The impact of illustrations on public understanding of the aim of cancer screening

ObjectiveTo study the effectiveness of visual illustrations in improving people's understanding of the preventive aim of flexible sigmoidoscopy (FS) screening.MethodsThree-hundred and eighteen people aged 60–64 were offered an appointment to attend FS screening and randomly allocated to receive either written information alone or written information plus illustrations. The illustrations showed the adenoma–carcinoma sequence and how it can be interrupted by removing polyps found during FS. Telephone interviews were conducted with a randomly selected sub-set of people prior to their screening appointment to assess their knowledge and understanding of the test (n = 65). The interviews were tape-recorded, transcribed and content analysed by researchers blind to the condition people had been allocated to.ResultsIn the written information only group, 57% understood that the test was looking for polyps rather than just cancer, whilst in the group who received written information and illustrations, 84% understood this. Logistic regression analyses confirmed that addition of illustrations resulted in significantly better understanding (OR = 3.75; CI: 1.16–12.09; p = 0.027), and this remained significant controlling for age, gender and Townsend scores (an area-based measure of deprivation) (OR = 10.85; CI: 1.72–68.43; p = 0.01).ConclusionIllustrations improved understanding of the preventive aim of FS screening.Practice implicationsPictoral illustrations could be used to facilitate patient understanding of screening.