[Leaflets and websites on colorectal cancer screening and their quality assessment from experts' views]. / Printmedien- und Internetangebote mit Informationen zur Darmkrebsfrüherkennung und ihre kriteriengestützte Bewertung aus Expertensicht.

In Germany, individuals who have statutory health insurance have free access to colorectal cancer (CRC) screening tests, and can choose between a fecal occult blood test and a screening colonoscopy. Evidence-based health information may support informed choices regarding whether or not to undergo CRC screening. The aim of this study was to assess whether the available German information materials on CRC screening meet evidence-based health information standards. A systematic search was made for print media and websites on CRC screening addressed to German people with average CRC risk (search period for print media August 2010, for websites January-March 2012). The identified information was assessed with a newly developed comprehensive list of criteria. In all, 41 print media, including 28 flyers and 13 brochures, and 36 websites were identified and assessed. These materials reported more often the benefits than the risks of CRC screening, and quantified presentations of benefits and risks were less frequently given. Most of the materials called for participation and did not indicate the option to decide whether or not to attend CRC screening. This bias in favor of screening was increased by fear-provoking or downplayed wording. Most materials included false and misleading information. The requirements for evidence-based patient information were currently not met by most of the leaflets and websites in Germany. Feedback was given to the producers of the leaflets including a discussion of the findings. The results may be used to revise existing leaflets or to develop new health information on CRC screening.

[Are German information materials on colorectal cancer screening understandable or do they fail? Rating of health information by users with different educational backgrounds]. / Sind Informationsmaterialien zur Darmkrebsfrüherkennung in Deutschland verständlich oder verfehlen sie ihre Wirkung? : Bewertung von Gesundheitsinformationen durch Nutzerinnen und Nutzer mit unterschiedlichem Bildungshintergrund.

Evidence-based patient information is an essential part of decision making in health issues. A qualitative study was conducted to examine whether consumers consider the health information on colorectal cancer screening in Germany helpful in supporting their decision making. In this study, eight texts from different German authors about colorectal cancer screening were evaluated with a criteria-based selection. The texts were tested for understandability, structure, design, and effect on readers. Thirteen semi-structured focus groups were formed including 59 higher-educated and 15 lower-educated testers, 46 % of them being male with a mean age of 62.9 years. The transcripts were analyzed by content-analytic assessment. The testers provided detailed comments on the content and design of the texts. They revealed inaccuracies and suggested improvements of the texts. The testers differed from each other in terms of the intensity of their participation in the discussions and comprehension of the material. The reception of the flyers and brochures varied according to the educational level of the testers. Lower-educated testers often skipped passages of texts about risks as well as passages containing numbers and graphics. The texts had different effects on the testers, regardless of the level of education. If adverse effects were presented, some testers became scared while others were reassured because they felt informed. Most of the testers appreciated a call for participation as a central message of the text. Sometimes, if there was no clear appeal to attend the screening, the testers even asked for it. The recently introduced political strategy of promoting an informed choice is applied to an unprepared population who was used to getting a clear yes-or-no recommendation. Thus, at first, the population has to learn how to make an informed choice. This topic must be addressed and taken into account in the process of developing health information. Since this is not always the case, we conclude that current materials are limited in their contribution toward the decision of attending CRC screening.

[Mammography and cervical cancer screening--a systematic review about women's knowledge, attitudes and participation in Germany]. / Früherkennung von Brust- und Gebärmutterhalskrebs--ein systematischer Review zu Wissen, Einstellungen und Inanspruchnahmeverhalten der Frauen in Deutschland.

INTRODUCTION: In the German statutory health insurance system, women can take part in free mammography and cervical cancer screening. The aim of this study is to investigate women's knowledge of, attitudes to and participation in these screening measures as well as the determinants of eligible women living in Germany. METHODS: We conducted a systematic literature search, supplemented by an Internet search, of Medline and other German and English databases for the period 2000-2010. Data extraction and quality assessment were carried out by 2 independent reviewers. Data synthesis was qualitative. RESULTS: We identified 12 studies on mammography and cervical cancer screening. Most women were found to be aware of the option of free screening. The majority of women were able to name risk factors for breast cancer correctly. This was not the case in cervical cancer, where women said they were insufficiently informed. To a significant extent, they were also uninformed about the benefits of screening and incidence of false-positive and false-negative test results in mammography. In 2007, 54% of the invited women took part in the organised mammography screening program with large variations in participation rate among the Federal states. It appears that better educated women or those with a private health insurance participate in the programme less frequently. However, one third of the non-participants attend a mammography outside the screening program. Data for participation in cervical cancer screening are inconsistent. There is some evidence that younger women, married women and those with higher education are more likely to participate in the screening. CONCLUSIONS: The interviewees' substantial lack of knowledge underscores the need for optimising communication on the aims, benefits and risks of screening tests to enable women to make an informed decision. It is desirable to continuously monitor women's knowledge about and participation in screening and determinants thereof with a view to laying the foundations for target group-specific information strategies.