title: Development and preliminary evaluation of a bowel cancer screening decision aid for adults with lower literacy.
abstract: OBJECTIVE
  Several countries have recently implemented national bowel cancer screening programs. To ensure equal access to screening, information is needed to suit adults ranging in literacy level. Decision aids are effective in providing balanced information and have been applied in screening. However, few have been designed for populations with lower education and literacy. This article describes the development and preliminary evaluation of a bowel cancer screening decision aid for this group.
  
  
  METHODS
  We conducted face-to-face interviews with adults of varying literacy ability, to develop the decision aid (Stage 1). We applied principles of plain language, created visual illustrations to support key textual messages, and used colour coding to direct the reader through the booklet. We then explored its acceptability and comprehension among consumers with higher and lower education (Stage 2). Participants were recruited from a community sample with lower education and a university alumni network.
  
  
  RESULTS
  A total of 75 participants were interviewed, 43 with lower educational attainment and 32 with university education. The decision aid was positively reviewed by both education groups. Results highlighted the need to clarify the purpose of the decision aid and the availability of choice in the context of screening, especially to those with lower education.
  
  
  CONCLUSIONS
  The 2 stage iterative development process identified important factors to consider in the development of decision tools for this target group, and is recommended.
  
  
  CONCLUSIONS
  Our findings have implications for how to support people with lower education and literacy make informed screening decisions.
authors.affiliation: Screening and Diagnostic Test Evaluation Program, Centre for Medical Psychology and Evidence Based Decision Making, School of Public Health, University of Sydney, New South Wales, NSW, Australia. sians@health.usyd.edu.au
authors.forename: Sian K
authors.initials: SK
authors.lastname: Smith
authors.forename: Lyndal
authors.initials: L
authors.lastname: Trevena
authors.forename: Alexandra
authors.initials: A
authors.lastname: Barratt
authors.forename: Ann
authors.initials: A
authors.lastname: Dixon
authors.forename: Don
authors.initials: D
authors.lastname: Nutbeam
authors.forename: Judy M
authors.initials: JM
authors.lastname: Simpson
authors.forename: Kirsten J
authors.initials: KJ
authors.lastname: McCaffery
mesh_terms: D000368:Aged; D003661:Decision Support Techniques; D004522:Educational Status; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009517:New South Wales; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012307:Risk Factors; D013997:Time Factors