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van Strien-Knippenberg IS, Arjangi-Babetti H, Timmermans DRM, Schrauwen L, Fransen MP, Melles M, Damman OC. Communicating the results of risk-based breast cancer screening through visualizations of risk: a participatory design approach. BMC Med Inform Decis Mak 2024; 24:78. [PMID: 38500098 PMCID: PMC10949766 DOI: 10.1186/s12911-024-02483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Risk-based breast cancer (BC) screening raises new questions regarding information provision and risk communication. This study aimed to: 1) investigate women's beliefs and knowledge (i.e., mental models) regarding BC risk and (risk-based) BC screening in view of implications for information development; 2) develop novel informational materials to communicate the screening result in risk-based BC screening, including risk visualizations of both quantitative and qualitative information, from a Human-Centered Design perspective. METHODS Phase 1: Interviews were conducted (n = 15, 40-50 years, 5 lower health literate) on women's beliefs about BC risk and (risk-based) BC screening. Phase 2: In three participatory design sessions, women (n = 4-6 across sessions, 40-50 years, 2-3 lower health literate) made assignments and created and evaluated visualizations of risk information central to the screening result. Prototypes were evaluated in two additional sessions (n = 2, 54-62 years, 0-1 lower health literate). Phase 3: Experts (n = 5) and women (n = 9, 40-74 years) evaluated the resulting materials. Two other experts were consulted throughout the development process to ensure that the content of the information materials was accurate. Interviews were transcribed literally and analysed using qualitative thematic analysis, focusing on implications for information development. Notes, assignments and materials from the participatory design sessions were summarized and main themes were identified. RESULTS Women in both interviews and design sessions were positive about risk-based BC screening, especially because personal risk factors would be taken into account. However, they emphasized that the rationale of risk-based screening and classification into a risk category should be clearly stated and visualized, especially for higher- and lower-risk categories (which may cause anxiety or feelings of unfairness due to a lower screening frequency). Women wanted to know their personal risk, preferably visualized in an icon array, and wanted advice on risk reduction and breast self-examination. However, most risk factors were considered modifiable by women, and the risk factor breast density was not known, implying that information should emphasize that BC risk depends on multiple factors, including breast density. CONCLUSIONS The information materials, including risk visualizations of both quantitative and qualitative information, developed from a Human-Centered Design perspective and a mental model approach, were positively evaluated by the target group.
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Affiliation(s)
- Inge S van Strien-Knippenberg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Hannah Arjangi-Babetti
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Laura Schrauwen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Marijke Melles
- Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Gadd N, Lee S, Sharman MJ, Obamiro K. Educational interventions to improve bowel cancer awareness and screening in Organisation for Economic Co-operation and Development countries: A scoping review. Prev Med Rep 2024; 39:102653. [PMID: 38384964 PMCID: PMC10879007 DOI: 10.1016/j.pmedr.2024.102653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Objectives Summarise theory informed educational interventions for improving bowel cancer awareness and screening. Methods A search was conducted in PubMed, EMBASE, Web of Science and CINAHL. English studies from 2016 to 2022 which implemented community-based bowel cancer awareness and/or screening education interventions for adults in Organisation for Economic Co-operation and Development countries were included. Results Sixty-two studies were included, 32 measured both screening and awareness (24 measured screening only, 6 measured awareness only). Education interventions were grouped and summarised in five education types: lay community health education/counselling (n = 28), education material (n = 5), health professional education/counselling (n = 10), mass media (n = 5) and other (n = 19). Other included education interventions which did not fit into the four types previously mentioned. Six studies tested more than one education type. Each type within these studies were reported/summarised separately within the appropriate education type. Lay educators resulted in improved awareness and screening. Brochures were effective education materials for screening and combined with lay educators resulted in increased awareness. State-wide mass media campaigns significantly improved screening uptake for up to 2-months post-campaign. Fear and loss-framed messaging improved screening intentions compared to humour or gain-based messaging. Decision aids had limited improvements in awareness. Facebook campaign and telephone counselling had limited improvements in screening. Conclusions Lay community health educators, brochures, and mass media campaigns occurring multiple times a year may be effective interventions in improving screening and/or awareness. Such approaches should be considered when developing community education. Education interventions should include multiple components suggested above to maximise improvements of awareness and screening.
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Affiliation(s)
- Nicola Gadd
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Simone Lee
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Matthew J Sharman
- School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Kehinde Obamiro
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
- Central Queensland Centre for Rural and Remote Health, James Cook University, Emerald, Queensland, Australia
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Pluymen LPM, Yebyo HG, Stegeman I, Fransen MP, Dekker E, Brabers AEM, Leeflang MMG. Perceived Importance of the Benefits and Harms of Colorectal Cancer Screening: A Best-Worst Scaling Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:918-924. [PMID: 36646279 DOI: 10.1016/j.jval.2022.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To elicit the relative importance of the benefits and harms of colorectal cancer (CRC) screening among potential screening participants in the Dutch population. METHODS In a consensus meeting with 11 experts, risk reduction of CRC and CRC deaths (benefits) and complications from colonoscopy, stress of receiving positive fecal immunological test (FIT) results, as well as false-positive and false-negative FIT results (harms) were selected as determinant end points to consider during decision making. We conducted an online best-worst scaling survey among adults aged 55 to 75 years from the Dutch Health Care Consumer Panel of The Netherlands Institute for Health Services Research to elicit preference values for these outcomes. The preference values were estimated using conditional logit regression. RESULTS Of 265 participants, 234 (89%) had ever participated in CRC screening. Compared with the stress of receiving a positive FIT result, the outcome perceived most important was the risk of CRC death (odds ratio [OR] 4.5; 95% confidence interval [CI] 3.9-5.1), followed by risk of CRC (OR 4.1; 95% CI 3.6-4.7), a false-negative FIT result (OR 3.1; 95% CI 2.7-3.5), colonoscopy complications (OR 1.6; 95% CI 1.4-1.8), and a false-positive FIT result (OR 1.4; 95% CI 1.3-1.6). The magnitude of these differences in perceived importance varied according to age, educational level, ethnic background, and whether the individual had previously participated in CRC screening. CONCLUSION Dutch men and women eligible for FIT-based CRC screening perceive the benefits of screening to be more important than the harms.
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Affiliation(s)
- Linda P M Pluymen
- Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands.
| | - Henock G Yebyo
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Inge Stegeman
- Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam P Fransen
- Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Evelien Dekker
- Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne E M Brabers
- Nivel, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Mariska M G Leeflang
- Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
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Bolt ILLE, Schermer MHN, Bomhof-Roordink H, Timmermans DRM. Informed Decision-Making and Capabilities in Population-based Cancer Screening. Public Health Ethics 2022; 15:289-300. [PMID: 36727101 PMCID: PMC9883722 DOI: 10.1093/phe/phac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Informed decision-making (IDM) is considered an important ethical and legal requirement for population-based screening. Governments offering such screening have a duty to enable invitees to make informed decisions regarding participation. Various views exist on how to define and measure IDM in different screening programmes. In this paper we first address the question which components should be part of IDM in the context of cancer screening. Departing from two diverging interpretations of the value of autonomy-as a right and as an ideal-we describe how this value is operationalized in the practice of informed consent in medicine and translate this to IDM in population-based cancer screening. Next, we specify components of IDM, which is voluntariness and the requirements of disclosure and understanding. We argue that whereas disclosure should contain all information considered relevant in order to enable authentic IDM, understanding of basic information is sufficient for a valid IDM. In the second part of the paper we apply the capability approach in order to argue for the responsibility of the government to warrant equal and real opportunities for invitees for IDM. We argue that additional conditions beyond mere provision of information are needed in order to do so.
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Affiliation(s)
- Ineke L L E Bolt
- Corresponding author: Ineke Bolt, Department of Medical Ethics, Philosophy & History of Medicine, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | | | - Hanna Bomhof-Roordink
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Selmouni F, Guy M, Muwonge R, Nassiri A, Lucas E, Basu P, Sauvaget C. Effectiveness of Artificial Intelligence-Assisted Decision-making to Improve Vulnerable Women's Participation in Cervical Cancer Screening in France: Protocol for a Cluster Randomized Controlled Trial (AppDate-You). JMIR Res Protoc 2022; 11:e39288. [PMID: 35771872 PMCID: PMC9382552 DOI: 10.2196/39288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The French organized population-based cervical cancer screening (CCS) program transitioned from a cytology-based to a human papillomavirus (HPV)-based screening strategy in August 2020. HPV testing is offered every 5 years, starting at the age of 30 years. In the new program, women are invited to undergo an HPV test at a gynecologist's, primary care physician's, or midwife's office, a private clinic or health center, family planning center, or hospital. HPV self-sampling (HPVss) was also made available as an additional approach. However, French studies reported that less than 20% of noncompliant women performed vaginal self-sampling when a kit was sent to their home. Women with lower income and educational levels participate less in CCS. Lack of information about the disease and the benefits of CCS were reported as one of the major barriers among noncompliant women. This barrier could be addressed by overcoming disparities in HPV- and cervical cancer-related knowledge and perceptions about CCS. OBJECTIVE This study aimed to assess the effectiveness of a chatbot-based decision aid to improve women's participation in the HPVss detection-based CCS care pathway. METHODS AppDate-You is a 2-arm cluster randomized controlled trial (cRCT) nested within the French organized CCS program. Eligible women are those aged 30-65 years who have not been screened for CC for more than 4 years and live in the disadvantaged clusters in the Occitanie Region, France. In total, 32 clusters will be allocated to the intervention and control arms, 16 in each arm (approximately 4000 women). Eligible women living in randomly selected disadvantaged clusters will be identified using the Regional Cancer Screening Coordinating Centre of Occitanie (CRCDC-OC) database. Women in the experimental group will receive screening reminder letters and HPVss kits, combined with access to a chatbot-based decision aid tailored to women with lower education attainment. Women in the control group will receive the reminder letters and HPVss kits (standard of care). The CRCDC-OC database will be used to check trial progress and assess the intervention's impact. The trial has 2 primary outcomes: (1) the proportion of screening participation within 12 months among women recalled for CCS and (2) the proportion of HPVss-positive women who are "well-managed" as stipulated in the French guidelines. RESULTS To date, the AppDate-You study group is preparing and developing the chatbot-based decision aid (intervention). The cRCT will be conducted once the decision aid has been completed and validated. Recruitment of women is expected to begin in January 2023. CONCLUSIONS This study is the first to evaluate the impact of a chatbot-based decision aid to promote the CCS program and increase its performance. The study results will inform policy makers and health professionals as well as the research community. TRIAL REGISTRATION ClinicalTrials.gov NCT05286034; https://clinicaltrials.gov/ct2/show/NCT05286034. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/39288.
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Affiliation(s)
- Farida Selmouni
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Marine Guy
- Regional Cancer Screening Coordinating Centre of Occitanie, Carcassonne, France
| | - Richard Muwonge
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Abdelhak Nassiri
- Faculty of Law, Economics, Management and Economic and Social Administration, University of Western Brittany, Brest, France
| | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Catherine Sauvaget
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
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van Strien‐Knippenberg IS, Boshuizen MCS, Determann D, de Boer JH, Damman OC. Cocreation with Dutch patients of decision-relevant information to support shared decision-making about adjuvant treatment in breast cancer care. Health Expect 2022; 25:1664-1677. [PMID: 35579109 PMCID: PMC9327829 DOI: 10.1111/hex.13510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To support patients in shared decision-making about treatment options, patient decision aids (PtDAs) usually provide benefit/harm information and value clarification methods (VCMs). Recently, personalized risk information from prediction models is also being integrated into PtDAs. This study aimed to design decision-relevant information (i.e., personalized survival rates, harm information and VCMs) about adjuvant breast cancer treatment in cocreation with patients, in a way that suits their needs and is easily understandable. METHODS Three cocreation sessions with breast cancer patients (N = 7-10; of whom N = 5 low health literate) were performed. Participants completed creative assignments and evaluated prototypes of benefit/harm information and VCMs. Prototypes were further explored through user testing with patients (N = 10) and healthcare providers (N = 10). The researchers interpreted the collected data, for example, creative and homework assignments, and participants' presentations, to identify key themes. User tests were transcribed and analysed using ATLAS.ti to assess the understanding of the prototypes. RESULTS Important information needs were: (a) need for overview/structure of information directly after diagnosis and; (b) need for transparent benefit/harm information for all treatment options, including detailed harm information. Regarding VCMs, patients stressed the importance of a summary/conclusion. A bar graph seemed the most appropriate way of displaying personalized survival rates; the impact of most other formats was perceived as too distressful. The concept of 'personalization' was not understood by multiple patients. CONCLUSIONS A PtDA about adjuvant breast cancer treatment should provide patients with an overview of the steps and treatment options, with layers for detailed information. Transparent information about the likelihood of benefits and harm should be provided. Given the current lack of information on the likelihood of side effects/late effects, efforts should be made to collect and share these data with patients. Further quantitative studies are needed to validate the results and to investigate how the concept of 'personalization' can be communicated. PATIENT OR PUBLIC CONTRIBUTION Ten breast cancer patients participated in three cocreation sessions to develop decision-relevant information. Subsequent user testing included 10 patients. The Dutch Breast Cancer Association (BVN) was involved as an advisor in the general study design.
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Affiliation(s)
- Inge S. van Strien‐Knippenberg
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | | | - Jasmijn H. de Boer
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Olga C. Damman
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
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Knottnerus B, Heijmans M, Rademakers J. The role of primary care in informing and supporting people with limited health literacy in the Netherlands during the COVID-19 pandemic: a qualitative interview study. BMC PRIMARY CARE 2022; 23:115. [PMID: 35546226 PMCID: PMC9091153 DOI: 10.1186/s12875-022-01723-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, people have been confronted with a large amount of information about the virus and the governmental measures against its spreading. However, more than a quarter of individuals have limited health literacy (HL), meaning that they have difficulty finding, understanding, and applying health information. The purpose of this interview study was to investigate how individuals with limited HL acquire information about COVID-19 and governmental measures, what difficulties they experience in understanding and applying it, and what may be needed to overcome these difficulties. We also addressed other problems that they might face as a result of the pandemic. Using our findings, we aimed to make recommendations on the possible role of primary care in informing and supporting patients with limited HL during the pandemic. METHODS Between June and October 2020, 28 individuals with limited HL were interviewed by phone (age range 20-84). The interviews were semi-structured and focused on the first months of the pandemic in the Netherlands (March/April/May 2020). RESULTS The participants generally found COVID-19-related information abundant and complicated, and sometimes contradictory. Information provision by their own health care professionals was highly appreciated, especially in the context of chronic illnesses. General health care problems resulting from COVID-19 measures were postponement of regular care and difficulty with digital contacts. CONCLUSIONS Individuals with limited HL may benefit from provision of COVID-19-related information and support by their own health care providers. This applies in particular to patients with chronic illnesses. Primary care professionals are in the ideal position to take this role.
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Affiliation(s)
- Bart Knottnerus
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands.
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Jany Rademakers
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
- CAPHRI (Care and Public Health Research Institute), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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Rademakers J, Rolink M, Heijmans M. Information Needs of People With Limited Health Literacy Regarding a New "Opt-Out" Organ Donation System: A Qualitative Study in the Netherlands. Transpl Int 2022; 35:10295. [PMID: 35368644 PMCID: PMC8967934 DOI: 10.3389/ti.2022.10295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Abstract
Background: In the Netherlands, new legislation on organ donation was implemented, based on a “opt-out” consent system, which means that all adults are presumed to consent for organ donation, unless they actively register their decision not to donate. A public information campaign preceded the law change. In the Netherlands, 29% of the population has limited health literacy (LHL). The aim of the study was to gain insight in the information needs of Dutch citizens with LHL regarding organ donation and the new legislation, as well as in their preferred information channels. Methods: A qualitative study was performed; 30 people participated in four focus groups and six individual interviews. Transcripts were coded, interviews were thematically analysed. Results: People with LHL need specific information to make an informed decision on organ donation. Relevant topics: 1) choice options, 2) eligibility, 3) role of partner and/or family, 4) impact on quality of care, and 5) process of organ donation. Information should be easy to understand. Conclusion: Current standard materials are too difficult and abstract. People with LHL require personal support to tailor general information to their personal situation, and practical help to actually register their choice. Suggestions on how to improve information is provided.
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Affiliation(s)
- Jany Rademakers
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Department of Family Medicine, CAPHRI (Care and Public Health Research Institute), Maastricht University, Maastricht, Netherlands
| | - Marlon Rolink
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Monique Heijmans
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
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Flander L, Dekker E, Andersen B, Larsen MB, Steele RJ, Malila N, Sarkeala T, van der Vlugt M, de Klerk C, Knottnerus B, Bertels L, Woudstra A, Spaander MCW, Fransen M, Heinavaara S, Dillon M, Ait Ouakrim D, Jenkins M. What can We Learn From High-Performing Screening Programs to Increase Bowel Cancer Screening Participation in Australia? Cancer Control 2022; 29:10732748221121383. [PMID: 35969473 PMCID: PMC9381723 DOI: 10.1177/10732748221121383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second most diagnosed cancer in men and women and second most common cause of cancer death in Australia; Australia’s CRC incidence and mortality are among the world’s highest. The Australian National Bowel Cancer Screening Program began in 2006; however, only 33% of those approached for the first time by the Program between 2018 and 2019 returned the kit. Of the 5.7 million kits sent during this period, only 44% were returned. Our aim was to identify practices and features of national bowel cancer screening programs in countries with similar programs but higher screening participation, to identify potential interventions for optimising Australian CRC screening participation. Methods We searched published and grey literature for CRC screening programs reporting at least 50% screening participation using postal invitation and free return of iFOBT home kits. Interviews were conducted with cancer registry staff and academic researchers, focused on participant and practitioner engagement in screening. Results National programs in Netherlands, Scotland, Denmark, and Finland reported over 50% screening participation rates for all invitation rounds. Shared characteristics include small populations within small geographic areas relative to Australia; relatively high literacy; a one-sample iFOBT kit; national registration systems for population cancer screening research; and screening program research including randomised trials of program features. Conclusions Apart from the one-sample kit, we identified no single solution to persistent Australian low uptake of screening. Research including randomised trials within the program promises to increase participation. Impact This screening program comparison suggests that within-program intervention trials will lead to increased Australian screening participation.
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Affiliation(s)
- Louisa Flander
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, 26066Amsterdam UMC, AZ Amsterdam, Netherlands
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, 53198Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, 53198Randers Regional Hospital, Randers, Denmark
| | - Robert J Steele
- Ninewells Hospital & Medical School, 3042University of Dundee, Dundee, UK
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | | | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, 26066Amsterdam UMC, AZ Amsterdam, Netherlands
| | - Clasine de Klerk
- Department of Gastroenterology and Hepatology, 26066Amsterdam UMC, AZ Amsterdam, Netherlands
| | - Bart Knottnerus
- 8123Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Lucinda Bertels
- 113896Erasmus School of Health Policy and Management, Rotterdam, Netherlands
| | - Anke Woudstra
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mirjam Fransen
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute 1105AZ Amsterdam, Netherlands
| | | | - Mary Dillon
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia.,Department of Information and Service Management, 4321Aalto University, Finland
| | - Driss Ait Ouakrim
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia
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Visscher BB, Vervloet M, Te Paske R, van Dijk L, Heerdink ER, Rademakers J. Implementation of an animated medication information tool in community pharmacies, with a special focus on patients with limited health literacy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:566-572. [PMID: 34427591 DOI: 10.1093/ijpp/riab038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The animated medication information tool 'Watchyourmeds' provides information in an accessible manner through animated videos and therefore appears to be especially suitable for people with limited health literacy. This study aimed to assess the implementation of this animated medication information tool in Dutch community pharmacies, with a special focus on patients with limited health literacy. METHODS A cross-sectional survey based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was sent to approximately 75% of the ±1900 community pharmacies in the Netherlands through email newsletters of pharmacy networks. KEY FINDINGS 140 pharmacists (⁓10%) completed the survey and 125 of them (89%) indicated that they offered the animated medication information tool to their patients. 108 pharmacists indicated that the tool was offered to all patients, not only to patients with limited health literacy. The distribution method was primarily passive (patients were given a leaflet and were not explicitly pointed to or informed about the tool). Two frequently cited motivations for offering the tool were that it complemented other sources of information and that the health insurer provided a financial incentive. The main reasons patients refused to use the tool were that they had no access to or no affinity for the required technology. CONCLUSIONS This study demonstrated that the tool is used in community pharmacies and that it is offered to all patients, regardless of their presumed health literacy level. A more active method of offering the tool may be warranted to better reach patients with limited health literacy.
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Affiliation(s)
- Boudewijn B Visscher
- Researchgroup Innovations in Pharmaceutical Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Roland Te Paske
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,Department of PharmacoTherapy, -Epidemiology, and -Economics (PTEE), Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, the Netherlands
| | - Eibert R Heerdink
- Researchgroup Innovations in Pharmaceutical Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Jany Rademakers
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,CAPHRI, Care and Public Health Research Institute, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
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11
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Douma LN, Uiters E, Verweij MF, Timmermans DRM. Autonomous and informed decision-making: The case of colorectal cancer screening. PLoS One 2020; 15:e0233308. [PMID: 32469889 PMCID: PMC7259584 DOI: 10.1371/journal.pone.0233308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/01/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION It is increasingly considered important that people make an autonomous and informed decision concerning colorectal cancer (CRC) screening. However, the realisation of autonomy within the concept of informed decision-making might be interpreted too narrowly. Additionally, relatively little is known about what the eligible population believes to be a 'good' screening decision. Therefore, we aimed to explore how the concepts of autonomous and informed decision-making relate to how the eligible CRC screening population makes their decision and when they believe to have made a 'good' screening decision. METHODS We conducted 27 semi-structured interviews with the eligible CRC screening population (eighteen CRC screening participants and nine non-participants). The general topics discussed concerned how people made their CRC screening decision, how they experienced making this decision and when they considered they had made a 'good' decision. RESULTS Most interviewees viewed a 'good' CRC screening decision as one based on both reasoning and feeling/intuition, and that is made freely. However, many CRC screening non-participants experienced a certain social pressure to participate. All CRC screening non-participants viewed making an informed decision as essential. This appeared to be the case to a lesser extent for CRC screening participants. For most, experiences and values were involved in their decision-making. CONCLUSION Our sample of the eligible CRC screening population viewed aspects related to the concepts of autonomous and informed decision-making as important for making a 'good' CRC screening decision. However, in particular the existence of a social norm may be affecting a true autonomous decision-making process. Additionally, the present concept of informed decision-making with its strong emphasis on making a fully informed and well-considered decision does not appear to be entirely reflective of the process in practice. More efforts could be made to attune to the diverse values and factors that are involved in deciding about CRC screening participation.
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Affiliation(s)
- Linda N. Douma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marcel F. Verweij
- Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Danielle R. M. Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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12
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Gabel P, Edwards A, Kirkegaard P, Larsen MB, Andersen B. The LEAD trial-The effectiveness of a decision aid on decision making among citizens with lower educational attainment who have not participated in FIT-based colorectal cancer screening in Denmark: A randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2020; 103:359-368. [PMID: 31451360 DOI: 10.1016/j.pec.2019.08.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/21/2019] [Accepted: 08/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES This trial tested the effectiveness of a self-administered web-based decision aid, targeted at citizens with lower educational attainment, on informed choice about colorectal cancer screening participation as assessed by group levels of knowledge, attitudes and uptake. METHODS The randomised controlled trial was conducted among 2702 screening-naïve Danish citizens, 53-74 years old, with lower educational attainment. Baseline questionnaire respondents (62%) were allocated to intervention and control groups. Intervention group citizens received the decision aid. Outcomes were informed choice, worries and decisional conflict. RESULTS Analyses were conducted among 339 eligible citizens. The mean difference in knowledge score change between intervention and control group was 0.00 (95% confidence interval (CI): -0.38;0.38). Trends towards more positive screening attitudes (mean difference in score change: 0.72, 95% CI: -0.38;1.81) and higher screening uptake (7.6%, 95% CI:-2.2;17.4%) were observed. Worries (-0.33, 95% CI: -0.97;0.32) and decisional conflict (mean difference: -3.5, 95%CI: -7.0;-0.1) were slightly reduced. CONCLUSIONS The decision aid did not affect informed choice or knowledge. However, there were trends towards increased screening uptake and more positive screening attitudes. PRACTICE IMPLICATIONS Being a simple intervention and easily administered, the decision aid could represent a cost-effective way of enhancing screening uptake, and some elements of informed decision-making.
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Affiliation(s)
- Pernille Gabel
- Department of Public Health Programmes, Randers Regional Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Adrian Edwards
- Department of Public Health Programmes, Randers Regional Hospital, Denmark; Division of Population Medicine, School of Medicine, Cardiff University, UK.
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Denmark.
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Denmark.
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
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13
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Woudstra AJ, Smets EMA, Dekker E, Broens THF, Penning J, Smith S, McCaffery K, Fransen MP. Development and pilot-testing of a colorectal cancer screening decision aid for individuals with varying health literacy levels. PATIENT EDUCATION AND COUNSELING 2019; 102:1847-1858. [PMID: 31064682 DOI: 10.1016/j.pec.2019.04.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/15/2019] [Accepted: 04/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Making an informed decision about colorectal cancer screening requires health literacy. Our aim was to develop and pilot-test a computer-based decision aid to support informed decision making about whether or not to participate in colorectal cancer screening for individuals with varying health literacy levels in the Netherlands. METHODS First, we designed and adapted the decision aid prototype among 25 individuals with low (n = 15) and adequate (n = 10) health literacy. Second, we used a before/after study to assess changes in knowledge, attitude, intention, decisional conflict, deliberation, anxiety and risk perception in an online survey among 81 individuals eligible for colorectal cancer screening with low (n = 35) and adequate (n = 46) health literacy. RESULTS The decision aid was acceptable, comprehensible, reduced decisional conflict, increased deliberation and improved knowledge about colorectal cancer screening, but not about colorectal cancer, among individuals with adequate and low health literacy. Usability was slightly higher for participants with adequate health literacy compared to those with low health literacy. CONCLUSION The decision aid is promising in supporting informed decision making about colorectal cancer screening, also among individuals with lower health literacy. PRACTICE IMPLICATIONS Further refinement of interactive features, such as videos, animations and the values clarification exercise, is needed to increase the usability of the decision aid.
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Affiliation(s)
- Anke J Woudstra
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Ellen M A Smets
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Evelien Dekker
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology & Hepatology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Tom H F Broens
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Judith Penning
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sian Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, Lowy Research Centre, UNSW Sydney, NSW, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public health, The University of Sydney, NSW, 2006, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Mirjam P Fransen
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
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14
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Knowledge, attitudes, and worries among different health literacy groups before receiving first invitation to colorectal cancer screening: Cross-sectional study. Prev Med Rep 2019; 14:100876. [PMID: 31080706 PMCID: PMC6506556 DOI: 10.1016/j.pmedr.2019.100876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/20/2019] [Accepted: 04/22/2019] [Indexed: 01/27/2023] Open
Abstract
Background Colorectal cancer screening uptake is associated with knowledge, attitudes and worries about screening. People with higher levels of health literacy usually have higher screening-related knowledge, but its association with attitudes and worries is sparsely described.The aim of this study was to describe knowledge, attitudes, and worries about colorectal cancer screening among unscreened citizens, and to estimate the association between these and health literacy. Methods In a cross-sectional study 10,030 53-74 year-old Central Denmark Region citizens received a questionnaire assessing knowledge, attitudes, worry and health literacy. Socioeconomic and -demographic data were linked from Statistics Denmark after data collection. Results In total, 7142 (71.2%) questionnaires were completed. A good general level of knowledge was observed (4.91 and 5.13 out of 7 for men and women, respectively). Citizens tended to be positive towards screening (21.4 and 21.3 on a 4-28 range scale for men and women respectively), and showed low levels of worries (8.8 and 9.09 on a 3-15 range scale for men and women respectively). Knowledge decreased and worries increased with lower levels of health literacy. Further, attitudes tended to be more positive with higher levels of health literacy. Conclusions In general, citizens tend to have good knowledge, positive attitudes and few worries about colorectal cancer screening. People with lower health literacy could benefit from targeted interventions that address knowledge and worries about screening to support informed decision making.
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15
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Gabel P, Larsen MB, Kirkegaard P, Edwards A, Andersen B. The LEAD trial - the effectiveness of a decision aid on decision making among citizens with lower educational attainment who have not participated in FIT-based colorectal cancer screening in Denmark: study protocol for a randomized controlled trial. Trials 2018; 19:543. [PMID: 30305114 PMCID: PMC6180588 DOI: 10.1186/s13063-018-2921-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 09/17/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Colorectal cancer screening participation is a preference-sensitive choice, in which trade-offs between benefits and harms must be made by individual citizens. Often the decision is made without any contact with healthcare professionals. Citizens with lower educational attainment tend to participate less in colorectal cancer screening than citizens with average educational attainment. Further, they tend to have lower levels of knowledge about colorectal cancer screening. Providing lower educational attainment citizens with a targeted decision aid embracing their diverse information needs might increase these citizens' ability to make informed decisions. The aim of this trial is to test the effectiveness of such a newly developed self-administered decision aid. METHODS The LEAD (Lower Educational Attainment Decision aid) trial will be conducted as a two-arm randomized controlled trial among 10,000 50-74-year-old citizens, resident in the Central Denmark Region not yet invited to take up colorectal cancer screening. Citizens will receive a baseline questionnaire. Respondents will be allocated into the intervention or the control groups. Citizens in the intervention group will receive the decision aid whereas the control group will not. Those who return a stool sample within 45 days after receiving the screening invitation and those with medium or higher educational attainment are excluded. Both groups will receive a follow-up questionnaire 90 days after being invited to colorectal cancer screening. A historic cohort consisting of 5000 50-74-year-old citizens resident in the Central Denmark Region, having received their screening invitation in the beginning of 2017 will be included. This cohort will receive a follow-up questionnaire 6-9 months after they received the screening invitation. Informed choice will be evaluated by assessing levels of knowledge, attitudes, and screening uptake. Analyses will be conducted as intention-to-treat analyses. Additionally, differences between levels of worry and decisional conflict between groups will be assessed as secondary outcomes. DISCUSSION This trial will evaluate whether a targeted decision aid is a feasible way of enhancing informed choice among lower educational attainment citizens in colorectal cancer screening. Further, it may guide decisions about providing information material in cancer screening in general. TRIAL REGISTRATION ClinicalTrials.gov, NCT03253888 . Registered on 17 August 2017.
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Affiliation(s)
- Pernille Gabel
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark.
- Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark
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16
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Dreier M, Krueger K, Walter U. Patient-rated importance of key information on screening colonoscopy in Germany: a survey of statutory health insurance members. BMJ Open 2018; 8:e019127. [PMID: 30007923 PMCID: PMC6082454 DOI: 10.1136/bmjopen-2017-019127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Primary colonoscopic screening is considered to be of great benefit but also has the potential to cause severe harm. Thus, eligible subjects should be supported in making an informed choice whether to participate. OBJECTIVES To identify information on screening colonoscopy that colonoscopy-naïve subjects rate as particularly important for decision making. DESIGN Survey of German statutory health insurance members using a written questionnaire in November 2015. STUDY POPULATION Colonoscopy-naïve individuals aged 50 to 65 years. MAIN OUTCOME MEASURES Importance of key information about screening colonoscopy, including potential risks and benefits, baseline risk of colorectal cancer/polyps and practical aspects of the procedure, as well as associations between participants' characteristics and their judgement of information as to being 'very important'. RESULTS Of 1871 respondents (overall response rate: 31%), a subgroup of 370 colonoscopy-naïve subjects was eligible for inclusion (average age: 55 years, 47% male). Information on the risks was rated as very important by most respondents, unimportant by 6%. Information on the benefits was considered unimportant by 26%. Regression analysis showed that less educated persons regarded most items to be more often relevant than highly educated subjects. A greater proportion of women than men rated details regarding pain and practical aspects as very important. Subjects with a low educational level living alone were identified as the group with the least interest in information on risks. CONCLUSION Cultivating awareness around the central meaning of the (quantitative) benefits of screening in informed decision making should be focused on more in future information materials. The high requirement of less educated people to become more informed provides a strong motivation for further efforts to develop evidence-based information that adequately informs this group. Tailoring information according to gender-specific needs may be warranted in light of the observed differences in information preferences between women and men.
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Affiliation(s)
- Maren Dreier
- Institute of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
| | - Kathrin Krueger
- Institute of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
| | - Ulla Walter
- Institute of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
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17
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Woudstra AJ, Timmermans DRM, Uiters E, Dekker E, Smets EMA, Fransen MP. Health literacy skills for informed decision making in colorectal cancer screening: Perceptions of screening invitees and experts. Health Expect 2018; 21:636-646. [PMID: 29266661 PMCID: PMC5980534 DOI: 10.1111/hex.12658] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The process of informed decision making (IDM) requires an adequate level of health literacy. To ensure that all individuals have equal opportunity to make an informed decision in colorectal cancer (CRC) screening, it is essential to gain more insight into which health literacy skills are needed for IDM. Our aims were (i) to explore how individuals make a decision about CRC screening and (ii) to explore which skills are needed for IDM in CRC screening and (iii) to integrate these findings within a conceptual framework. METHODS We conducted 3 focus groups with individuals eligible for CRC screening (n = 22) and 2 focus groups with experts in the field of health literacy, oncology and decision making, including scientific researchers and health-care professionals (n = 17). We used framework analysis to analyse our data. RESULTS We identified and specified ten health literacy skills, which varied from the ability to read and understand CRC screening information to the ability to weigh up pros and cons of screening for personal relevance. The skills were linked to 8 decision-making stages in CRC screening within a conceptual framework. We found differences in perceptions between screening invitees and experts, especially in the perceived importance of CRC screening information for IDM. CONCLUSIONS This study provides insight into the decision-making stages and health literacy skills that are essential for IDM in CRC screening. The proposed conceptual framework can be used to inform the development of context-based measurement of health literacy and interventions to support IDM in cancer screening.
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Affiliation(s)
- Anke J. Woudstra
- Department of Public HealthAcademic Medical CenterAmsterdam Public Health research instituteUniversity of AmsterdamAmsterdamThe Netherlands
| | - Daniëlle R. M. Timmermans
- Department of Public and Occupational Health and the EMGO institute for Health and Care ResearchVU University Medical CenterAmsterdam Public Health research instituteAmsterdamThe Netherlands
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and HepatologyAcademic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
| | - Ellen M. A. Smets
- Department of Medical PsychologyAcademic Medical CenterAmsterdam Public Health research instituteUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mirjam P. Fransen
- Department of Public HealthAcademic Medical CenterAmsterdam Public Health research instituteUniversity of AmsterdamAmsterdamThe Netherlands
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18
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Gabel P, Kirkegaard P, Larsen MB, Edwards A, Andersen B. Developing a Self-Administered Decision Aid for Fecal Immunochemical Test-Based Colorectal Cancer Screening Tailored to Citizens With Lower Educational Attainment: Qualitative Study. JMIR Form Res 2018; 2:e9. [PMID: 30684402 PMCID: PMC6334704 DOI: 10.2196/formative.9696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/15/2018] [Accepted: 04/03/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Citizens with lower educational attainments (EA) take up colorectal cancer screening to a lesser degree, and more seldom read and understand conventional screening information than citizens with average EAs. The information needs of citizens with lower EA are diverse, however, with preferences ranging from wanting clear recommendations to seeking detailed information about screening. Decision aids have been developed to support citizens with lower EA in making informed decisions about colorectal cancer screening participation, but none embrace diverse information needs. OBJECTIVE The aim of this study was to develop a self-administered decision aid for participation in fecal immunochemical test-based colorectal cancer screening. The decision aid should be tailored to citizens with lower EA and should embrace diverse information needs. METHODS The Web-based decision aid was developed according to an international development framework, with specific steps for designing, alpha testing, peer reviewing, and beta testing the decision aid. In the design phase, a prototype of the decision aid was developed based on previous studies about the information needs of lower EA citizens and the International Patient Decision Aid Standards guidelines. Alpha testing was conducted using focus group interviews and email correspondence. Peer review was conducted using email correspondence. Both tests included both lower EA citizens and health care professionals. The beta testing was conducted using telephone interviews with citizens with lower EA. Data were analyzed using thematic analysis. RESULTS The developed decision aid presented information in steps, allowing citizens to read as much or as little as wanted. Values clarification questions were included after each section of information, and answers were summarized in a "choice-indicator" on the last page, guiding the citizens toward a decision about screening participation. Statistics were presented in both natural frequencies, absolute risk formats and graphically. The citizens easily and intuitively navigated around the final version of the decision aid and stated that they felt encouraged to think about the benefits and harms of colorectal cancer screening without being overloaded with information. They found the decision aid easy to understand and the text of suitable length. The health care professionals agreed with the citizens on most parts; however, concerns were raised about the length and readability of the text. CONCLUSIONS We have developed a self-administered decision aid presenting information in steps. We involved both citizens and health care professionals to target the decision aid for citizens with lower EA. This decision aid represents a new way of communicating detailed information and may be able to enhance informed choices about colorectal cancer screening participation among citizens with lower EA.
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Affiliation(s)
- Pernille Gabel
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark
| | - Adrian Edwards
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark.,Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers NØ, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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19
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Morony S, Webster AC, Buchbinder R, Kirkendall S, McCaffery KJ, Clerehan R. A Linguistic Analysis of Health Literacy Demands of Chronic Kidney Disease Patient Education Materials. Health Lit Res Pract 2018; 2:e1-e14. [PMID: 31294272 PMCID: PMC6608909 DOI: 10.3928/24748307-20171227-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/13/2017] [Indexed: 12/01/2022] Open
Abstract
Background: Instruments to assess the quality and comprehensibility of printed patient education materials may lack proper consideration of how readers derive meaning from text. The Evaluative Linguistic Framework (ELF) considers how factors that influence readers' expectations about health care texts also affect their ability to understand them. The ELF has demonstrated value in improving the quality of patient materials about medication, consent, and self-reported questionnaires, but has not yet been used to evaluate a corpus of patient education materials about chronic disease self-management. Objective: This study sought to apply the ELF to examine specific elements of printed self-management patient education materials for chronic kidney disease (CKD) not captured by other tools. Methods: From a previously published systematic review, we identified 14 patient education materials (eight self-management, six diet and nutrition) for people with CKD. We used the ELF to identify the different ways the text could be structured, its intended purpose, the relationship established between reader and writer, presence of signposting, its complexity and technicality of language, and factual content. Key Results: Our analysis identified nine possible structural units, of which “introducing the problem” and “instructing the reader to self-manage” were common to all materials. However, there was no consistency or common sequence to these units of text. The intended readership and aims of the author(s) were not always clear; many materials made assumptions about what the reader knew, the language was often complex and dense, and the meta-discourse was sometimes distracting. Conclusions: Our analysis suggests CKD document developers can benefit from a theoretically grounded linguistic tool that focuses on the intended audience and their specific needs. The ELF identified structural units of text, aligned with rhetorical elements that can be uniformly applied for developing self-management education materials for CKD, and provided checks for language complexity. Further work can determine its usefulness for other (e.g., electronic) formats and other chronic diseases. [HLRP: Health Literacy Research and Practice. 2018;2(1):e1–e14.] Plain Language Summary: Helping patients make meaning from information about their condition is a key goal of health care organizations. We analyzed chronic kidney disease patient education materials on self-management using the Evaluative Linguistic Framework. The purpose and intended audience were frequently unclear. We identified nine structural units of text that may assist information providers to plan and structure content.
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Affiliation(s)
- Suzanne Morony
- Address correspondence to Suzanne Morony, PhD, MPsych(Org), Sydney School of Public Health, 126a, Edward Ford Building A27, The University of Sydney, NSW 2006, Australia;
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Marlow LAV, Meisel SF, Wardle J. Ethnic minority women prefer strong recommendations to be screened for cancer. BMC Public Health 2017; 17:164. [PMID: 28158990 PMCID: PMC5291956 DOI: 10.1186/s12889-017-4093-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer screening invitations can explicitly recommend attendance or encourage individuals to consider the risks and benefits before deciding for themselves. Public preferences for these approaches might vary. We explored ethnic minority women's preferences for a strong recommendation to be screened. METHODS Women aged 30-60 years from Indian, Pakistani, Bangladeshi, Caribbean, African and white British backgrounds (n = 120 per group) completed face-to-face interviews with a multi-lingual interviewer. The interview included a question on which approach to screening invitations they would prefer: i) A strong recommendation from the National Health Service (NHS) to go for screening, ii) A statement that the NHS thinks you should go for screening, but it's up to you to decide, iii) No recommendation. Analyses examined predictors of preference for a strong recommendation. RESULTS Preferences varied by ethnicity (χ 2(5) = 98.20, p <.001). All ethnic minority groups had a preference for a strong recommendation to be screened (53-86% across ethnic groups vs 31% white British). Socio-demographic factors (marital status, education and employment), and indicators of acculturation (main language and migration status), contributed to explaining recommendation preferences (χ 2(5) = 35.95 and χ 2(3) = 11.59, respectively, both p <.001), but did not mediate the ethnicity effect entirely. Self-rated comprehension of written health information did not contribute to the model. CONCLUSIONS A strong recommendation to participate in cancer screening appears to be important for ethnic minority women, particularly non-English speakers. Future research could explore how to best arrive at a consensus that respects patient autonomy while also accommodating those that would prefer to be guided by a trusted source.
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Affiliation(s)
- Laura A V Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Susanne F Meisel
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Jane Wardle
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, London, WC1E 6BT, UK
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