Preference for deliberation and perceived usefulness of standard- and narrative-style leaflet designs: Implications for equitable cancer-screening communication

Abstract

Background: In the United Kingdom, cancer screening invitations are mailed with information styled in a standard, didactic way to allow for informed choice. Information processing theory suggests this ‘standard-style’ could be more appealing to people who prefer deliberative thinking. People less likely to engage in deliberative thinking may be disenfranchised by the design of current standard-style information. Purpose: To examine the distribution of preference for deliberative thinking across demographic groups (Study 1), and explore associations between preference for deliberative thinking and perceived usefulness of standard- and narrative-style screening information (Study 2). Methods: Study 1, adults aged 45-59 (n = 4,241) were mailed a questionnaire via primary care assessing preference for deliberative thinking and demographic characteristics. Study 2, a separate cohort of adults aged 45-59 (n = 2,058) were mailed standard- and narrative-style leaflets, and a questionnaire assessing demographic characteristics, preference for deliberative thinking and perceived leaflet usefulness. Data were analysed using multiple regression. Results: In Studies 1 (n=1,783) and 2 (n=650), having lower socioeconomic status, being a women and of non-white ethnicity was associated with lower preference for deliberative thinking. In Study 2, the standard-style leaflet was perceived as less useful among participants with lower preference for deliberative thinking, while perceived usefulness of the narrative-style leaflet did not differ by preference for deliberative thinking. Conclusions: Information leaflets using a standard-style may disadvantage women and those experiencing greater socio-economic deprivation. More work is required to identify design styles that have a greater appeal for people with low preference for deliberative thinking.