Erika L. Thompson

Utilizing a Multidimensional Health Literacy Framework to Assess Cervical Cancer Screening Nonadherence

Health literacy is an amenable factor that can improve screening uptake. However, associations between the multidimensional health literacy domains and cervical cancer screening nonadherence are not known and should be considered to improve screening rates. The current quantitative study assessed the associations of multiple health literacy domains with cervical cancer screening nonadherence. Women aged 30 to 65 years without a hysterectomy were surveyed online ( N = 812). Assessing, understanding, and appraising measures from the European Health Literacy Survey Questionnaire were adapted for cervical cancer screening. The outcome variable measured the application of cervical cancer information regarding adherence to the 2012 cervical cancer screening guidelines (yes/no). Adjusted logistic regression odds ratios (aORs) estimated nonadherence. Most of the women were non-Hispanic (81.4%) or White (68.1%), and aged 30 to 39 years (40%). The majority of the women (71%) were adherent to screening recommendations. The model with all domains of health literacy had the best model fit statistics compared with other models with different health literacy components. Older age and lack of insurance were statistically significant for screening nonadherence. Difficulty understanding health information (aOR = 3.15; 95% confidence interval [CI; 1.80, 5.51]) and less worry about cervical cancer (aOR = 1.74; 95% CI [1.03, 2.94]) were associated with higher odds of nonadherence. Higher cervical cancer knowledge (aOR = 0.93; 95% CI [0.87, 0.98]) and Hispanic ethnicity (aOR = 0.36; 95% CI [0.21, 0.61)] were associated with lower odds of nonadherence. Incorporating a multidimensional health literacy framework may better inform the need to develop easily understood interventions that address cervical cancer perceived vulnerability and acknowledge systemic sociodemographic influences on screening perceptions.

Human Papillomavirus–Related Cancer Prevention Among People Experiencing Housing Instability: A Systematic Review

Background Human papillomavirus (HPV)–related cancer is highly preventable through HPV vaccination and cancer screening, but people experiencing homelessness or housing instability (PEH) may not engage in these behaviors due to conflicting priorities. This systematic review synthesized and estimated HPV-related cancer prevention behaviors among PEH. Methods Using PRISMA guidelines, articles published before 2023 were located via PubMed, Ovid/Medline, CINAHL, and Embase. Full-text, peer-reviewed studies that measured HPV-related cancer prevention in any sample of people experiencing homelessness were included. Two researchers abstracted data independently, with high interrater reliability (>90%). Results were narratively summarized with consensus, and proportions were compared using preventive behavior. Results After reviewing 405 articles, we included 18 articles from the United States from 1998 to 2022. There were 6674 people (e.g., women, youth, men who have sex with men) experiencing homelessness assessed for HPV-related cancer prevention behaviors. Pooled prevalence was approximately 59.8% (±6%) for cervical cancer screening in the last 3 years and 42.9% (±4.7%) for HPV vaccination initiation. Other factors related to housing instability and HPV-related cancer prevention included gender, sexual trauma, and procedural pain, with mixed results for housing status and HPV knowledge. Conclusions Findings demonstrate the varied adherence to HPV-related cancer prevention, with rates consistently below recommended World Health Organization guidelines. Future studies should adjust for specific risk factors in modeling that may be associated with or modified by the effects of homelessness and evaluate upstream prevention (e.g., vaccination) and other types of HPV-related cancer (e.g., anal cancer).