What impact do questionnaire length and monetary incentives have on mailed health psychology survey response?

Objectives: Response rates to health-related surveys are declining. This study tested two strategies to improve the response rate to a health psychology survey mailed through English general practices: (1) sending a shortened questionnaire and (2) offering a monetary incentive to return a completed questionnaire. Design: Randomized controlled trial. Methods: Adults (n = 4,241) aged 45–59 years, from four General Practices in South-East England, were mailed a survey on attitudes towards bowel cancer screening. Using a 2 × 4 factorial design, participants were randomized to receive a ‘short’ (four A4 pages) or a ‘long’ (seven A4 pages) questionnaire, and one of four monetary incentives to return a completed questionnaire – (1) no monetary incentive, (2) £2.50 shop voucher, (3) £5.00 shop voucher, and (4) inclusion in a £250 shop voucher prize draw. Age, gender, and area-level deprivation were obtained from the General Practices. Results: The overall response rate was 41% (n = 1,589). Response to the ‘short’ questionnaire (42%) was not significantly different from the ‘long’ questionnaire (40%). The £2.50 incentive (43%) significantly improved response rates in univariate analyses, and remained significant after controlling for age, gender, area-level deprivation, and questionnaire length. The £5.00 (42%) and £250 prize draw (41%) incentives had no significant impact on response rates compared to no incentive (38%). Conclusions: A small monetary incentive (£2.50) may slightly increase response to a mailed health psychology survey. The length of the questionnaire (four pages vs. seven pages) did not influence response. Although frequently used, entry into a prize draw did not increase response. Achieving representative samples remains a challenge for health psychology

Prevalence and characteristics of pictures in cancer screening information: Content analysis of UK print decision support materials

This paper answers calls for further theoretical work into types of pictures used in health information. Pictures influence message reception, interpretation, and retention, making this an important area for research in health communication. A content analysis was used to produce a systematic and theory-orientated assessment of the use of pictures in cancer screening information materials (N = 44) produced for invitees to either cervical, breast or bowel screening in the United Kingdom. The main categories investigated in this study were function, content and style of the pictures. Pictures used in cancer screening information materials were twice as likely to be used to demonstrate what something looked like or depict a situation (display pictures) than to convey a specific cancer screening message (message pictures). The messages being conveyed were predominantly related to screening procedures (51%) or outcomes (38%) rather than screening experiences (6%) or decisions (9%). Pictures were rarely used to portray a narrative in the materials (n = 12). The paper brings conceptual clarity to the ways pictures can be, and have so far been used, to communicate cancer screening information. This study identifies that pictures conveying a cancer-related message, and pictures in the format of a narrative, should be used more often in print cancer screening communications

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

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

Why colorectal screening fails to achieve the uptake rates of breast and cervical cancer screening : a comparative qualitative study

Funding: National Awareness and Early Diagnosis Initiative Grant (C9227/A17676) awarded to co-PIs KR and CMcC.Background In Scotland, the uptake of clinic-based breast (72%) and cervical (77%) screening is higher than home-based colorectal screening (~60%). To inform new approaches to increase uptake of colorectal screening, we compared the perceptions of colorectal screening among women with different screening histories. Methods We purposively sampled women with different screening histories to invite to semistructured interviews: (1) participated in all; (2) participated in breast and cervical but not colorectal (‘colorectal-specific non-participants’); (3) participated in none. To identify the sample we linked the data for all women eligible for all three screening programmes in Glasgow, Scotland (aged 51–64 years; n=68 324). Interviews covered perceptions of cancer, screening and screening decisions. Framework method was used for analysis. Results Of the 2924 women invited, 86 expressed an interest, and 59 were interviewed. The three groups’ perceptions differed, with the colorectal-specific non-participants expressing that: (1) treatment for colorectal cancer is more severe than for breast or cervical cancer; (2) colorectal symptoms are easier to self-detect than breast or cervical symptoms; (3) they worried about completing the test incorrectly; and (4) the colorectal test could be more easily delayed or forgotten than breast or cervical screening. Conclusion Our comparative approach suggested targets for future interventions to increase colorectal screening uptake including: (1) reducing fear of colorectal cancer treatments; (2) increasing awareness that screening is for the asymptomatic; (3) increasing confidence to self-complete the test; and (4) providing a suggested deadline and/or additional reminders.PostprintPeer reviewe

Markers of assimilation of problematic experiences in dementia within the LivDem project

© 2015, © The Author(s) 2015. This study aimed to determine whether the Markers of Assimilation of Problematic Experiences in Dementia scale (MAPED) can be used to identify whether the way in which participants talk about dementia changed during the group. All eight sessions of a LivDem group, which were attended by participants were recorded and transcribed. An initial analysis identified 160 extracts, which were then rated using the MAPED system. Inter-rater reliability was 61% and following a resolution meeting, 35 extracts were discarded, leaving 125 extracts with an agreed marker code. All of the participants were identified as producing a speech marker relating to dementia, and these varied between 0 (warding off) to 6 (problem solution). Examples of these markers are provided. The proportion of emergence markers (indicating the initial stages of assimilation) compared to later markers changed significantly between the first four sessions and the final sessions. This difference was still significant even when the markers produced by the most verbal participant, Graham, were excluded. The use of process measures within psychotherapy complements more conventional outcome measures and has both theoretical and clinical implications

The impact of theory-based messages on COVID-19 vaccination intentions: a structured summary of a study protocol for a randomised controlled trial

Objectives Uptake of vaccination against COVID-19 is key to controlling the pandemic. However, a significant proportion of people report that they do not intend to have a vaccine, often because of concerns they have about vaccine side effects or safety. This study will assess the impact of theory-based messages on COVID-19 vaccination intention, drawing on the Necessity-Concerns framework to address previously reported beliefs and concerns about COVID-19 vaccination, and assess whether hypothesised variables (illness coherence, perceived necessity and concerns) mediate change in vaccination intention. Trial design Prospective, parallel two-arm, individually randomised (1:1) trial. Participants Adults aged over 18 years, living in Scotland and not vaccinated for COVID-19. A quota sampling approach will be used with the aim of achieving a nationally representative sample on gender, region and ethnic group, with oversampling of individuals with no educational qualifications or with only school-level qualifications. Intervention and comparator Intervention: Brief exposure to online text and image-based messages addressing necessity beliefs and concerns about COVID-19 vaccination. Comparator: Brief exposure to online text and image-based messages containing general information about COVID-19 and COVID-19 vaccination. Main outcomes Primary outcome: Self-reported intention to receive a vaccine for COVID-19 if invited, immediately post-intervention. Secondary outcomes: Self-reported COVID-19 illness coherence, perceived necessity of a COVID-19 vaccine and concerns about a COVID-19 vaccine, immediately post-intervention. Randomisation Quasi-randomisation performed automatically by online survey software, by creating a variable derived from the number of seconds in the minute that the participant initiates the survey. Participants starting the survey at 0-14 or 30-44 seconds in the minute are allocated to the intervention and 15-29 or 45-59 seconds to the comparator. Blinding (masking) Participants will not be blinded to group assignment but will not be informed of the purpose of the study until they have completed the follow-up survey. Investigators will be blinded to allocation as all procedures will be undertaken digitally and remotely without any investigator contact with participants. Numbers to be randomised (sample size) A total of 1,094 will be randomised 1:1 into two groups with 547 individuals in each. Trial Status Protocol version number 1.0, 26th February 2021. Recruitment status: Not yet recruiting, set to start April 2021 and end April 2021. Trial registration ClinicalTrials.gov, NCT04813770, 24th March 2021. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol

Using picture narratives to support equitable and informed participation in lung cancer screening

Background: The use of pictures and narratives in print health communication has been successful in improving engagement, comprehension, and behavioural enactment. However, the use of these two modalities in an integrated way for health communication has been less extensively researched. Through the thesis, the term ‘picture narratives’ is used to refer to the portrayal of a narrative through a sequence of static visual images. Lung cancer is the third most common cause of death in Scotland – with some of the highest rates of lung cancer being in the most socioeconomically deprived areas of Glasgow. Lung cancer screening (LCS) is currently being trialled in the UK and, if expanded to a national screening programme, could greatly reduce the burden of lung cancer for individuals and for society. To be able to build understanding into the application of picture narratives in health communication, I developed and tested example picture narrative information in the context of LCS. Methodology: A multidisciplinary approach was taken while developing the picture narratives to ensure they were well designed before evaluating their effectiveness. The first stage of the design process (Study 1) was content analysis of picture narrative use in current practice, looking at official information materials produced for invitees to cancer screening in the UK. The second design stage (Study 2) involved an analysis of the ways in which LCS related topics have been portrayed in comics. This study was used to identify culturally prevalent images, symbols and conventions used for picture narrative portrayals of cancer which could be adopted in the designs to increase recognisability and appropriateness. The third design stage (Study 3) was a community-based design workshop with twelve people aged between 50 and 75 who smoke and were living in a low-resource area of Glasgow. This workshop was used to explore LCS information design preferences and perceptions surrounding LCS within the target audience to make the picture narrative designs more engaging, acceptable, and supportive. Picture narrative LCS information was then created based on the findings of these studies alongside an expert review, the support of a professional artist and usability testing with eight members of the target audience (Study 4). The picture narrative LCS information was then tested (Study 5) in a questionnaire study of randomised controlled trial design, with 311 people living in Glasgow aged between 50 and 75, to determine their effectiveness in supporting informed decision-making in an equitable way in comparison to the same lung screening information provided as text with pictures and as text alone. Support of informed decision-making was measured via LCS knowledge acquisition, LCS eligibility self-assessment accuracy and LCS related beliefs. Main findings: The picture narrative format was not found to support informed decision making when compared to the picture condition, producing lower knowledge scores and lower eligibility self-assessment accuracy. The LCS information provided as text with pictures was found to be most equitable, with the gap in knowledge scores between people with higher and lower levels of social economic deprivation being significantly smaller than when provided in text-only format. This thesis reaffirms the importance of using pictures that have been developed in a culturally sensitive way when producing health information materials that aim to both engage and inform. Other avenues and opportunities for making use of picture narratives for supporting informed and equitable participation in lung cancer screening are considered

Evidencing the impact of cancer trials: insights from the 2014 UK Research Excellence Framework

Introduction: An impactful clinical trial will have real-life benefits for patients and society beyond the academic environment. This study analyses case studies of cancer trials to understand how impact is evidenced for cancer trials and how impact evaluation can be more routinely adopted and improved. Methods: The United Kingdom (UK) Government allocates research funding to higher-education institutions based on an assessment of the institutions’ previous research efforts, in an exercise known as the Research Excellence Framework (REF). In addition to each institution’s journal publications and research environment, for the first time in 2014, allocation of funding was also dependent on an evaluation of the wider, societal impact of research conducted. In the REF2014, impact assessment was performed by evaluation of impact case studies. In this study, case studies (n = 6637) submitted by institutions for the REF2014 were accessed and those focussing on cancer trials were identified. Manual content analysis was then used to assess the characteristics of the cancer trials discussed in the case studies, the impact described and the methods used by institutions to demonstrate impact. Results: Forty-six case studies describing 106 individual cancer trials were identified. The majority were phase III randomised controlled trials and those recruiting patients with breast cancer. A list of indicators of cancer trial impact was generated using the previous literature and developed inductively using these case studies. The most common impact from a cancer trial identified in the case studies was on policy, in particular citation of trial findings in clinical guidelines. Impact on health outcomes and the economy were less frequent and health outcomes were often predicted rather than evidenced. There were few descriptions identified of trialists making efforts to maximise trial impact. Discussion: Cancer trial impact narratives for the next REF assessment exercise in 2021 can be improved by evidencing actual rather than predicted Impact, with a clearer identification of the beneficiaries of cancer trials and the processes through which trial results are used. Clarification of the individuals responsible for performing impact evaluations of cancer trials and the provision of resources to do so needs to be addressed if impact evaluation is to be sustainable

Adapting participatory workshops to a virtual setting: Co-design with Muslim women of a faith-based intervention to encourage cancer screening uptake

Early diagnosis of cancer through screening can reduce deaths and treatment burden if the people invited participate. Yet inequalities in screening participation remain: ethnic minority groups in particular experience barriers to cancer screening that need to be addressed in order to contribute to improving equality in health outcomes. Community-centred, participatory approaches can ensure that cancer screening interventions are culturally appropriate to the communities they are intended to serve. Virtual participatory research faces unique challenges in building the rapport required for successful collaboration between participants and researchers. This article describes the successful adaption of face-to-face participatory methods to co-designing, online, an intervention using faith-based messages to reduce cancer screening barriers. Based on the World Café method, we conducted four two-hour workshops by video call with a group of 10 Muslim women (29-65 years) from Glasgow, UK. Activities included i) plenary and small-group discussions, ii) graphic recording, and iii) expert presentations. The workshops covered four topics: Islam and health, screening barriers, faith-based messages for screening barriers, and delivering a faith-based intervention. Anonymous feedback questionnaires evaluating each workshop showed the women found the workshops interesting, informative, and helpful. They reported being glad they had participated. Our findings highlight the importance of interactive discussion and low participant burden to optimise online co-design. The workshops created a faith-based cancer screening intervention engaging and accessible to Muslim women