Development and pilot-testing of a colorectal cancer screening decision aid for individuals with varying health literacy levels

Anke Woudstra, Ellen Smets, E Dekker, T Broens, J Penning, Sian K Smith, K McCaffery, Mirjam Fransen

Research output: Contribution to journalArticlepeer-review

12 Citations (SciVal)
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Objective: Making an informed decision about colorectal cancer screening requires health literacy. Our aim was to develop and pilot-test a computer-based decision aid to support informed decision making about whether or not to participate in colorectal cancer screening for individuals with varying health literacy levels in the Netherlands. Methods: First, we designed and adapted the decision aid prototype among 25 individuals with low (n = 15) and adequate (n = 10) health literacy. Second, we used a before/after study to assess changes in knowledge, attitude, intention, decisional conflict, deliberation, anxiety and risk perception in an online survey among 81 individuals eligible for colorectal cancer screening with low (n = 35) and adequate (n = 46) health literacy. Results: The decision aid was acceptable, comprehensible, reduced decisional conflict, increased deliberation and improved knowledge about colorectal cancer screening, but not about colorectal cancer, among individuals with adequate and low health literacy. Usability was slightly higher for participants with adequate health literacy compared to those with low health literacy. Conclusion: The decision aid is promising in supporting informed decision making about colorectal cancer screening, also among individuals with lower health literacy. Practice implications: Further refinement of interactive features, such as videos, animations and the values clarification exercise, is needed to increase the usability of the decision aid.

Original languageEnglish
Pages (from-to)1847-1858
Number of pages12
JournalPatient Education and Counseling
Issue number10
Early online date30 Apr 2019
Publication statusPublished - 1 Oct 2019


  • Colorectal cancer screening
  • Computer-based
  • Decision aid
  • Health literacy
  • Informed decision making
  • Sustainability

ASJC Scopus subject areas

  • General Medicine


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