Information should not be so oversimplified that it no longer allows informed decisions to be made [13] and [14], but presenting it in a format that is more closely aligned with preferred processing styles (i.e. gist) can reduce its cognitive burden [26], particularly for individuals with lower levels of literacy and numeracy [5] and [26]. This is because individuals with low

basic skills often have difficulty in separating the Dabrafenib supplier relevant gist from non-essential information [23]. It is therefore recommended that gist-based information is presented separately to more detailed (verbatim) information [27]. The provision of a supplementary gist leaflet is therefore justified. Processing numerical information related to CRC screening was identified as a particular problem in our previous study of people reading existing information booklet supplied to individuals in the English CRC screening programme [4]. To overcome these difficulties, we attempted to encourage gist-based processing by providing a verbal description of the number which provides an evaluative label (i.e. gist) of the number (e.g. ‘most people [98 out of 100]’). This approach has been used successfully in previous

research [28], [29] and [30], with evidence to suggest it increases deliberative processing of the numerical information [31]. In line with current evidence, natural frequencies with the same denominator were used to present key numerical information [32]. In keeping with PD0325901 the ‘less is more’ approach [22], we further encouraged gist-based processing by removing specific

concepts which were deemed ambiguous and non-essential in our previous study [4]. For example, when reading information about follow-up testing in the existing booklet, individuals responded with strong negative emotions which led aminophylline to disengagement with the information. Text on this concept was therefore included, but it was kept to a minimum. Additional literature was also consulted when identifying non-essential constructs. For example, the concept of preventing CRC was removed because of the unconvincing evidence that FOB-based screening reduces incidence of CRC [33]. We therefore focused on the primary mechanism by which FOB screening works; the early detection of colorectal adenomas. A further example of streamlining was the removal of academic references from within the text to accommodate the preferences of low literacy individuals [34]. The removal of non-essential concepts resulted in four pages of text being used for the gist leaflet, compared with 15 pages in ‘The Facts’ booklet. Guidelines on the layout of health information designed for low literacy groups suggest providing essential information at the beginning of the text [9], as this has been shown to improve comprehension and decision-making [23].