The impact of supplementary narrative-based information on colorectal cancer screening beliefs and intention

McGregor, Lesley; Wagner, Christian von; Vart, Gemma; Yuen, Wing Chee; Raine, Rosalind; Wardle, Jane; Robb, Kathryn A.

doi:10.1186/s12885-015-1167-3

Cited by 37 publications

(36 citation statements)

References 38 publications

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“…Providing accurate and comprehensible information can educate the public about screening and thereby improve their capacity to make an informed choice . Cancer communication can also reduce perceived barriers to screening, by either correcting previous biases or providing accurate information on an unfamiliar topic . European Union guidelines recommend organized screening programs should provide written information to improve public understanding of the aims, benefits, and disadvantages of screening .…”

Section: Discussionmentioning

confidence: 99%

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Inequalities in cancer screening participation: examining differences in perceived benefits and barriers

et al. 2016

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ObjectiveInequalities exist in colorectal cancer (CRC) screening uptake, with people from lower socioeconomic status backgrounds less likely to participate. Identifying the facilitators and barriers to screening uptake is important to addressing screening disparities. We pooled data from 2 trials to examine educational differences in psychological constructs related to guaiac fecal occult blood testing.MethodsPatients (n = 8576) registered at 7 general practices in England, within 15 years of the eligible age range for screening (45‐59.5 years), were invited to complete a questionnaire. Measures included perceived barriers (emotional and practical) and benefits of screening, screening intentions, and participant characteristics including education.ResultsAfter data pooling, 2181 responses were included. People with high school education or no formal education reported higher emotional and practical barriers and were less likely to definitely intend to participate in screening, compared with university graduates in analyses controlling for study arm and participant characteristics. The belief that one would worry more about CRC after screening and concerns about tempting fate were strongly negatively associated with education. In a model including education and participant characteristics, respondents with low emotional barriers, low practical barriers, and high perceived benefits were more likely to definitely intend to take part in screening.ConclusionsIn this analysis of adults approaching the CRC screening age, there was a consistent effect of education on perceived barriers toward guaiac fecal occult blood testing, which could affect screening decision making. Interventions should target specific barriers to reduce educational disparities in screening uptake and avoid exacerbating inequalities in CRC mortality.

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Section: Discussionmentioning

confidence: 99%

“…Data were from 2 randomized trials testing narrative and low literacy (“gist‐based”) CRC screening information materials . Patients were from 7 general practices in areas of mixed socioeconomic deprivation in England (narrative = 3; gist = 4).…”

Section: Methodsmentioning

confidence: 99%

Inequalities in cancer screening participation: examining differences in perceived benefits and barriers

et al. 2016

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“…Both leaflets demonstrated this potential when their effect was evaluated on the basis of knowledge and attitudes, with additional evidence that the narrative leaflet increased intention to attend screening. 171,215 However, in the trials, neither of the leaflets increased bowel cancer screening uptake, either in lower SEC groups or overall. One possible explanation for the discrepancy from the pilot data is the emerging body of evidence indicating that the determinants of intention may differ from the determinants of action and perhaps we influenced intentions rather than actions.…”

Section: Discussionmentioning

confidence: 93%

“…The evaluation/pilot trial of the current narrative leaflet indicated an increase in intention and positive outcomes on factors predictive of screening intention, including enhanced personal risk and reduced impact of disgust as a barrier. 171 However, within the RCT, this intention did not translate to an increase in screening attendance, again adding to the mixed evidence available on the effectiveness of health education interventions. Another reason why both gist and narrative leaflets did not show the promised effect is that the development of such interventions is limited to a highly selected sample of people willing to participate in research.…”

Section: Comparison With Other Studiesmentioning

confidence: 94%

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Raine

Atkin

Wagner

et al. 2017

Programme Grants Appl Res

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Objective: To reduce socioeconomic inequalities in uptake of the NHS BCSP ’ s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group. Design: Workstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘ gist ’ information, (2) a ‘ narrative ’ leaflet, (3) ‘ general practice endorsement ’ (GPE) and (4) an ‘ enhanced reminder ’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention. Methods: Interventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘ usual care ’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘ gist ’ leaflet ( n = 163,525), (2) ‘ narrative ’ leaflet ( n = 150,417), (3) GPE on the invitation letter ( n = 265,434) and (4) ER ( n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual ’ s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘ definitive ’ test result of either ‘ normal ’ (i.e. no further investigation required) or ‘ abnormal ’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome. Results: The gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; all p -values > 0.05). GPE showed no effect on the gradient ( p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10; p < 0.0001]. ER showed a significant interaction with SECs ( p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20; p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06; p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11; p = 0.001). All interventions were inexpensive to provide. Limitations: In line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect. Conclusions: Enhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results hig...

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“…Of these twelve studies, nine used a randomized (controlled) trial design. In these randomized (controlled) trial studies, the main intervention was narrative information with the control groups receiving: a culturally targeted presentation, general information about CRC, a stock (ie, no tailoring, no narrative), tailored narrative or tailored educational message, a numeric risk tool, risk information, an educational video about car safety and a promotora and video intervention . Narrative interventions were targeted at various ethnic groups.…”

Section: Resultsmentioning

confidence: 99%

How narratives influence colorectal cancer screening decision making and uptake: A realist review

Woudstra

Suurmond

2019

Health Expectations

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Background Although narratives have been found to affect decisions about preventive behaviours, including participation in cancer screening, the underlying mechanisms of narratives remain unclear. Objective The purpose of this study was to summarize and synthesize existing literature on narrative interventions in the context of colorectal cancer screening. Our main research question was as follows: How, when and for whom do narratives work context of decision making about colorectal cancer screening participation? Methods We undertook a realist review to collect evidence on narratives in the context of colorectal cancer screening. A search of the literature was performed in Embase, MEDLINE/PubMed, Cinahl and PsycINFO. We included empirical evaluations (qualitative or quantitative) of narrative interventions. In total, 15 studies met the inclusion criteria. A content‐based taxonomy of patient narrative types in decision aids formed the basis for our initial programme theory. Main result We identified four mechanisms: (a) process narratives that address perceived barriers towards screening lead to improved affective forecasting, (b) experience narratives that demonstrate the screening procedure lead to increased self‐efficacy, (c) experience narratives that depict experiences from similar others lead to more engagement and (d) outcome narratives that focus on outcomes of colorectal cancer (CRC) screening decision decrease or increase fear of colorectal cancer. The evidence was limited on which narrative type may facilitate or bias informed decision making in colorectal cancer screening. Discussion and conclusion The findings indicate the importance of more detailed descriptions of narrative interventions in order to understand how mechanisms may facilitate or bias informed decision making in colorectal cancer screening.

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The impact of supplementary narrative-based information on colorectal cancer screening beliefs and intention

Cited by 37 publications

References 38 publications

Inequalities in cancer screening participation: examining differences in perceived benefits and barriers

Inequalities in cancer screening participation: examining differences in perceived benefits and barriers

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

How narratives influence colorectal cancer screening decision making and uptake: A realist review

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