Of 4,523 letters sent, 906 (20%) of the women were unreachable due to incorrect contact information and 871 (19%) were ineligible due to language, race/ethnicity, illness, or having changed physicians. Of the 2,746 eligible women contacted, 1,319 (48%) completed the baseline screening, 157 declined to participate and two were found ineligible for a final sample of 1,160.
shows the characteristics of the sample stratified by race/ethnicity. There were significant differences by race/ethnicity for all variables shown with White women generally having higher income, more private health insurance, and better measure of physical functioning (each difference, p < .001). Race/ethnic minority women had significantly less formal education, especially Latinas and Chinese, and lower numeracy scores with differences ranging from 1.7 for Other Asians to 3.7 for Latinas.
Characteristics of 1160 Women Answering Visual Displays of Breast, Colon, and Cervical Cancer Risk, San Francisco Primary Care Clinical Sites, 2004-2006
Correct Responses to Visual Display Task
shows the percent of women who answered the visual display tasks correctly by cancer scenario and race/ethnicity. The icon array of the “wall of 100 women” for the breast and colon cancer surveys was administered to 912 participants. The percentage of women who circled the correct number of icons in this visual ranged from 46% for breast cancer risk to 55% for colon cancer risk. Race/ethnic minority women had significantly lower proportion of correct responses compared to their White counterparts. These were large differences with fewer than half correct responses for the Breast Cancer scenario for African American, Chinese and Latina women.
Number and percent of women who answered visual display task correctly by cancer scenario and stratified by race/ethnicity, San Francisco Primary Care Clinical Sites, 2004-2006
The remaining 248 women were administered both the icon array of the “wall of 10,000 women” and the graphic magnifying glass visuals corresponding to risk of cervical cancer. Only 25% of women who were administered the cervical cancer survey correctly responded to the magnifying glass task and no significant differences were found by race/ethnicity groups. Similar results were found for the correct responses to the Wall of 10,000 women with significantly fewer correct responses for African Americans, Chinese and Latina women.
The “wall of 100 women” was rated the easiest to use among the two icon arrays and graphic; most Whites (92%), Chinese (92%), Other Asians (80%), Latinas (75%) and African Americans (72%) reported it was easy to use. The magnifying glass visual was rated as the second easiest to use by 81% of Whites, 72% of Other Asians, 66% of Latinas, 61% of African Americans, and 55% of Chinese women. Half of the participants (52%) completing the cervical cancer visual rated the “wall of 10,000 women” easy to use. There was poor concordance between women’s rated ease of use and correct completion of the icon arrays and graphic (data not shown). For example, in the “wall of 100 women”, 92% of both White and Chinese women reported this icon array was easy to use. Yet, 87% of White women answered correctly and less than half (42%) of Chinese women answered correctly. About three-quarters (76%) of Latina participants reported that the “wall of 100 women” was easy to use, but only a third (32%) answered correctly. Among 76% of African American women reporting ease of use, 42% answered correctly. Of the 90% of women who reported the “wall of 10,000 women” easy to use, 67% answered correctly.
Predictors of Correct Responses to Visual Display Tasks
The first set of regression models examined the effects of race/ethnicity after adjusting for all covariates on three different “wall of women” visual task outcomes: Three combined “wall of women scenarios”, “wall of 100 women scenarios” for breast and colon cancer, and “wall of 10,000 women scenario” for cervical cancer (). In the overall model, African American and Latino women were significantly less likely to translate the verbal provision of cancer risk to a visual format correctly, compared to Whites. Those with less than a high school education were less likely to use the icon arrays correctly but women who had a higher numeracy score or reported the icon arrays easier to use were more likely to use them correctly.
Logistic regression models of correct/incorrect use of wall of women visuals, San Francisco Primary Care Clinical Sites, 2004-2006
Among the participants who completed the “wall of 100 women” task, African American, Chinese, and Latino women were significantly less likely to translate the verbal provision of cancer risk to a visual format correctly, compared to Whites. In this model, women with less than high school education or even high school graduates were less likely to use this icon array correctly compared to those with some college or more. Correct risk translation to the visual format was more likely among women with a higher numeracy score or who rated this visual display task easy to use. Among those who completed the “wall of 10,000 women” task, only Latinas were significantly less likely to use the visual correctly, compared to Whites. Women who had a higher numeracy score were again significantly more likely to use this visual display correctly.
Correlates of Numeracy
Because numeracy was significantly associated with correct responses on “wall of women” outcomes, in addition to the independent association of race/ethnicity, we examined correlates of numeracy. presents results of linear models regressing numeracy scores onto race/ethnicity after controlling for age, education, occupational status, and income. Compared to Whites, women from other race/ethnic backgrounds had significantly lower numeracy scores. In the total sample, average numeracy scores of race/ethnic groups ranged from 0.51 to 1.72 points lower than that of Whites (out of a possible total of 8 points). Similar findings were noted among the women who were administered the “wall of 100 women” visual display task. Among those administered the “wall of 10,000 women” task, only African American (1.62 points) and other Asian (1.04 points) women’s average numeracy scores were significantly lower than that for Whites. Across all regression models, less than high school education and even high school graduates were significantly associated with lower numeracy ranging from 0.71 to 3.10 points. Similar but smaller differences were found by income.
Correlates of Numeracy in 1160 Women, San Francisco Primary Care Clinical Sites, 2004-2006