How Is Health Literacy Related to Pap Testing Among US Women?

  • Erika L. ThompsonEmail author
  • Christopher W. Wheldon
  • Cheryl A. Vamos
  • Stacey B. Griner
  • Ellen M. Daley


While Pap testing has significantly reduced the burden of cervical cancer, not all women follow prevention recommendations of cervical cancer screening every 3 years. Health literacy regarding Pap testing may influence the adoption of this behavior. The objective of this study was to assess the health literacy-related factors associated with Pap testing among a nationally representative sample of women in the USA. The Health Information National Trends Survey Cycles 4.4 and 5.1 were restricted to women 21–65 years of age (N = 2992). Questions were selected using the Integrated Model of Health Literacy domains: access (i.e., seeking cancer information), understand (i.e., HPV awareness, HPV knowledge), appraise (i.e., prevention not possible, chance of getting cancer), and apply (i.e., received a Pap in last 3 years [outcome]). Survey-weighted, logistic regression models estimated how the health literacy domains were associated with Pap testing, using SAS 9.4. In the sample, 81.1% of women received a Pap test within the last 3 years. The analysis revealed women who knew HPV is an STD (aOR = 1.64, 95% CI 1.20–2.26) were more likely to have received a Pap test in the last 3 years, while controlling for sociodemographic factors. These findings indicate that knowledge about HPV may be associated with Pap testing behavior among US women. Continued research is needed to examine the impact of health literacy on Pap testing given the changes in screening guidelines, with the ultimate goal of decreasing cervical cancer.


Cervical cancer Screening Health literacy Women 



The authors would like to acknowledge the developers and administrators of the Health Information National Trends Survey—the National Cancer Institute. The present study reflects the analyses and interpretations of the authors and do not reflect the views of the National Cancer Institute.


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Copyright information

© American Association for Cancer Education 2018

Authors and Affiliations

  1. 1.Department of Health Behavior and Health Systems, School of Public HealthUniversity of North Texas Health Science CenterFort WorthUSA
  2. 2.Division of Cancer Control and Population SciencesNational Cancer InstituteBethesdaUSA
  3. 3.Department of Community and Family Health, College of Public HealthUniversity of South FloridaTampaUSA
  4. 4.The Chiles Center, College of Public HealthUniversity of South FloridaTampaUSA

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