title: How do people interpret information about colorectal cancer screening: observations from a think-aloud study.
abstract: BACKGROUND
  The English NHS Bowel Cancer Screening Programme biennially invites individuals aged 60-74 to participate in screening. The booklet, 'Bowel Cancer Screening: The Facts' accompanies this invitation. Its primary aim is to inform potential participants about the aims, advantages and disadvantages of colorectal cancer screening.
  
  
  OBJECTIVE
  To provide detailed commentary on how individuals process the information contained within 'The Facts' booklet.
  
  
  METHODS
  This study comprised of 18 interviews with individuals aged 45-60 and used a 'think-aloud' paradigm in which participants read aloud the booklet. Participant utterances (verbal statements made in response to researcher-led prompts) were transcribed and analysed using a combination of content and thematic analysis.
  
  
  RESULTS
  A total of 776 coded utterances were analysed (mean = 43.1 per person; range = 8-95). While overall comprehension was satisfactory, several problem areas were identified such as the use of complex unfamiliar terminology and the presentation of numerical information. Specific sections such as colonoscopy risk information evoked negative emotional responses. Participants made several suggestions for ways in which comprehension might be improved.
  
  
  CONCLUSIONS
  Public perceptions of the NHS Bowel Cancer Screening Programme information materials indicated that specific aspects of the booklet were difficult to process. These materials may be an appropriate target to improve public understanding of the aims, benefits and disadvantages of colorectal cancer screening. These findings will contribute to a broader NIHR-funded project that aims to design a supplementary 'gist-based' information leaflet suitable for low literacy populations.
authors.affiliation: Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Smith
authors.affiliation: Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Vart
authors.affiliation: Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.affiliation: Colorectal Unit, Department of Surgery, University College London Hospitals, London, UK.
authors.forename: Austin
authors.initials: A
authors.lastname: Obichere
authors.affiliation: Community Health and Learning Foundation, Leicester, UK.
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Baker
authors.affiliation: Department of Applied Health Research, UCL, London, UK.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Raine
authors.affiliation: Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.affiliation: Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: von Wagner
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D032882:Comprehension; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*
keywords: cancer screening; colorectal cancer; fuzzy-trace theory; literacy; patient information; think aloud
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