Development and pilot-testing of a colorectal cancer screening decision aid for individuals with varying health literacy levels

Anke J Woudstra; Ellen M A Smets; Evelien Dekker; Tom H F Broens; Judith Penning; Sian Smith; Kirsten McCaffery; Mirjam P Fransen

doi:10.1016/j.pec.2019.04.029

Development and pilot-testing of a colorectal cancer screening decision aid for individuals with varying health literacy levels

Patient Educ Couns. 2019 Oct;102(10):1847-1858. doi: 10.1016/j.pec.2019.04.029. Epub 2019 Apr 30.

Authors

Anke J Woudstra¹, Ellen M A Smets², Evelien Dekker³, Tom H F Broens⁴, Judith Penning⁵, Sian Smith⁶, Kirsten McCaffery⁷, Mirjam P Fransen⁵

Affiliations

¹ Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands. Electronic address: a.j.woudstra@amc.uva.nl.
² Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
³ Amsterdam UMC, University of Amsterdam, Department of Gastroenterology & Hepatology, Meibergdreef 9, Amsterdam, the Netherlands.
⁴ Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands.
⁵ Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
⁶ Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, Lowy Research Centre, UNSW Sydney, NSW, Australia.
⁷ Wiser Healthcare, Sydney School of Public health, The University of Sydney, NSW, 2006, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia.

PMID: 31064682
DOI: 10.1016/j.pec.2019.04.029

Abstract

Objective: Making an informed decision about colorectal cancer screening requires health literacy. Our aim was to develop and pilot-test a computer-based decision aid to support informed decision making about whether or not to participate in colorectal cancer screening for individuals with varying health literacy levels in the Netherlands.

Methods: First, we designed and adapted the decision aid prototype among 25 individuals with low (n = 15) and adequate (n = 10) health literacy. Second, we used a before/after study to assess changes in knowledge, attitude, intention, decisional conflict, deliberation, anxiety and risk perception in an online survey among 81 individuals eligible for colorectal cancer screening with low (n = 35) and adequate (n = 46) health literacy.

Results: The decision aid was acceptable, comprehensible, reduced decisional conflict, increased deliberation and improved knowledge about colorectal cancer screening, but not about colorectal cancer, among individuals with adequate and low health literacy. Usability was slightly higher for participants with adequate health literacy compared to those with low health literacy.

Conclusion: The decision aid is promising in supporting informed decision making about colorectal cancer screening, also among individuals with lower health literacy.

Practice implications: Further refinement of interactive features, such as videos, animations and the values clarification exercise, is needed to increase the usability of the decision aid.

Keywords: Colorectal cancer screening; Computer-based; Decision aid; Health literacy; Informed decision making.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Colorectal Neoplasms / diagnosis*
Decision Support Techniques*
Early Detection of Cancer
Female
Health Literacy*
Humans
Male
Mass Screening / methods*
Middle Aged
Netherlands
Pilot Projects