Accessibility of standardized information of a national colorectal cancer screening program for low health literate screening invitees: A mixed method study.
To explore the accessibility of standardized printed information materials of the national Dutch colorectal cancer screening program among low health literate screening invitees and to assess the effect of the information on their knowledge about colorectal cancer and the screening program.



Linguistic tools were used to analyze the text and design characteristics. The accessibility, comprehensibility and relevance of the information materials were explored in interviews and in observations (n=25). The effect of the information on knowledge was assessed in an online survey (n=127).



The materials employed a simple text and design. However, respondents expressed problems with the amount of information, and the difference between screening and diagnostic follow-up. Knowledge significantly increased in 10 out of 16 items after reading the information but remained low for colorectal cancer risk, sensitivity of testing, and the voluntariness of colorectal cancer screening.



Despite intelligible linguistic and design characteristics, screening invitees with low health literacy had problems in accessing, comprehending and applying standard information materials on colorectal cancer screening, and lacked essential knowledge for informed decision-making about participation.



To enable equal access to informed decision-making, information strategies need to be adjusted to the skills of low health literate screening invitees.
Department of Public Health, Academic Medical Center-University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.p.fransen@amc.uva.nl.
Mirjam P
MP
Fransen
Department of Gastroenterology and Hepatology, Academic Medical Center-University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: e.dekker@amc.uva.nl.
Evelien
E
Dekker
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands; National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands. Electronic address: drm.timmermans@vumc.nl.
Daniëlle R M
DRM
Timmermans
National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands. Electronic address: ellen.uiters@rivm.nl.
Ellen
E
Uiters
Department of Public Health, Academic Medical Center-University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.l.essink-bot@amc.uva.nl.
Marie-Louise
ML
Essink-Bot
D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D032882:Comprehension; D054626:Consumer Health Information / Q000706:statistics & numerical data*; D003657:Decision Making; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000523:psychology*; D008875:Middle Aged; D009426:Netherlands; D011795:Surveys and Questionnaires
Colorectal cancer; Decision-making; Early detection of cancer; Health communication; Health literacy