After health literacy: towards a socio-structural understanding of gender-specific determinants of colorectal cancer screening non-participation
1
Health Promotion Administration, Ministry of Health and Welfare, Taipei City, Taiwan, Province of China
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Previous evidence showed low health literacy (HL) and low socioeconomic status (SES) link to poor uptake in colorectal cancer (CRC) screening. However, recent evidence indicated non-linear associations between higher HL and CRC screening. This suggests the relationship between HL and CRC screening may become more complex since ongoing changes in society. Therefore, examining what factors relate to reasons for non-participation is crucial for advancing strategies.
METHODS:
We analyzed 2021 Taiwan National Health Interview Survey data for adults aged 50-74 (n=1213). HL was measured using the HLS-EU-Q16 and categorized into four gradients: inadequate, problematic, sufficient and excellent. Reasons for non-participation (collected through a multiple-response question) were grouped into four categories: personal perception, emotional and attitudinal, knowledge and information, and structural and practical barriers, following the Health Belief Model. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aORs) between HL gradients and non-participation categories across gender-specific and pooled samples, controlling demographic and SES variables.
RESULTS:
Personal perception was the leading reason (68.46%) for non-participation in CRC screening, followed by structural and practical barriers (24.22%). This pattern was consistent across all HL gradients, suggesting limited marginal effects in CRC screening. Among women, occupational skill level (ISCO-08, 1-4 from elementary to managerial) was significant (P=0.00016), particularly in structural and practical barriers (Level4, aOR=5.02; 95%CI=1.94-13.01). Among men, age, education, and income showed significant associations with reasons for non-participation. Those with middle-income were likely to report knowledge and information barriers (aOR=5.01; 95%CI=1.70-14.74), senior-high education in contrast (aOR=0.15; 95%CI=0.03-0.72), while those in Level4 occupations (aOR=2.35; 95%CI=1.00-5.51) cited structural and practical barriers. In pooled model, most SES effects vanished; only age and occupation retained significance.
CONCLUSIONS:
Findings suggest Taiwan may have effectively enhanced HL and reduced CRC screening inequalities across SES groups. Future efforts should shift toward gender-specific and socio-structural strategies.
Previous evidence showed low health literacy (HL) and low socioeconomic status (SES) link to poor uptake in colorectal cancer (CRC) screening. However, recent evidence indicated non-linear associations between higher HL and CRC screening. This suggests the relationship between HL and CRC screening may become more complex since ongoing changes in society. Therefore, examining what factors relate to reasons for non-participation is crucial for advancing strategies.
METHODS:
We analyzed 2021 Taiwan National Health Interview Survey data for adults aged 50-74 (n=1213). HL was measured using the HLS-EU-Q16 and categorized into four gradients: inadequate, problematic, sufficient and excellent. Reasons for non-participation (collected through a multiple-response question) were grouped into four categories: personal perception, emotional and attitudinal, knowledge and information, and structural and practical barriers, following the Health Belief Model. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aORs) between HL gradients and non-participation categories across gender-specific and pooled samples, controlling demographic and SES variables.
RESULTS:
Personal perception was the leading reason (68.46%) for non-participation in CRC screening, followed by structural and practical barriers (24.22%). This pattern was consistent across all HL gradients, suggesting limited marginal effects in CRC screening. Among women, occupational skill level (ISCO-08, 1-4 from elementary to managerial) was significant (P=0.00016), particularly in structural and practical barriers (Level4, aOR=5.02; 95%CI=1.94-13.01). Among men, age, education, and income showed significant associations with reasons for non-participation. Those with middle-income were likely to report knowledge and information barriers (aOR=5.01; 95%CI=1.70-14.74), senior-high education in contrast (aOR=0.15; 95%CI=0.03-0.72), while those in Level4 occupations (aOR=2.35; 95%CI=1.00-5.51) cited structural and practical barriers. In pooled model, most SES effects vanished; only age and occupation retained significance.
CONCLUSIONS:
Findings suggest Taiwan may have effectively enhanced HL and reduced CRC screening inequalities across SES groups. Future efforts should shift toward gender-specific and socio-structural strategies.
| eISSN: | 2654-1459 |
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