How Do Women Interpret the NHS Information Leaflet about Cervical Cancer Screening?

Background. Organized screening programs often rely on written materials to inform the public. In the United Kingdom, women invited for cervical cancer screening receive a leaflet from the National Health Service (NHS) to support screening decisions. However, information about screening may be too complex for people to understand, potentially hindering informed decision making. Objectives. We aimed to identify women’s difficulties in interpreting the leaflet used in England and negative and positive responses to the leaflet. Methods. We used a sequential mixedmethods design involving 2 steps: cognitive think-aloud interviews (n = 20), followed by an England-wide survey (n = 602). Data were collected between June 2017 and December 2018, and participants included women aged 25 to 64 y with varying sociodemographics. Results. Interview results revealed misunderstandings concerning screening results, benefits, and additional tests and treatment, although participants tended to react positively to numerical information. Participants were often unfamiliar with the potential harms associated with screening (i.e., screening risks), key aspects of human papillomavirus, and complex terms (e.g., dyskaryosis). Survey results indicated that interpretation difficulties were common (M correct items = 12.5 of 23). Lower understanding was associated with lower educational level (b’s .0.15, P’s \0.001), lower numeracy scores (b = 0.36, P \ 0.001), and nonwhite ethnicity (b = 0.10, P = 0.007). The leaflet was evaluated positively overall. Conclusions. Despite previous user testing of the leaflet, key information may be too complex for some recipients. As a consequence, they may struggle to make informed decisions about screening participation based on the information provided. We discuss implications for the improvement of communications about screening and decision support

How to improve impact reporting for sustainability

Measuring real-world impact is vital for demonstrating the success of a project and one of the most direct ways to justify taxpayers’ contributions towards public funding. Impact reporting should identify and examine the potential positive and negative consequences of the continuing operations of a proposed project and suggest strategies to expand, further develop, mitigate, avoid or offset them. Designing a tool or methodology that will capture the impact of collaborative research and innovation projects related to sustainability requires input from technical experts but also from experts in the domains of survey design and communication. Without survey design insights and testing it can be very difficult to achieve unambiguous and accurate reporting of impacts. This paper proposes six key recommendations that should be considered for those monitoring projects when identifying metrics and designing a sustainability impact report. These recommendations stem from a series of in-depth interviews about sustainability and innovation impact reporting with research project co-ordinators in the process industries (e.g., cement, ceramics, chemicals, engineering, minerals and ores, non-ferrous metals, steel and water sectors). Our results show that factors such as ambiguous terminology, two-in-one questions, the stage of the project, over-hypothetical estimates, inadequate formats and alternatives and lack of guidelines can negatively influence the data collected in usual project monitoring activities and jeopardise the overall validity of the reporting. This work acts as a guideline for those monitoring to improve how they ask for impact data from projects, whether they are introducing new impact metrics or evaluating existing ones

Consumers' perceptions of energy use and energy savings: A literature review

Background. Policy makers and program managers need to better understand consumers' perceptions of their energy use and savings to design effective strategies for promoting energy savings. Methods. We reviewed 14 studies from the emerging interdisciplinary literature examining consumers' perceptions electricity use by specific appliances, and potential savings. Results. We find that: (1) electricity use is often overestimated for low-energy consuming appliances, and underestimated for high-energy consuming appliances; (2) curtailment strategies are typically preferred over energy efficiency strategies; (3) consumers lack information about how much electricity can be saved through specific strategies; (4) consumers use heuristics for assessing the electricity use of specific appliances, with some indication that more accurate judgments are made among consumers with higher numeracy and stronger pro-environmental attitudes. However, design differences between studies, such as variations in reference points, reporting units and assessed time periods, may affect consumers' reported perceptions. Moreover, studies differ with regard to whether accuracy of perceptions was evaluated through comparisons with general estimates of actual use, self-reported use, household-level meter readings, or real-time smart meter readings. Conclusion. Although emerging findings are promising, systematic variations in the measurement of perceived and actual electricity use are potential cause for concern. We propose avenues for future research, so as to better understand, and possibly inform, consumers' perceptions of their electricity use. Ultimately, this literature will have implications for the design of effective electricity feedback for consumers, and related policies

Understanding and Informing Consumers' Perceptions of Their Electricity Use

Policy makers are increasingly encouraging households to save electricity, so as to reduce greenhouse gas emissions. However, such encouragements may be ineffective if consumers are unaware of how much electricity is used by different appliances, such as their laptop, air conditioner, or washing machine. The main aim of this thesis is to understand and inform consumers' perceptions of their electricity consumption used by their appliances. The literature review demonstrated that consumers appear to have misperceptions of their energy use. It also showed that there is only limited number of studies in this domain and that there is a lack of wider theoretical framework. This literature review underlines several methodological shortcomings in previous studies, including: (i) consumers’ perceptions of electricity use by appliance is evaluated in comparison to their self-reported or estimated use rather than to their actual use; (ii) consumers report their perceptions of electricity use after reviewing only one reference point that may influence their judgements; (iii) most studies ask participants to express their electricity use in kilowatt-hours even though consumers prefer to see their electricity expressed in a ‘money’ format; (iv) participants report their electricity use for different time periods (i.e., per month or per hour), which makes it difficult to compare findings across studies. In order to address existing gaps in the literature, this thesis has four key research questions: 1.Will different reporting units (kWh vs. money) influence consumers’ judgments about electricity use compared to their actual use as measured at the appliance level? (Study 1; Study 3) 2.Will the provision of single or multiple reference points influence consumers’ judgments about electricity use? (Study 2A) 3.Which set of multiple reference points influence consumers’ judgments about electricity use? (Study 2B) 4.Will different time periods (hour vs. month) influence consumers’ judgments about electricity use? (Study 3) The key findings across the three studies confirmed that consumers may not be aware of how much electricity is used by specific appliances in their household. When asked to express their estimates in energy units over monthly time periods, consumers underestimated the use of higher consuming appliances such as air conditioners and dishwashers while overestimated the use of lower consuming appliances such as TVs and mobile phone chargers. When asked to express their estimates in monetary units over hourly time periods, consumers overestimated the use for all appliances. Furthermore, consumers’ accuracy of perceptions is higher when electricity use is assed in energy units in comparison to monetary units (Study 1 and 3), and when it is assessed over monthly time periods in comparison to hourly ones (Study 3). The theoretical contribution of this thesis is that it builds on findings from behavioural decision-making, especially the use of different heuristics to understand how consumers make judgments about their electricity use. It also applies existing theories of reference points to the domain of energy use. For example, participants may have used reference points to adjust their estimates, following the anchoring and adjustment heuristic. Also, providing participants with a single low or multiple reference points showed that distributional information helped them to make more accurate judgements about their electricity use (Study 2A). The methodological contributions of this thesis are two-fold. First, by having more accurate and precise measures of actual energy use I was able to assess the discrepancies between actual and perceived electricity use. This is the first time in this domain that electricity consumption has been measured by using sub-meter data for each appliance (Study 1). Second, I examined whether there is a difference in observed main effects when using actual electricity data (gathered through Pecan Research Institute) and estimated electricity data provided from secondary data (Study 1). My findings showed that the main effects remained similar which means that estimated data can be used as a reliable data source in certain situations where is not possible to obtain a measure of real-time electricity data. The practical contribution is that a better understanding of consumers’ judgement processes can potentially improve communications about their electricity use through electricity bills and in-home displays. For example, higher energy consuming appliances should be displayed more vividly (i.e. attention grabbing and colourful labels or design solutions) when developing effective feedback design because consumers tend to underestimate their electricity use. Also, when participants are trying to decide which appliance to upgrade or assess where to replace one with a more efficient model they should focus on their energy use over monthly time periods. Another contribution is that multiple reference points should be included while presenting information about specific appliance electricity use to improve the accuracy of those perceptions

How do women interpret the NHS information leaflet about cervical cancer screening?

Background. Organized screening programs often rely on written materials to inform the public. In the United Kingdom, women invited for cervical cancer screening receive a leaflet from the National Health Service (NHS) to support screening decisions. However, information about screening may be too complex for people to understand, potentially hindering informed decision making. Objectives. We aimed to identify women’s difficulties in interpreting the leaflet used in England and negative and positive responses to the leaflet. Methods. We used a sequential mixed-methods design involving 2 steps: cognitive think-aloud interviews (n = 20), followed by an England-wide survey (n = 602). Data were collected between June 2017 and December 2018, and participants included women aged 25 to 64 y with varying sociodemographics. Results. Interview results revealed misunderstandings concerning screening results, benefits, and additional tests and treatment, although participants tended to react positively to numerical information. Participants were often unfamiliar with the potential harms associated with screening (i.e., screening risks), key aspects of human papillomavirus, and complex terms (e.g., dyskaryosis). Survey results indicated that interpretation difficulties were common (M correct items = 12.5 of 23). Lower understanding was associated with lower educational level (β’s >0.15, P’s <0.001), lower numeracy scores (β = 0.36, P < 0.001), and nonwhite ethnicity (β = 0.10, P = 0.007). The leaflet was evaluated positively overall. Conclusions. Despite previous user testing of the leaflet, key information may be too complex for some recipients. As a consequence, they may struggle to make informed decisions about screening participation based on the information provided. We discuss implications for the improvement of communications about screening and decision support.The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this study was provided in part by a Population Research Fellowship awarded by Cancer Research UK (reference C57775/ A22182) to Yasmina Okan, in addition to internal funding provided by the University of Leeds. Dafina Petrova is supported by a Juan de la Cierva Fellowship (FJCI-2016-28279) from the Spanish Ministry of Science, Innovation and Universities. Samuel G. Smith is supported by Yorkshire Cancer Research. Wändi Bruine de Bruin was supported in part by the Swedish Foundation for Humanities and Social Sciences programme on Science and Proven Experience (VBE)