title: A lack of information engagement among colorectal cancer screening non-attenders: cross-sectional survey.
abstract: The NHS Cancer Screening Programmes in England now operate a policy of 'informed choice' about participation in cancer screening. Engagement with written information about screening is important to facilitate informed choice, although the degree to which the screening-eligible public engages with the available information is unknown. We examined the association between reading of the standard informational booklet ('Bowel Cancer Screening: The Facts') and participation in the nationally organised NHS Bowel Cancer Screening Programme in England.
  
  
  
  Face-to-face interviews were conducted with 1307 adults who were age-eligible for nationally organised colorectal cancer (CRC; also called bowel cancer) in a population-based survey in England in 2014. Respondents were shown an image of 'The Facts' booklet and were asked how much of it they had read when they received their screening invitation ('none', 'a little', 'some', 'most', 'almost all', or 'all'). Logistic regression was used to estimate the associations between screening uptake status ('never' vs. 'ever') and self-reported reading of 'The Facts' booklet (dichotomised to 'none vs. 'any'), adjusting for age, sex, ethnicity, educational attainment, and occupation-based social grade.
  
  
  
  Overall, 69 % of the sample (908/1307) had participated in CRC screening at least once ('ever' screeners). One-fifth of the sample reported that they had read 'none' of 'The Facts' booklet (22 %; 287/1307), while half reported having read 'all' of it (52 %; 680/1307). Reading of the booklet was strongly differential according to screening uptake status: nearly two-thirds of 'never' screeners had read none of 'The Facts' booklet (63 %; 251/399), compared to less than one in twenty 'ever' screeners (4 %; 36/908); adjusted OR = 39.0; 95 % CI: 26.2-58.1 for reading 'none' in 'never' vs. 'ever' screeners.
  
  
  
  Although 'The Facts' booklet is intended to support informed choices about CRC screening, the majority of unscreened individuals report that they have read none of it. The degree to which public engagement with the decision-making process about cancer screening is socially unequal must be better understood so that comprehensive and equitable public communication strategies can be developed.
authors.affiliation: Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Kobayashi
authors.affiliation: Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK. j.waller@ucl.ac.uk.
authors.forename: Jo
authors.identifier: 0000-0003-4025-9132
authors.initials: J
authors.lastname: Waller
authors.affiliation: Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: von Wagner
authors.affiliation: Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
mesh_terms: D000328:Adult; D000368:Aged; D002755:Choice Behavior; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D004739:England; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D012959:Socioeconomic Factors; D013222:State Medicine
keywords: Colorectal cancer screening; Decision making; England; Faecal occult blood test; Population screening; Public education; Survey