A mixed-methods study to evaluate the acceptability of information leaflets for breast cancer screening

Aims and objectives To obtain feedback regarding the comprehension and acceptability of an information leaflet on breast cancer screening among women. Background Women usually receive a leaflet inviting them to participate in breast cancer screening programmes for early detection of breast cancer. These leaflets include relevant information about mammograms to aid with decision-making. It is important to know how the target population perceives these leaflets, as this may influence the attitude towards breast cancer screening. Design A mixed-methods study (concurrent triangulation design). Methods Participants were 41 women aged between 40-60 years in the north of Spain. The leaflet included information about breast cancer, mammograms, benefits/risks of screening, and the breast cancer mortality and survival rates in relation to screening. Three written methods were used to assess the leaflet: a readability assessment (Flesch Index) and two comprehension assessments (Cloze and multiple-choice questions). In addition, 26 semi-structured interviews were conducted to explore the women's opinions regarding comprehension, acceptability and the contribution of the leaflet as a decision aid. The COREQ checklist was used to guarantee the quality and rigour of the qualitative study. Results Overall, women found the leaflet fairly easy to read and most understood the content. Some women found the information on mortality alarming, difficult to understand and a cause for rejection. The leaflet was viewed as a decision aid, although further information was requested on mammograms, the need for complementary tests and the risks and symptoms of breast cancer. Conclusion The leaflet was accepted by women and, overall, easy to understand. The participation of the target population enabled the content and format of the leaflet to be adjusted to their needs. Relevance for clinical practice Nurses can contribute towards improving the breast cancer screening leaflets, considering women's perceptions surrounding screening.