions designed to improve health among people with low literacy. The most common outcome studied was health knowledge; fewer studies examined health behaviors, intermediate markers, or measures of disease prevalence or severity. The effectiveness of interventions appeared mixed. Limitations in research quality and heterogeneity in outcome measures make drawing firm conclusions about effective strategies difficult. Only 5 articles examined the interaction between literacy level and the effect of the intervention; they also found mixed results. CONCLUSIONS: Several interventions have been developed to improve health for people with low literacy. Limitations in study design, interventions tested, and outcomes assessed make drawing conclusions about effectiveness difficult. Further research is required to understand better the types of interventions that are most effective and efficient for overcoming literacy-related barriers to good health.

Clinical Trials as Topic↗
PubMed2006

Impact of health literacy on socioeconomic and racial differences in health in an elderly population.

BACKGROUND: Differences in health literacy levels by race and education are widely hypothesized to contribute to health disparities, but there is little direct evidence. OBJECTIVE: To examine the extent to which low health literacy exacerbates differences between racial and socioeconomic groups in terms of health status and receipt of vaccinations. DESIGN: Retrospective cohort study. PARTICIPANTS (OR PATIENTS OR SUBJECTS): Three thousand two hundred and sixty noninstitutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, OH; Houston, TX; South Florida; and Tampa, FL. MEASUREMENTS: Dependent variables were physical health SF-12 score, mental health SF-12 score, self-reported health status, receipt of influenza vaccine, and receipt of pneumococcal vaccine. Independent variables included health literacy, educational attainment, race, income, age, sex, chronic health conditions, and smoking status. RESULTS: After adjusting for demographic and health-related variables, individuals without a high school education had worse physical and mental health and worse self-reported health status than those with a high school degree. Accounting for health literacy reduced these differences by 22% to 41%. Black individuals had worse self-reported health status and lower influenza and pneumococcal vaccination rates. Accounting for health literacy reduced the observed difference in self-reported health by 25% but did not affect differences in vaccination rates. CONCLUSIONS: We found that health literacy explained a small to moderate fraction of the differences in health status and, to a lesser degree, receipt of vaccinations that would normally be attributed to educational attainment and/or race if literacy was not considered.

Aged↗
PubMed2006

Limited literacy in older people and disparities in health and healthcare access.

OBJECTIVES: To determine the relationship between health literacy, demographics, and access to health care. DESIGN: Cross-sectional study, Health, Aging and Body Composition data (1999/2000). SETTING: Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS: Two thousand five hundred twelve black and white community-dwelling older people who were well functioning at baseline (without functional difficulties or dementia). MEASUREMENTS: Participants' health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine. Scores were categorized into 0 to sixth-, seventh- to eighth-, and ninth-grade and higher reading levels (limited health literacy defined as <9th grade). Participants' demographics, socioeconomic status, comorbidities, and three indicators of healthcare access (whether they had a doctor/regular place of medical care, an influenza vaccination within the year, or insurance for medications) were also assessed. RESULTS: Participants' mean age was 75.6, 52% were female, 38% were black, and 24% had limited health literacy. After adjusting for sociodemographics, associations remained between limited health literacy and being male, being black, and having low income and education, diabetes mellitus, depressive symptoms, and fair/poor self-rated health (P<.02). After adjusting for sociodemographics, health status, and comorbidities, older people with a sixth-grade reading level or lower were twice as likely to have any of the three indicators of poor healthcare access (odds ratio=1.96, 95% confidence interval=1.34-2.88). CONCLUSION: Limited health literacy was prevalent and was associated with low socioeconomic status, comorbidities, and poor access to health care, suggesting that it may be an independent risk factor for health disparities in older people.

Aged↗
PubMed2003

The impact of early literacy guidance on language skills of 3-year-olds.

The objective of this prospective study was to determine the impact of early literacy anticipatory guidance (AG) with provision of books on language development in 3-year-olds in an early literacy program at a University-affiliated inner-city pediatric clinic. The Peabody Picture Vocabulary Test (PPVT-III) and the Expressive One Word Picture Vocabulary Test (EOWPVT-R) were administered to 33-39-month-old children exposed to an early literacy program, which included AG and provision of an age-appropriate book at each well-child visit starting at 2 months old. Children with developmental delays were excluded. Parental surveys on literacy and demographic data were obtained. Univariate and multivariate analyses were performed. Sixty-four children were evaluated; 88% African American, 89% Medicaid recipients. Fifty-eight percent of families reported family-centered literacy orientation. The PPVT-III scores directly correlated with the number of AG visits with book given x number of books purchased (r2 = 0.025, p = 0.0006). Higher scores in EOWPVT-R were predicted by race and the number of visits with books given x number of books purchased (r2 = 0.182, p = 0.0009). All families reported reading together, half reporting positive family-centered literacy. Given the same number of books purchased for each child, the outcome scores were higher the greater the number of clinic visits wherein AG included early literacy and provision of books.

Adolescent↗
PubMedDate not supplied

Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes.

OBJECTIVES: We sought to determine whether literacy mediates the relationship between education and glycemic control among diabetes patients. METHODS: We measured educational attainment, literacy using the Short Test of Functional Health Literacy in Adults (s-TOFHLA), and glycemic control (HbA1c) in 395 diabetes patients at a U.S. public hospital. We performed path analysis to compare two competing models to explain glycemic control. The direct effects model estimated how education was related to HbA1c; the mediational model estimated the strength of the direct relationship when the additional pathway from education to literacy to HbA1c was added. RESULTS: Both the model with a direct effect of education on HbA1c and the model with literacy as a mediator were supported by good fit to observed data. The mediational model, however, was a significant improvement, with the additional path from literacy to HbA1c reducing the discrepancy from observed data (p < 0.01). After including this path, the direct relationship between education and HbA1c fell to a non-significant threshold. CONCLUSIONS: In a low-income population with diabetes, literacy mediated the relationship between education and glycemic control. This finding has important implications for both education and health policy.

Diabetes Mellitus↗
PubMed2004

Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: does literacy make a difference?

PURPOSE: To evaluate whether lower literacy is associated with poorer knowledge and more negative attitudes and beliefs toward colorectal cancer screening among veterans without recent colorectal cancer screening. PATIENTS AND METHODS: Three hundred seventy-seven male veterans, age 50 years and older, who had not undergone recent colorectal cancer screening, were surveyed about their knowledge, attitudes, and beliefs regarding colorectal cancer screening. Patients' literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine, an individually administered screening test for reading. RESULTS: Thirty-six percent of the 377 men had an eighth grade literacy level or higher. Men with lower literacy were 3.5 times as likely not to have heard about colorectal cancer (8.8% v 2.5%; P =.006), 1.5 times as likely not to know about screening tests (58.4% v 40.9%; P =.0001), and were more likely to have negative attitudes about fecal occult blood testing (FOBT), but not about flexible sigmoidoscopy. Specifically, men with lower literacy skills were two times as likely to be worried that FOBT was messy (26.7% v 13.3%; P =.008), 1.5 times as likely to feel that FOBT was inconvenient (28.7% v 18%; P =.05), and four times as likely to state they would not use an FOBT kit even if their physician recommended it (17.9% v 4.0%; P =.02). CONCLUSION: Limited literacy may be an overlooked barrier in colorectal cancer screening among veterans.

Aged↗