Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK.
Cancer Registry of Granada, Andalusian School of Public Health, Granada, Spain.
Med Decis Making. 2019 Oct;39(7):738-754. doi: 10.1177/0272989X19873647. Epub 2019 Sep 26.
Organized screening programs often rely on written materials to inform the public. In the United Kingdom, women invited for cervical cancer screening receive a leaflet from the National Health Service (NHS) to support screening decisions. However, information about screening may be too complex for people to understand, potentially hindering informed decision making. We aimed to identify women's difficulties in interpreting the leaflet used in England and negative and positive responses to the leaflet. We used a sequential mixed-methods design involving 2 steps: cognitive think-aloud interviews ( = 20), followed by an England-wide survey ( = 602). Data were collected between June 2017 and December 2018, and participants included women aged 25 to 64 y with varying sociodemographics. Interview results revealed misunderstandings concerning screening results, benefits, and additional tests and treatment, although participants tended to react positively to numerical information. Participants were often unfamiliar with the potential harms associated with screening (i.e., screening risks), key aspects of human papillomavirus, and complex terms (e.g., ). Survey results indicated that interpretation difficulties were common ( correct items = 12.5 of 23). Lower understanding was associated with lower educational level (β's >0.15, 's <0.001), lower numeracy scores (β = 0.36, < 0.001), and nonwhite ethnicity (β = 0.10, = 0.007). The leaflet was evaluated positively overall. Despite previous user testing of the leaflet, key information may be too complex for some recipients. As a consequence, they may struggle to make informed decisions about screening participation based on the information provided. We discuss implications for the improvement of communications about screening and decision support.
组织化的筛查项目通常依赖于书面材料来告知公众。在英国，受邀进行宫颈癌筛查的女性会收到国民保健署（NHS）提供的宣传册，以支持筛查决策。然而，有关筛查的信息可能过于复杂，导致人们难以理解，从而可能阻碍知情决策的制定。
我们旨在确定女性在解释英国使用的宣传册时遇到的困难，以及对宣传册的负面和正面反应。我们使用了一种顺序混合方法设计，包括 2 个步骤：认知思考 aloud 访谈（n = 20），随后进行了一项全英范围的调查（n = 602）。数据收集于 2017 年 6 月至 2018 年 12 月之间，参与者包括年龄在 25 至 64 岁之间、社会人口统计学特征各异的女性。
访谈结果显示，参与者对筛查结果、益处以及额外的测试和治疗存在误解，但他们往往对数字信息反应积极。参与者通常不熟悉与筛查相关的潜在危害（即筛查风险）、人乳头瘤病毒的关键方面以及复杂术语（例如）。调查结果表明，解释困难很常见（正确项目 = 23 项中的 12.5 项）。理解程度较低与教育水平较低（β>0.15，P<0.001）、计算能力得分较低（β=0.36，P<0.001）和非白种人种族（β=0.10，P=0.007）有关。总体而言，宣传册得到了积极评价。
尽管该宣传册之前已经经过用户测试，但对一些收件人来说，关键信息可能过于复杂。因此，他们可能难以根据提供的信息就参与筛查做出明智的决定。我们讨论了改进与筛查和决策支持相关的沟通的影响。
