The Impact of Picture Narrative Format on Print Lung Screening Communication Outcomes

Study Overview
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Brief Summary
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The purpose of this study is to test whether a picture narrative format is more successful, than text with pictures or text alone, in communicating lung screening information (primarily defined by positive attitudes towards the design and increase in knowledge) to people likely to be invited to lung screening where available.

Detailed Description
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Population screening is key to detecting lung cancer early at a more treatable stage. Uptake of screening should be equitable (i.e., screening benefits all eligible members of the population and does not contribute further to health disparities) and informed (i.e., participants have been involved in the decision to take part and their decision aligns with their values and circumstances). Print decision support materials are the primary mechanism for encouraging engagement with cancer screening and supporting decision making. It is essential that we identify print communication techniques that are effective in informing invitees about lung screening. The intervention, picture narrative information about lung screening, was previously developed through codesign and prototype testing with people likely to be eligible for lung screening (50 to 75 years old, past or current heavy smokers). Participants will be randomised to one of three groups: Picture narrative format, Text with pictures (control 1) or, Text-only (control 2). This study will assess whether presenting lung screening information in a picture narrative format can improve lung cancer screening knowledge, eligibility self-assessment and attitudes. It will also assess whether perceptions of the information designs can explain any impact of the intervention on these outcomes and whether there are differences across socioeconomic groups.

Official Title
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The Impact of Picture Narrative Format on Knowledge and Acceptability for Lung Screening Print Decision Support Materials

Conditions
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Cancer Screening

Intervention / Treatment
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* Behavioral: Picture narrative information format
* Behavioral: Text with pictures information format
* Behavioral: Text-only information format


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Living in Glasgow Willing and able to respond unaided to invitation to participate in the trial and give informed consent. Aged between 49 and 75 years Exclusion Criteria:

Ages Eligible for Study
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Minimum Age: 49 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants are randomly assigned to one of three groups. They will receive the same lung screening information but the format of this information will be determined by which group they have been randomised to. All participants will complete a questionnaire immediately after viewing the lung screening information.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Picture narrative lung screening information<br>Participants in this arm receive information about lung screening purpose, eligibility, benefits and risks in a format which uses text in combination with sequences of pictures to communicate a coherent message. The designs follow conventions from comics/graphic narratives and key stakeholders were involved during the design process. | Behavioral: Picture narrative information format<br>* Lung screening information formatted as picture narratives<br>|
| Active Comparator: Text with pictures lung screening information<br>Participants in this arm receive information about lung screening purpose, eligibility, benefits and risks in a format that uses text with non-narrative pictures for decoration. The pictures have been extracted from the picture narratives being used Arm 1. | Behavioral: Text with pictures information format<br>* Lung screening information formatted as text and non-narrative pictures<br>|
| Active Comparator: Text-only lung screening information<br>Participants in this arm receive information about lung screening purpose, eligibility, benefits and risks in a format that uses text and no pictures. | Behavioral: Text-only information format<br>* Lung screening information formatted as text with no pictures<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Participant Lung Cancer Screening Knowledge scores | Participants will be asked 6 multiple choice questions related to the lung screening information presented to the participants during the intervention, covering; Procedure, Eligibility - who, Eligibility - why, Benefits, Adverse effects, Potential results. | Immediately post-intervention | 
| Lung Cancer Screening Eligibility self-assessment | Concordance between self-reported personal eligibility for lung cancer screening and actual eligibility based on self-reported age and smoking behaviour. | Immediately post-intervention | 
| Participant Lung Cancer Screening Attitudes | Self-administered four-item lung cancer screening attitudes measure covering cancer fear, fatalism, benefits, and worry, previously used by Smits et al 2018. | Immediately post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Participant Design appraisal ratings | Self-administered nine-item measure rating perceptions of appeal, enjoyment, interest, ease of use, trustworthiness, appropriateness, helpfulness, informativity. Alongside a single item asking participants whether enough information was provided. | Immediately post-intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Health Communication, Lung cancer screening, Messages, Comprehension, Visual, Narrative, Comics