The impact of illustrations on public understanding of the aim of cancer screening

Objective: To study the effectiveness of visual illustrations in improving people's understanding of the preventive aim of flexible sigmoidoscopy (FS) screening. Methods: Three-hundred and eighteen people aged 60-64 were offered an appointment to attend FS screening and randomly allocated to receive either written information alone or written information plus illustrations. The illustrations showed the adenoma-carcinoma sequence and how it can be interrupted by removing polyps found during FS. Telephone interviews were conducted with a randomly selected sub-set of people prior to their screening appointment to assess their knowledge and understanding of the test (n = 65). The interviews were tape-recorded, transcribed and content analysed by researchers blind to the condition people had been allocated to. Results: In the written information only group, 57% understood that the test was looking for polyps rather than just cancer, whilst in the group who received written information and illustrations, 84% understood this. Logistic regression analyses confirmed that addition of illustrations resulted in significantly better understanding (OR = 3.75; CL 1. 16-12.09; p = 0.027), and this remained significant controlling for age, gender and Townsend scores (an area-based measure of deprivation) (OR = 10.85; CI: 1.72-68.43; p = 0.01). Conclusion: Illustrations improved understanding of the preventive aim of FS screening. Practice implications: Pictoral illustrations could be used to facilitate patient understanding of screening. (c) 2006 Elsevier Ireland Ltd. All rights reserved.