Communicating Colorectal Cancer Information to Low-Health Literacy Populations

Background: Year one-evaluation results from Iowa's Colorectal Cancer (CRC) Program suggested clinic staff that interfaced with low-health literacy populations would benefit from the creation of a communication tool specific to these patients.

Program background: To fill this gap, three short informational videos were developed by the Iowa Department of Public Health. The Health Belief Model was used a theoretical foundation to create the initial video content with a specific focus on alleviating patient barriers including: experiencing negative emotions or discomfort when discussing sensitive health topics, inability to read written information, and overall lack of knowledge about health topics.

Evaluation Methods and Results:  The content of the three videos was evaluated with potential consumers (low-income individuals between the ages of 50 and 75) via eight focus groups across the state. In these groups individuals watched each video then rated them via a short survey instrument on overall likability, appropriateness and whether or not they elicited specific positive or negative emotions. Focus group participants also responded to questionnaire items meant to assess knowledge gains on content specific to each video. After participants filled out questionnaires for each video, qualitative feedback on the series of videos was collected as was general information about how respondents would want to view information about a sensitive health topic like CRC. Questionnaire and verbal responses showed that overall participants in the target age range liked the the videos, did not find them confusing, found them appropriate, and reported gaining appropriate knowledge from each video. Participants reported high liking for the cartoons and general lightness of the videos, the most highly reported reactions to the video were that they were "funny" and "cute". Verbal feedback about the videos suggested that while focus group participants liked the videos overall there were certain images they found disturbing and there may be certain locations both on their own and in primary care settings where they may not want to watch the video.

Conclusions:  Overall the approach to creating videos aimed at a low-health literacy populations seems to be a promising one. Actual results on screening behavior can not be measured until the videos are deployed to clinics, however preliminary conclusions support the notion that these videos may be an effective way of communicating with low-health literacy populations. Although the scene in the video showing a cartoon version of a colonoscopy may need to be edited or used less frequently in one of the videos, the overall use of cartoons seemed to appropriate and was reported as likable, some participants simply felt that depicting a colonoscopy might be taking things too far.

Implications for research and/or practice:  Implications for practice include that older populations will watch videos and find them appropriate, useful, and likable. Additionally colorectal cancer and more generally topics of cancers that may cause embarassment may benefit from using lighter approaches to providing health information.