Objective To examine correlations between health literacy, knowledge/attitude on colorectal cancer screening and colonoscopy compliance among middle-aged and elder residents positive for colorectal cancer preliminary screening in Shanghai city for improving colonoscopy compliance among community residents.

Methods We conducted a questionnaire survey and follow-up for colonoscopy result among 1 959 residents aged ≥ 50 years and with positive results of colorectal cancer preliminary screening in Major Public Health Projects of Shanghai city in 2015 and 2016. Health Literacy Management Scale (HeLMS) Chinese version and a self-modified questionnaire on knowledge, attitude and practice (KAP) about colorectal cancer were adopted in the study.

Results The overall health literacy score was 109.44 and the dimension scores of health literacy were significantly different from each other (P < 0.001) among all the participants. The overall average score of KAP about colorectal cancer screening was 61.55 and the average score of attitude and belief items was significantly higher than that of knowledge (P < 0.001). There was a significant linear correlation between the overall health literacy score and the score of KAP about colorectal cancer screening, with a correlation coefficient of 0.226 (P < 0.001). Significant differences in the overall score of health literacy and total score of KAP about colorectal cancer screening were observed between the participants with and without colonoscopy and there was a positive correlation between total score of KAP about colorectal cancer screening and colonoscopy compliance among the participants.

Conclusion The overall health literacy score and total score of KAP about colorectal cancer screening correlate with colonoscopy compliance among middle-aged and elder residents positive for colorectal cancer preliminary screening and the results suggest that improving health literacy and the KAP about colorectal cancer screening could promote coloscopy compliance in the residents.