Addressing colorectal cancer screening gaps in Uruguay: a health literacy perspective

Uruguay has the highest colorectal cancer (CRC) mortality rate in the world, given the high prevalence of risk factors and low screening rates. Despite national guidelines recommending regular FIT screening between the ages of 50 and 74, less than half of the eligible population has obtained the test. Clearly, efforts are needed to increase screening rates. Little is known, however, about factors that promote FIT uptake among Uruguayans. To address this research gap, a theoretical analysis was conducted based on the health literacy model, to understand the relative contribution of individual and organizational health literacy variables in screening behaviors.

Through community-based outreach, a national sample of 398 Uruguayan women and men was recruited. Participants had never been diagnosed with CRC and were 50 to 74 years of age, consistent with national screening guidelines.

Analyses showed that when examining individual health literacy, knowledge of cancer more generally, and of CRC in particular, had the largest predictive value. However, when adding organizational health literacy variables to the model, recommendation by a health care provider yielded odds of screening 210 times higher.

The dramatic effect of a provider's recommendation has important implications for future theory building, research, and practice. Additionally, this study supports the use of a health literacy conceptualization to understand predictors of cancer screening in Uruguay.