The association between health literacy and theory of planned behavior with performance of cancer screening tests among rural patients: Cross- sectional study

Low health literacy is one of the social health determinants associated with cancer-related disparities. The aim of this study is to explore the relationships between health literacy and theory of planned behavior in performance of cancer screening tests by person undercover of rural health centers in Fasa, Fars Province, Iran in 2018. In this cross-sectional study, 850 persons older than 18 years of age were selected with cluster sampling. Data were collected by a questionnaire consisting of four sections evaluating demographic information, cancer screening behaviors, subjects' health literacy and constructs of theory of planned behavior. The frequency of acceptable health literacy was respectively in Comprehension (39.41%), Reading (37.41%), Decision making (36.70%), Availability (36.23%) and Evaluation (35.76%). 37.65% of subjects (n = 320) had an acceptable health literacy level (n = 320), 46% (n = 391) had medium level and 16.35% (n = 139) had weak level. Results indicated that, there is significant relationship between health literacy and undergoing breast self-examination, Pap smear test, prostate specific antigen test (PSA) and Fecal occult blood test (FOBT). Also, theory of planned behavior predicted 41% variance in breast cancer screening behavior, 39% in cervical cancer screening, 40% PSA, 37% in mammography and 42% in FOBT. In each four cases, the role of behavioral intention was considerable. This study confirmed the correlation between cancer screening behaviors, health literacy and constructs of theory of planned behavior. Therefore, for promoting cancer screening behaviors and health literacy, theory of planned behavior can be used as a principle in health education and promotion programs.