Effects of a leaflet on breast cancer screening knowledge, explicit attitudes, and implicit associations.

OBJECTIVE: To assess the effect of an information leaflet on knowledge, explicit attitudes, implicit associations, and attendance for breast cancer screening. METHODS: Dutch women (aged 49-75 years) were approached three months before their breast cancer screening invitation. After providing informed consent, participants were randomised to receiving the information leaflet (intervention condition) or not (control condition). Screening knowledge, explicit attitudes, and implicit associations were assessed through web-based questionnaires, at baseline and two weeks later. Actual screening attendance data were collected. RESULTS: In total, 988 women completed both questionnaires. Participants in the leaflet condition scored higher on knowledge (9.9 versus 9.6, p < 0.001, scale 0-11), and more often had positive explicit attitudes (97 % versus 95 %, p = 0.03), than those in the control condition. This contrast was bigger among first-time invitees. Implicit associations were not correlated with explicit attitudes or attendance. Explicit attitudes were moderately correlated with attendance (r=.30, p < 0.001). CONCLUSION: The information leaflet led to more knowledge and more positive explicit attitudes. Implicit associations towards breast cancer screening were not correlated with attendance. PRACTICE IMPLICATIONS: Encouragement to learn about the screening programme can increase levels of knowledge of invitees and therefore support their decision-making about participation. This might be especially relevant for first-time invitees.

Informed decision-making based on a leaflet in the context of prostate cancer screening.

OBJECTIVE: We aimed to assess to what extent men make informed choices in the context of prostate cancer screening and how written material contributes to that process. METHODS: We developed a leaflet describing prostate cancer screening, and a questionnaire consisting of knowledge, attitude, and intended screening uptake components to assess informed decision-making. The leaflet and questionnaire were pilot-tested among men of the target population, adapted accordingly, and sent to 761 members of an online research panel. We operationalized whether the leaflet was read as spending one minute on the leaflet page and by a self-reported answer of respondents. RESULTS: The response rate was 66% (501/761). The group who read the leaflet (n = 342) correctly answered a knowledge item significantly more often (10.9 versus 8.8; p < 0.001) than those who did not read the leaflet (n = 159), and made more informed choices (73% versus 56%; p = 0.001). There were no significant differences in attitude and intended screening uptake between both groups. CONCLUSION: Having read the leaflet could be one of the factors associated with increased levels of knowledge and informed decision-making. PRACTICAL IMPLICATIONS: The results of this study showed that increasing knowledge and supporting informed decision-making with written material are feasible in prostate cancer screening.