Examining acceptance, readability and comprehension of Digital communication as part of three population-based cancer screening programs

PROBLEM In the Netherlands, there are three population-based cancer screening programs: (1) breast cancer screening (for women aged 50-75 years), (2) cervical cancer screening (for women, aged 30-60 years), and (3) bowel cancer screening (men and women, aged 55-75 years).Currently, most communication (invitation/result letters, information folders) is paper-based. The government aims to replace the paper-based communication with digital communication. This can have benefits (i.e., costs, convenience and access to information) as well as risks: Those eligible for screening differ in age (30-75), gender, socioeconomic status (SES) and literacy skills. It has been shown that acceptability of digital communication is lower among elderly, people with low literacy skills or a low educational level. Moreover, it has been shown that readability, information processing and comprehension differs when similar information is communicated by paper or digitally. CALL QUESTIONS Prior to digitalizing communication, it is important to understand for whom (which end user groups) digital communication is acceptable or not, why, under which conditions, and for which communication moment (e.g., invitation, result). It is also important to understand how and why readability, comprehension and acceptability differs between the type of communication (paper vs. digital), for which user groups and which communication moments. Finally, it is important to understand how readability, comprehension and acceptability could be promoted, if barriers in digital communication do exist. PROJECT AIMS This project addresses the previous questions in order to understand the needs and demands for digital communication about cancer screening for different user groups (differed by age, gender, SES, literacy skills) for different communication moments (i.e., invitation, result). First, this project aims to provide answers on when, how and for whom digital communication is acceptable, and how acceptability could be facilitated. Second, we aim to examine how digitizing communication has an impact on ease of reading, readability, comprehension and acceptability, for which type of users. Third, we aim to increase an understanding of how digital communication (in terms of content, lay-out, delivery mode) could be optimized, in case of barriers, to improve readability, comprehension and use. Finally, we aim to provide recommendations regarding the implementation of population-based (digital) communication. PROJECT PLAN To reach the aims, the project will consist of three work packages (WPs). WP1 consists of two studies. Study 1 is a qualitative study. Focus group interviews will be held with diverse users groups to: (a) explore the extent to which digital information is used; (b) examine (dis)advantages (including ethical) of digital over printed communication; (c) Examine ways to overcome potential barriers. Study 2 is a survey study among representatives eligible for screening (N=600). Based on the Technology Acceptance Model (TAM), we will examine (reasons for) acceptability of the digital communication, for which users groups and communication moments. WP 1 will provide answers on the acceptability of digital cancer screening communication, for which user groups and communication moments, and will provide insight into facilitating factors as well as barriers need to be addressed. WP2 consists of three different usability studies addressing readability, comprehension and acceptability of screening communication, taking into account the diverse end users and communication moments. In the first study we will test differences in readability, comprehension and acceptability between paper-based and digital communication (N=64). The second and third usability studies (N=24 per study) consist of small-scale usability experiments in which we will examine whether adaptations of the digital communication increases readability, comprehension and acceptability, compared to the original digital communication. Adaptations will focus on: (1) reading ease (e.g., layout), (2) reading understanding (e.g., icons, illustrations, audio/visual aids), (3) easiness of use. This WP will provide practical recommendations for digital communication (i.e., concepts and proof of principle). WP3 examines how to implement digital communication, and whether the client portal (part of ScreenIT) would be a good means for implementation. We will organize a workshop with relevant stakeholders (e.g., screening coordinators, screening organizations, representative users groups, organization responsible for the IT structure, ethicist, professionals involved in communication). This WP will result in practical recommendations on the feasibility of digital communication about cancer screening, requirements and ethical implications for optimal implementation, possible limitations, and an agenda for future research.