Associations of basic and decision-making health literacy skills with psychological factors related to breast cancer screening: a bayesian network analysis

Abstract

Breast cancer screening is vital for early detection, yet participation among rural women remains low. Basic and decision-making health literacy skills are associated with how individuals understand and act on screening information, and this study examined how these two skills relate to key psychological factors involved in breast cancer screening. A cross-sectional study was conducted between May and June 2024 among rural women aged 40 years and above in Minoodasht, northern Iran. Using a geographically stratified multi-stage sampling approach, 261 rural women were selected from Health Houses affiliated with four Comprehensive Health Service Centers. Standardized questionnaires were used to assess demographics, misbeliefs, attitudes, perceived barriers, and health literacy skills. A Bayesian Network model was used to assess probabilistic relationships; statistical analyses were conducted in SPSS (v21) and Netica. Women with lower education demonstrated poorer performance in both health literacy domains, married women reported higher levels of misbeliefs, and older women perceived more screening barriers. Barriers and misbeliefs were more sensitive to decision-making than basic health literacy, while attitudes showed minimal change. These findings indicate that basic health literacy alone is insufficient unless women can translate information into informed decisions, highlighting the need to prioritize decision-making health literacy in interventions targeting rural women.