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

Patient Educ Couns. 2006 Nov;63(3):328-35. doi: 10.1016/j.pec.2006.03.016. Epub 2006 Sep 29.


Objective: To study the effectiveness of visual illustrations in improving people's understanding of the preventive aim of flexible sigmoidoscopy (FS) screening.

Methods: Three-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.

Results: In 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).

Conclusion: Illustrations improved understanding of the preventive aim of FS screening.

Practice implications: Pictoral illustrations could be used to facilitate patient understanding of screening.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Audiovisual Aids*
  • Colorectal Neoplasms / prevention & control*
  • Feasibility Studies
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Logistic Models
  • London
  • Male
  • Mass Screening*
  • Mental Recall
  • Middle Aged
  • Pamphlets
  • Patient Education as Topic / methods*
  • Sigmoidoscopy*