How do people interpret information about colorectal cancer screening: observations from a think-aloud study

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. Design, setting and participants 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. Conclusion 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.