Health Literacy and Colorectal Cancer: A Scoping Review Across the Cancer Care Continuum.

IntroductionHealth literacy is increasingly recognized as a critical determinant of cancer prevention, treatment adherence, and survivorship outcomes. In colorectal cancer (CRC), disparities in health literacy, particularly among ethnic minority and underserved populations, may contribute to reduced screening uptake, suboptimal treatment decisions, and poorer quality of life. Although numerous studies have examined the relationship between health literacy and CRC-related outcomes, the evidence remains fragmented across the CRC care continuum, including screening, treatment, survivorship, communication, and digital health. To address this gap, we conducted a scoping review to comprehensively characterize the current evidence regarding health literacy and CRC outcomes in vulnerable populations.MethodsWe conducted a scoping literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed was searched between January and March 2025 to identify peer-reviewed studies evaluating the influence of health literacy on CRC-related outcomes. Studies were included if they focused on CRC and assessed measurable associations between health literacy and outcomes related to screening, treatment adherence, survivorship, communication, financial toxicity, or patient-reported outcomes.ResultsThirty-nine studies met inclusion criteria and were included in the review. Across diverse geographic and clinical settings, limited health literacy was consistently associated with lower CRC screening rates, reduced knowledge of screening guidelines, increased fatalistic beliefs, and greater perceived barriers to screening. Among CRC patients, low health literacy was linked to poorer treatment adherence, lower chemotherapy uptake, reduced health-related quality of life (HRQoL), and higher mortality risk, particularly among vulnerable populations.ConclusionsThis scoping review reinforces that health literacy is a significant and modifiable determinant of CRC outcomes and contributes to persistent disparities across the CRC care continuum. Standardized, culturally and linguistically responsive interventions targeting literacy gaps should be prioritized to improve equitable CRC prevention, treatment, and survivorship care.