From Fatalism to Prevention: A Mixed-Methods Study of a Health Literacy-Tailored Intervention to Increase Cancer Screening Participation Among Vulnerable Populations in France

Background: Cancer screening participation in France remains below European benchmarks, particularly among socioeconomically vulnerable populations with low literacy. Tailored health education interventions may reduce health inequities. Methods: This study evaluated the impact of a culturally responsive, literacy-tailored educational intervention on knowledge, perceptions, and uptake of organized cancer screening (breast, colorectal, cervical) among adults with low literacy in the department of Ain, France. Between January 2019 and June 2020, 175 adults enrolled in French as a foreign language course participated in an intervention, consisting of eight weekly two-hour group sessions delivered by trained health promoters. A mixed-methods design included pre- and post-intervention textual analysis of participants’ narratives on “cancer” and verification of screening uptake through the regional cancer database. Results: Multivariate logistic regression examined associations between literacy, language proficiency, workshop participation, and completion of at least one screening. Post-intervention narratives reflected a marked shift from fear and fatalism toward prevention, risk awareness, and engagement with specific screening programs. Two years following the intervention, 72.4% of previously ineligible participants completed at least one screening. Conclusions: Literacy- and culturally tailored interventions can transform perceptions of cancer and substantially increase screening uptake among vulnerable populations. Addressing structural and communicative barriers through community-based, participatory approaches offers a sustainable pathway to reduce health inequities and promote empowerment in preventive health behaviors.