Chronic Diseases in Canada Volume 29 · Number 1 · 2008 Inside this issue 1 Health Literacy and Numeracy: Key Factors in Cancer Risk Comprehension L Donelle, JF Arocha, L Hoffman-Goetz 9 Colorectal Cancer Screening in Canada: Results of a National Survey MJ Sewitch, C Fournier, A Ciampi, A Dyachenko 22 Stroke Surveillance in Manitoba, Canada: Estimates from Administrative Databases. DF Moore, LM Lix, MS Yogendran, P Martens, A Tamayo 31 Population-Based Data Sources for Chronic Disease Surveillance LM Lix, MS Yogendran, SY Shaw, C Burchill, C Metge, R Bond 39 The Second National Sun Survey: Workshop Report Bronwen Waller, Erin Pichora, Loraine Marrett 43 Announcements Chronic Diseases in Canada a publication of the Public Health Agency of Canada CDIC Editorial Board Sylvie Stachenko Jacques Brisson Chronic Diseases in Canada (CDIC) is a quar- Principal Scientifi c Editor Laval University terly scientifi c journal focussing on cur rent (613) 946-3537 evidence relevant to the control and pre- Neil E Collishaw vention of chronic (i.e. non-communicable) Physicians for a Smoke-Free Canada diseases and injuries in Canada. Since 1980 Howard Morrison the journal has published a unique blend of Deputy Scientifi c Editor James A Hanley peer-reviewed feature articles by authors (613) 941-1286 McGill University from the public and private sectors and which may include research from such fi elds Robert A Spasoff Clyde Hertzman as epidemiology, public/community health, Associate Scientifi c Editor University of British Columbia bio statistics, the behavioural sciences, and health services or ecoZnomics. Only feature articles are peer reviewed. Authors retain Claire Infante-Rivard C Ineke Neutel University of Ottawa responsibility for the content of their arti- Associate Scientifi c Editor Institute on Care of cles; the opinions expressed are not neces- the Elderlys sarily those of the CDIC editorial committee Elizabeth Kristjansson nor of the Public Health Agency of Canada. Associate Scientifi c Editor Kathryn Wilkins Health Statistics Division Chronic Diseases in Canada Statistics Canada Public Health Agency of Canada Michelle Tracy 130 Colonnade Road Managing Editor Address Locator 6501A (613) 954-0697 Ottawa, Ontario K1A 0K9 Fax: (613) 941-3605 E-mail: [email protected] Indexed in Index Medicus/MEDLINE To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health. — Public Health Agency of Canada Published by authority of the Minister of Health. © Her Majesty the Queen in Right of Canada, represented by the Minister of Health, 2008 ISSN 0228-8699 Également disponible en français sous le titre : Maladies chroniques au Canada Health literacy and numeracy: Key factors in cancer risk comprehension L Donelle, RN, PhD (1); J. F. Arocha, PhD (2); L Hoffman-Goetz, PhD, MPH (2) inade quate numeracy skills among Abstract young9,17,18 and older adults.12,19 Cancer patients with decreased numeracy skills In this age of chronic disease and shared decision making, individuals are encouraged to may have a diminished ability to accurately contribute to decisions about health care. Health literacy, including numeracy, is requisite assess and personalize health risks.10,17,20 to meaningful participation and has been accepted as a determinant of health. The purpose of this study was to describe the infl uence of literacy, consisting of prose and numeracy Colorectal cancer is the fourth leading skill, math anxiety, attained education and context of information on participant ability cause of cancer among Canadians and the to comprehend Internet-based colorectal cancer prevention information. Prose, numeracy, second leading cause of cancer deaths.21 and math-anxiety data, as well as demographic details, were collected for 140 Canadian Further increases in incident colorectal adults, aged 50+ years. Participants had adequate prose literacy (STOFHLA) scores, high cancers are anticipated resultant to an STOFHLA numeracy scores, moderate levels of health-context numeracy, poorer general- aging population.21 Although colorectal context numeracy and moderate math anxiety. There was better comprehension by cancer screening programs have been participants of common (9.14/11) compared with uncommon (7.64/11) colorectal cancer introduced in select provinces, to date a information (p < 0.01). Prose literacy, numeracy, math anxiety and attained education national colorectal cancer screening program accounted for 60% of the variation in participant comprehension scores. Numeracy, has not been implemented in Canada. ranging from basic to advanced profi ciency, is required to understand online cancer risk Consequently, health education and patient information. Prose literacy enhances numeracy when the subject matter is less familiar. vigilance regarding risk awareness and These fi ndings highlight the importance of presenting Web-based information that preventive screening are encouraged. The accommodates diverse health literacy and numeracy levels. ability to understand cancer information is an essential health care skill and allows Key words: communication, risk, Internet, neoplasms, health literacy, numeracy individuals to engage in meaningful conversation with providers to assess their risk of disease and agree on best practices Introduction of individuals 60 years and older.13 appropriate to the determined risk.23,24 The Inadequate health literacy skill has been need for shared decision making is most Health literacy is essential to understanding identifi ed as an important barrier for compelling in cancer care where numerous health information and is defi ned as “the seniors to understand diagnoses and treatment options exist, and where different degree to which individuals have the treatment protocols.13-15 benefi ts and risks must be evaluated under capacity to obtain, process, and understand conditions of uncertainty.25 As a component basic health information and services needed Until recently, health literacy has been of decision making, risk comprehension to make appropriate health decisions.”1 portrayed mainly as a reading compre hen- involves the ability to judge the severity Furthermore, the Public Health Agency of sion skill with health numeracy attracting of potential harm which, in turn, depends Canada identifi es literacy as an important little research attention.16 Health numeracy on understanding the health message and determinant of health.2 Yet, many adults is “the degree to which individuals have numeric risk estimates.26 are limited in prose health literacy and the capacity to access, process, interpret, health numeracy skill. In particular, more communicate, and act on numerical, Other factors which likely affect numeracy older than younger adults demonstrate quantitative, graphical, biostatistical and skill are participants’ levels of math anxiety27 poor literacy skills.3-14 Estimates of probabilistic health information needed and the level of attained education. Risk inadequate or marginal health literacy to make effective health decisions.”16 comprehension skill is also infl uenced among seniors range from 34% of indivi- Published accounts of numeric compe- by prior experience and familiarity of duals aged 65 years and older4,7,14 to 81% tency within health care settings indicate information.8,28-30 Risk comprehension Author References 1 Faculty of Health Sciences University of Western Ontario London, ON 2 Department of Health Studies and Gerontology Faculty of Applied Health Sciences University of Waterloo, Waterloo, ON Correspondence: Laurie Hoffman-Goetz Department of Health Studies and Gerontology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Fax: 519-746-2510, Email: [email protected] Chronic Diseases in Canada 1 Vol 29, No 1, 2008 profi ciency may refl ect a familiarity with assessment consists of 36 prose multiple- articles of consumer-oriented, colorectal terms and concepts associated with risk that choice questions and 4 numeracy questions. cancer prevention information from the consti tute specialized content vocabulary.31-32 Correct responses on each of the prose and Canadian Cancer Society (CCS) Web site. Assorted health care experiences can also numeracy questions are assigned 2 and The Internet articles were selected for provide context from which the individual 7 points respectively, with a maximum similarities in terms of the cancer type, font can draw upon in order to enhance compre- score of 72 for the prose subscale and a size and readability. Internet article selection hension of the intended health care message. maximum score of 28 for the numeracy was based on the following criteria: (1) ≥ 6 subscale. A score from 0 to 55 indicates numerical references, (2) numerical refe- With Canadians increasingly using the inadequate functional health literacy rences in number or text form, (3) a maxi- Internet as an access point to health care refl ective of individuals who often misread mum grade 12 reading level (determined information,22 the purpose of this study very simple materials. Scores between 56 by SMOG readability assessment),37 and (4) was to determine the infl uence of prose to 66 indicate marginal health literacy and a maximum length of 3 pages. literacy skill, general- and health-context scores between 67 to 100 indicate adequate numeracy skill, math anxiety, level of skill.33 The STOFHLA has good internal Eligible Internet articles were screened by attained education and familiarity of