Health literacy skills for informed decision making in colorectal cancer screening: Perceptions of screening invitees and experts

• Published in: Health expectations : an international journal of public participation in health care and health policy 2018-06, Vol.21 (3), p.636-646
• Main Authors: Woudstra, Anke J., Timmermans, Daniëlle R. M., Uiters, Ellen, Dekker, Evelien, Smets, Ellen M. A., Fransen, Mirjam P.
• Format: Article
• Language: English
• Subjects: Aged; Cancer; Cancer screening; Clinical decision making; Colorectal cancer; colorectal cancer screening; Colorectal carcinoma; Colorectal Neoplasms - diagnosis; conceptual framework; context‐based measurement; Decision Making; Early Detection of Cancer; Experts; Female; Focus Groups; Health education; Health Literacy; Health Personnel; Humans; Informed decision making; Insight; Literacy skills; Male; Mass Screening; Measurement; Medical screening; Oncology; Original Research Paper; Original Research Papers; Participation; Patient satisfaction; Perception; Perceptions; Public health; Relevance; Researchers; Secondary education; Skills; Working groups
• ISSN: 1369-6513; 1369-7625; 1369-7625
• DOI: 10.1111/hex.12658

Background The process of informed decision making (IDM) requires an adequate level of health literacy. To ensure that all individuals have equal opportunity to make an informed decision in colorectal cancer (CRC) screening, it is essential to gain more insight into which health literacy skills are needed for IDM. Our aims were (i) to explore how individuals make a decision about CRC screening and (ii) to explore which skills are needed for IDM in CRC screening and (iii) to integrate these findings within a conceptual framework. Methods We conducted 3 focus groups with individuals eligible for CRC screening (n = 22) and 2 focus groups with experts in the field of health literacy, oncology and decision making, including scientific researchers and health‐care professionals (n = 17). We used framework analysis to analyse our data. Results We identified and specified ten health literacy skills, which varied from the ability to read and understand CRC screening information to the ability to weigh up pros and cons of screening for personal relevance. The skills were linked to 8 decision‐making stages in CRC screening within a conceptual framework. We found differences in perceptions between screening invitees and experts, especially in the perceived importance of CRC screening information for IDM. Conclusions This study provides insight into the decision‐making stages and health literacy skills that are essential for IDM in CRC screening. The proposed conceptual framework can be used to inform the development of context‐based measurement of health literacy and interventions to support IDM in cancer screening.