Abstract
BackgroundThere is broad agreement that cancer screening invitees should know the risks and benefits of testing before deciding whether to participate. In organised screening programmes, a primary method of relaying this information is via leaflets provided at the time of invitation. Little is known about why individuals do not engage with this information. This study assessed factors associated with reading information leaflets provided by the three cancer screening programmes in England.MethodsA cross-sectional survey asked screening-eligible members of the general population in England about the following predictor variables: uptake of previous screening invitations, demographic characteristics, and ‘decision-making styles’ (i.e. the extent to which participants tended to make decisions in a way that was avoidant, rational, intuitive, spontaneous, or dependent). The primary outcome measures were the amount of the leaflet that participants reported having read at their most recent invitation, for any of the three programmes for which they were eligible. Associations between these outcomes and predictor variables were assessed using binary or ordinal logistic regression.ResultsAfter exclusions, data from 275, 309, and 556 participants were analysed in relation to the breast, cervical, and bowel screening programmes, respectively. Notable relationships included associations between regularity of screening uptake and reading (more of) the information leaflets for all programmes (e.g. odds ratio: 0.16 for participants who never/very rarely attended breast screening vs. those who always attended previously; p = .009). Higher rational decision-making scores were associated with reading more of the cervical and bowel screening leaflets (OR: 1.13, p < .0005 and OR: 1.11, p = .045, respectively). Information engagement was also higher for White British participants compared with other ethnic groups for breast (OR: 3.28, p = .008) and bowel (OR: 2.58, p = .015) information; an opposite relationship was observed for older participants (OR: 0.96, p = .048; OR: 0.92, p = .029).ConclusionsInterventions that increase screening uptake may also increase subsequent engagement with information. Future research could investigate how to improve engagement at initial invitations. There may also be scope to reduce barriers to accessing non-English information and alternative communication strategies may benefit participants who are less inclined to weigh up advantages and disadvantages as part of their decision-making.
Highlights
There is broad agreement that cancer screening invitees should know the risks and benefits of testing before deciding whether to participate
Unmarried individuals have lower screening uptake than married individuals [9,10,11], as do those who do not already know someone diagnosed with cancer [12,13,14,15,16,17]; this may imply a lesser degree of engagement with information materials in these groups
Predictors of reading the breast screening information leaflet Analysing predictors of reading all of the breast screening leaflet showed that white British participants were more likely to have read all the leaflet than participants from other ethnic groups whereas participants who were older or had never or very rarely attended for screening were less likely to have read it all
Summary
There is broad agreement that cancer screening invitees should know the risks and benefits of testing before deciding whether to participate. A primary method of relaying this information is via leaflets provided at the time of invitation. In the UK, the primary method by which organised National Health Service (NHS) cancer screening programmes aim to achieve this is via information leaflets, generally posted to eligible individuals alongside an invitation to have a test (typically mammography for breast screening, cytology or human papillomavirus testing for cervical screening, or stool testing for bowel screening [4,5,6]). Invitees who do not read screening information and are not screened are unlikely to have made an informed decision not to participate These individuals may miss out on the health benefits of screening as a result of their lack of engagement
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