Abstract
Printed materials are widely used in cancer education. There are a considerable number of guidelines in the literature on the content and design characteristics of print materials. However, there is little outcome-based evidence about whether materials containing these characteristics are more effective under real-world conditions. Six pamphlets were designed such that two had most of these characteristics, one had content characteristics only, one had design characteristics only and two had few of the characteristics. The pamphlets encouraged women aged 50–69 years to join a Pap Test Reminder Service (PTRS). The pamphlets were mailed to a randomly selected sample of 7668 women. Registrations with the PTRS were monitored. Receipt, readership, acceptability, knowledge and attitudes were assessed by telephone interview. There were no significant differences between the pamphlet groups in registrations with the PTRS, receipt, readership, acceptability, knowledge or attitudes. It was concluded that the inclusion of content and design characteristics does not result in more effective print materials.
Introduction
Printed materials such as pamphlets are widely used as an educational tool in the area of cancer prevention and control. The provision of educational information (most often in print form) is considered to be a fundamental prerequisite of consumer participation in health care (Currie et al., 2001). While there are limitations on the degree to which print material alone can be expected to impact on health outcomes (Paul and Redman, 1997a), it is nonetheless apparent that they have been integral to public and patient education for some time. For example, one US study found the American Cancer Society held 51 current publications on cancer in English alone (Meade et al., 1992). An Australian study surveyed 21 health-related agencies, and found that taken as a group they had produced over 180 different current pamphlets and had distributed almost 5 million items in the previous 12 months (Paul and Redman, 1994).
A number of studies have explored the effectiveness of print materials such as pamphlets, booklets and leaflets as tools for public or patient education [e.g. (Janz et al., 1987; Turnbull and Irwig, 1992; Little et al., 2001)]. A review of the effectiveness of print materials found that pamphlets could be effective in changing knowledge, attitudes and behavior in relation to a wide range of health-related issues (Paul and Redman, 1997a). However, the consistency of the effect was found to be in part dependent on aspects of their implementation, such as whether they were used with patient samples or general public samples and whether they were used alone or in conjunction with other methods of intervention (Paul and Redman, 1997a).
As print materials are fundamental to many education programs (Hickner et al., 1990; Borland et al., 1991; MacKie et al., 1992), there has been considerable interest in defining and evaluating the characteristics which will maximize their impact [e.g. (Godolphin et al., 2001)]. A large number of studies have been undertaken to explore the content and design characteristics associated with print material effectiveness (Saroyen and Geis, 1988). Such studies vary from laboratory-based studies exploring the perception of characters of varying sizes under varying conditions [e.g. (Tinker, 1966)] to classroom-based studies of the comprehension of texts with varying syntactical structures (Duffy and Kabance, 1982) or presentation techniques (Stark, 1988). A review of the literature identified 62 characteristics that have been linked to the effectiveness of print materials in terms of outcomes such as legibility and comprehensibility (Paul and Redman, 1994). These characteristics include ‘content characteristics’, such as the use of short words, short sentences and the appropriate use of fear messages to motivate audiences, and ‘design characteristics’, such as the use of headings, organizing material into paragraphs, using a sufficiently large font and the use of color (Paul and Redman, 1994; Wright, 1997).
However, there are a number of shortcomings in the research linking inclusion of these characteristics to pamphlet effectiveness which limit the applicability of the existing research to pamphlet development in the real world. A review found that the overwhelming majority of research studies in the area had a sample size of less than 20 subjects per cell, did not test the print material in a natural reading environment and did not include a behavioral outcome as a measure of pamphlet effectiveness (Paul and Redman, 1994). Further, there appear to be no studies which examine application of all the characteristics in an integrated form as would be the case in practice.
The primary aim of the present study was to explore in a ‘real-world’ context whether pamphlets which exhibited the content and design characteristics identified in the literature were more effective in changing knowledge, attitudes and behavior than pamphlets which did not exhibit these characteristics. More specifically, the study aimed firstly to develop a series of pamphlets, some of which exhibited many of the content and design characteristics and some of which exhibited few of these characteristics. Second, the study aimed to explore whether pamphlets containing many of the content and design characteristics were more likely to be effective in achieving an objective behavioral outcome than were pamphlets with fewer of the characteristics. Third, the study aimed to explore whether pamphlets containing many of the content and design characteristics were more likely to be received, read, accepted, change knowledge and change attitudes than pamphlets with fewer of the characteristics. Finally, the study aimed to explore whether there were any changes in knowledge, attitudes and behavior among women who received one of the pamphlets compared with a control group who did not receive a pamphlet.
Method
A two-stage process was used. In Stage I, six pamphlets were developed in order to exhibit varying degrees of adherence to the literature on content and design. In Stage II, the impact of the pamphlets was tested via mailout to representative samples of people and measurement of changes in knowledge, attitudes and behavior.
Stage I: Development of the pamphlets
A checklist of the key characteristics of content and design identified in the literature as important for the effectiveness of print materials was developed as described in Paul and Redman (Paul and Redman, 1997b).
As the study aimed to evaluate the relative effectiveness of the pamphlets in achieving an objectively measurable behavioral outcome, it was decided the pamphlets would encourage women aged 50–69 to join the NSW Cancer Council’s Pap Test Reminder Service (PTRS). Women who enrolled with the PTRS (a service which has now been superseded) were sent mailed reminders when their Pap test was due. Approximately 2% of women in NSW, Australia were enrolled with the service prior to the study.
Six pamphlets were designed with the aid of the checklist. All six pamphlets contained the same essential items of information. These items were: why Pap tests are needed, a description of the Pap test, a description of the PTRS, the benefits of joining the PTRS, an explanation of how to join the PTRS, and a tear-off form to complete and mail back to the PTRS in order to join. The content and design characteristics of the six pamphlets were as follows.
‘High score’ pamphlets
Two pamphlets were designed to contain as many of the content and design characteristics as possible. For example, these pamphlets were presented on high quality paper in two colors with large clear font, contained short words and short sentences, used simple sentence constructions, included structured paragraphs with bolded topic headings, repeated important points, had an informative title (‘The Pap Test: Free Reminder Service’), included photographs of women in the appropriate age group, and highlighted the tear-off section women could use to join the PTRS.
‘Content only’ pamphlet
One pamphlet was designed to have the characteristics relating to content only and not to have the characteristics relating to design. For example, the text or content of this pamphlet was identical to one of the high score pamphlets, but was presented on red photocopy paper, in a small italic font with a poorly designed diagram of the reproductive system.
‘Design only’ pamphlet
One pamphlet was designed to have the characteristics relating to design only and not to have the characteristics relating to content. That is, the pamphlet included paragraphing, had bolded headings, an informative title and highlighted the tear-off section, but contained long words, technical jargon and long complex sentence constructions.
‘Low score’ pamphlets
Two pamphlets were designed to have as few as possible of the characteristics proposed in the literature. For example, one of the low score pamphlets was printed in very small black italic-style font on red paper, made no use of organizing devices such as paragraphs or headings and did not have a logical flow. The text contained technical jargon and long, complex sentences. The cover title was uninformative (‘Do it now’) was printed vertically rather than horizontally and no illustrations were used on the cover.
Two pamphlets were developed at each of the three ‘levels’ as some characteristics (e.g. the inclusion of visual images or photographs) may be approached in various ways. Each pamphlet was rated against the checklist by two independent coders, with a high level of agreement. A group of experts (n = 48) and lay people (n = 36) also rated the pamphlets (Paul and Redman, 1997b). Both experts and lay people rated the pamphlets containing a greater number of the content and design characteristics as being significantly more likely to be noticed, read, understood and change people’s behavior than the pamphlets containing fewer of these characteristics (Paul and Redman, 1997b).
Stage II: Testing pamphlet impact
Sample and procedure
Enrolment with the PTRS. The names and addresses of 7700 women aged from 50 to 69 years were randomly selected from the NSW electoral register. Selected women were randomly allocated into one of seven groups, with six groups receiving a pamphlet and the seventh group acting as a control. The sample size per group was calculated as being sufficient to detect 2% differences between groups in the number of women registering with the PTRS (with α = 0.05 and β = 0.8). Women who were currently registered with the PTRS (1.7% of the sample) were excluded from the study. Groups 1–6 were mailed a pamphlet in a personally addressed envelope. The pamphlet was not accompanied by a letter or any other introductory material in order that any effects found be due to the pamphlet alone. During the 4 weeks following the mailing of the pamphlets, registrations with the PTRS were monitored.
Receipt, readership, acceptability, knowledge and attitudes. At 4–6 weeks after the pamphlets had been mailed, a randomly selected subsample of women was contacted by telephone and asked to complete a telephone interview about the pamphlet. Nine hundred women were randomly selected from Groups 1–6 with equal representation from each of the six groups. In order to obtain adequate power to detect differences between the three ‘levels’ of adherence to content and design characteristics (within the study budget), Group 1 was combined with Group 2, Group 3 with Group 4 and Group 5 with Group 6. While the pamphlets mailed to Groups 3 and 4 were not as similar to each other as was the case with the other combined groups, both pamphlets had similar checklist scores, and so both represent a moderate inclusion of the content and design characteristics. Table I shows the number of women in each group who were mailed a pamphlet and the number of women in each group who were interviewed. The Results section describes eligibility and consent rate data for the interview sample.
Measures
Enrolment with the PTRS. During the 4 weeks following the mailing of the pamphlets, registrations with the PTRS using any of the six distinctive mail-back slips were monitored by the coordinator of the PTRS. The number of registrations in each group was recorded. The PTRS released only grouped data indicating the number of women in each group who joined the PTRS.
Receipt, readership, acceptability, knowledge, attitudes and demographic characteristics. The telephone interview contained 48 questions including: whether the pamphlet had been received (yes/no), read (yes/no; less than half/about half/most/all) and found to be acceptable; knowledge of Pap tests; knowledge of the PTRS; attitudes towards Pap tests; attitudes toward the PTRS; and demographic characteristics. The 15 acceptability items included items such as how easy the pamphlet was to read (very/moderately easy/moderately hard/very hard), whether it was interesting (very/moderately/not very/not at all) and ‘meant for me’ (definitely/probably/probably not/definitely not), whether it contained anything offensive (yes/no) or embarrassing (yes/no), ratings of the content and appearance of the pamphlet (very good/good/OK/poor/very poor), and whether it could be improved (yes/no; if yes how). Each of these items were based on existing items used in pre-testing by state cancer councils.
The 18 knowledge items (nine on Pap tests and nine on the PTRS) were constructed by isolating each common ‘item of information’ in the pamphlets and formulating a question for each item. Each knowledge item required the respondent to nominate information with no response prompts given. Of the 18 knowledge items, eight were closed questions and the remainder were open questions. A panel of six behavioral scientists reviewed the measure and agreed that all key items of information were adequately assessed by the interview. Attitudes toward Pap tests and the PTRS were gauged by asking respondents how preventable cervical cancer is, how important it is to have a regular Pap test and how important joining the PTRS is. The demographic characteristics included were: age, marital status, education, employment, whether the women had a hysterectomy and the number of years since the woman’s last Pap test. The interview was pilot-tested with a sample of women in the target age group.
Results
Were pamphlets containing many of the content and design characteristics more effective in causing women to enroll with the PTRS?
Figure 1 shows the proportion of each of the six groups who enrolled with the PTRS in the 4-week monitoring period. A 2×6 χ2 was calculated to test whether there were significant differences between the pamphlet groups in the proportion enrolling with the PTRS. The χ2 indicated there were no statistically significant differences between the groups (χ2 = 10.223, d.f. = 5, P > 0.05).
Were pamphlets containing many of the content and design characteristics more likely to be received, read, accepted, change knowledge and change attitudes?
Sample
Of the 1200 women selected for the 4-week telephone interview, 365 were not eligible as: a telephone number could not be found (286 women), the woman was no longer at that address (60 women), was deceased (seven women) or did not speak English (12 women). Of the 835 eligible women, 777 were contacted and 509 completed the interview (65.5% consent rate). Table I shows the number of women in each group who completed the interview.
The χ2 tests were used to assess the comparability of the groups on age group, marital status, education, employment, language spoken at home, having had a hysterectomy, ever having a Pap test and time since last Pap test. Where significant differences were found between groups according to the χ2, 95% confidence intervals (CIs) were compared to establish which groups were different from each other.
Only two significant differences between groups were found. The groups receiving the ‘low score’ pamphlets were more likely to be never married (16.3%, 95% CI = 9.74–22.3) than the groups receiving the ‘high score’ pamphlets (5.2%, 95% CI = 1.45–8.99), and the groups receiving the ‘content only’ and the ‘design only’ pamphlets (1.6%, 95% CI = 0–3.68), (χ2 = 31.01, d.f. = 12, P < 0.01). The groups receiving the ‘content only’ and ‘design only’ pamphlets were more likely to have a technical qualification (28%, 95% CI = 20.13–35.87) than the groups receiving the ‘low score’ pamphlets (11.7%, 95% CI = 5.93–17.41), (χ2 = 10.950, d.f. = 3, P < 0.05). The only difference between groups that could bias the results in favor of the pamphlets containing many of the content and design characteristics was the difference in marital status. Logistic regression analyses indicated that marital status was not a significant predictor on any of the outcome variables.
Outcomes
A 2×3 χ2 was calculated for each outcome to assess whether there was a difference among the three groups. Where a significant difference occurred, 95% CIs were used to establish which groups differed from each another. As multiple χ2 were being performed, the Bonferroni formula [P = 1 − (1 − a)1/n] was used to adjust the probability value indicating a significant result from P < 0.05 to P ⩽ 0.001.
Receipt and readership. There were no significant differences among the three pamphlet groups in the number of women who reported receiving the pamphlet or reading any part of the pamphlet at the 4-week follow-up. There was a significant difference among the groups in the number who reported reading more than half of the pamphlet (χ2 = 14.362, d.f. = 2, P = 0.001). The groups receiving the ‘low score’ pamphlets were more likely to report reading more than half of the pamphlet (95% CI = 61.60–84.40) than the group receiving the ‘high score’ pamphlets (95% CI = 44.14–60.86).
Acceptability. There were no differences among the groups on any of the acceptability items in the 4-week sample. More than 85% of each group rated the pamphlet they received as being attention getting, reliable, able to be believed, interesting and easy to read.
Knowledge. There were no significant differences among the groups on total number of messages remembered or any of the knowledge items. Responses on the nine items assessing knowledge of Pap tests were added to produce a total score out of nine then divided into ‘high’ and ‘low’ groups with a ‘high’ score being five or more correct answers (i.e. more than half of the items correct). There were no differences among the three pamphlet groups on the proportion of respondents having a high score on knowledge about Pap tests.
The nine items assessing knowledge of the PTRS were similarly added to produce ‘high’ and ‘low’ PTRS score, with a ‘high’ score being five or more correct answers. There were no differences among the three groups on the proportion of respondents having a high PTRS score. Those who reported not reading any of the pamphlets were excluded from the sample, and analyses conducted on knowledge of Pap test score and PTRS score. No significant differences among the groups were found.
Attitudes. As shown in Table II the only significant difference found among the groups was the proportion reporting that it was moderately or very important for them to have a Pap test (χ2 = 16.290, d.f. = 2, P < 0.001). The groups receiving the ‘content only’ and ‘design only’ pamphlets (95% CI = 83.49–94.50) were significantly more likely than those receiving the ‘high score’ pamphlets (95% CI = 59.98–76.02) and those receiving the ‘low score’ pamphlets (95% CI = 67.19–82.81) to report that it was very or moderately important for them to have a Pap test.
Were there any differences in behavior, knowledge and attitudes between the groups receiving pamphlets and the control group?
Behavior: enrollment with the PTRS
The groups receiving pamphlets were collapsed into one group, and their enrolment data compared to that of the control group. No women in the control group enrolled with the PTRS during the monitoring period. Groups receiving a pamphlet were significantly more likely than the control group to join the PTRS during the 4-week monitoring period (χ2 = 30.931, d.f. = 1, P < 0.001).
Knowledge and attitudes
The groups receiving a pamphlet were collapsed into one group, and their knowledge and attitude results compared to those of the control group which received no pamphlet.
Outcomes
The χ2 test was used to test for differences among the groups on each of the outcome measures. As multiple χ2 were being performed, the Bonferroni formula [P = 1 − (1 − a)1/n] was used to adjust the probability value indicating a significant result from P < 0.05 to P ⩽ 0.001. Only significant χ2 are reported below. Table III presents the outcomes for which there were significant differences between the pamphlet groups and the control group.
As shown in Table III, the groups receiving a pamphlet were significantly more likely than the group not receiving a pamphlet to have heard of the PTRS (χ2 = 33.999, d.f. = 1, P < 0.001), to know how to join the PTRS (χ2 = 38.920, d.f. = 1, P < 0.001) and to have a high PTRS knowledge score (χ2 = 19.900, d.f. = 1, P < 0.001). There were no significant differences on any of the items relating to knowledge of Pap tests or total knowledge of Pap tests score. There were no significant differences in attitudes between the groups receiving a pamphlet and the control group at the 4-week follow-up.
Discussion
The content and design characteristics identified in the literature about written health education materials were not found to play a significant role in the effectiveness of pamphlets in recruiting women to the PTRS. Pamphlets which were judged using the checklist to have many of the characteristics identified in the literature were no more effective in causing women to enroll with the PTRS than the pamphlets which had few of these characteristics.
The results of the 4-week interviews do not suggest that the pamphlets with high checklist scores were any more effective in causing women to recall receiving the pamphlet or to read the pamphlet than were the pamphlets with lower checklist scores. Similarly, there were no significant differences in the respondents’ ratings of the acceptability of the ‘high score’ pamphlets as compared to the ‘design only’, ‘content only’ or ‘low score’ pamphlets. Four weeks after receiving the pamphlet, knowledge of Pap tests and knowledge of the PTRS were no higher among women receiving a pamphlet containing many of the content and design characteristics than among women receiving a pamphlet containing few of the characteristics. Further, the group receiving the ‘high score’ pamphlets was no more likely than those receiving the pamphlets with lower checklist scores to have positive attitudes toward Pap tests and the PTRS. The few differences that were found between the groups were for a higher proportion of the groups receiving the ‘content only’ and ‘design only’ pamphlets to read more of the pamphlet, and report that it was important to have a Pap test as compared to the other pamphlet groups.
The final aim of the study was to explore whether there were any changes in knowledge, attitudes and behavior among women who received a pamphlet compared with a control group who did not receive a pamphlet. The control group was significantly less likely to enroll with the PTRS than the groups receiving pamphlets. None of the control group enrolled with the PTRS, while 2–5% of those receiving pamphlets enrolled with the PTRS during the monitoring period. The women not receiving a pamphlet were found to have significantly poorer knowledge about a number of aspects of the PTRS than did many of the women who received one of the pamphlets. There were no consistent differences between women who received a pamphlet and those who did not, on attitudes or knowledge of Pap tests, presumably due to existing high levels of knowledge on the topic. Thus, the mailing of a pamphlet (regardless of its content and design characteristics) was effective in improving knowledge of the PTRS and encouraging women to enroll with the PTRS.
The finding that the content and design of the pamphlets had little impact on their effectiveness is a surprising finding. The finding runs contrary to what might be expected by authors in the field of health education, who often recommend content and design characteristics should be used to ensure health education materials are effective (Allensworth and Luther, 1986; Kitching, 1990; Baker, 1991; Estey, 1991; Walsh, 1991). The finding would also be surprising for the experts and lay women who rated the pamphlets with many of the content and design characteristics as likely to be more effective than the pamphlets containing few of the content and design characteristics (Paul and Redman, 1997b).
Several potential explanations for the findings should be considered. First, there is a possibility of a ‘ceiling effect’, where the maximum potential effect of a pamphlet on behavior may have been too small to permit the detection of differences among the pamphlets in effectiveness. However, if this was the case, it would indicate that attempts to refine pamphlets by including all the content and design characteristics in the checklist may not be cost-effective. If the maximum possible effect a pamphlet can have is very small, time spent ‘improving’ a pamphlet will provide very little return. Further, a review of the effectiveness of print materials suggested that pamphlets tended to be more effective when used with patient populations rather than with the general population and were more consistently effective in conjunction with other methods of intervention (Paul and Redman, 1997a) or as part of an integrated campaign [e.g. (Jason et al., 1991; Pelletier et al., 1998)]. Therefore, the broader context in which a pamphlet is delivered may be of greater importance than the characteristics of the pamphlet itself. Of course the converse is possible—that in the context of a highly effective intervention, content and design characteristics may have more scope to be effective.
Second, it is possible the pamphlets were not sufficiently different from one another to be differentially effective, due to inadequacies in the checklist or the pamphlet development process. As described elsewhere (Paul and Redman, 1997b), experts rated 97% of the checklist items used to develop the pamphlets as important to pamphlet effectiveness. The experts gave the study pamphlets widely differing checklist scores, and the experts and lay women expected that there would be differences between the pamphlets on effectiveness (Paul and Redman, 1997b). Subjective responses also suggested a difference between the pamphlets, as the Cancer Council NSW was initially unwilling to be associated with the ‘low score’ pamphlets. Therefore, it is likely that the pamphlets were different from one another along the dimensions defined in the literature and by experts as important.
Third, it is possible that the sample size in the 4-week interview may have reduced the ability of the study to find a significant difference between groups on knowledge and attitudes. A larger sample size would have increased the power of the study; this may have been important because of the high hysterectomy rate and moderate consent rate in the sample. However, the sample size was sufficient to detect differences of between 15 and 20% on most of the self-report outcomes. In practice, it is unlikely to be worthwhile expending time or resources in order to achieve very small changes in knowledge and attitudes. Also, there was no effect found for behavior, despite the sample size for that outcome being sufficient to detect 2% differences between groups.
Fourth, the finding may be unique to the target group or type of behavior studied. It is possible that this particular target group (women aged 50–69 years) may be different to other target groups in the degree to which the content and design characteristics of a pamphlet affect their response to the pamphlet. It is also possible, in the case of a behavior such as joining the PTRS, that the pamphlet may have acted simply as a prompt for women who were already open to this behavior, with content and design characteristics having little role to play in changing knowledge and behavior. It is possible that the findings of the present study may not generalize to other health issues or types of behavior. There is a need for further research to explore this question. Studies duplicating the methodology with other target groups and other behaviors would provide valuable evidence about the generalizability of the findings. This would provide health professionals with an understanding of whether there is a need to include content and design characteristics under particular conditions, or whether the practice of including content and design characteristics can be abandoned.
Regardless of these potential reasons for the study findings, the findings have some important implications for those involved in the development of pamphlets. Although experts, lay people and the health education literature support the importance of content and design characteristics, content and design characteristics were found to have little impact on the effectiveness of the pamphlets trialed here. It would appear that those in the field of pamphlet production are acting on the basis of information that is not accurate under all conditions. While the generalizability of the study findings are yet to be explored, this research suggests that there is a need for pamphlet producers to question whether incorporating the content and design characteristics recommended in the literature will increase the effectiveness of their printed materials. The inclusion of content and design characteristics should not be relied upon as the major strategy for producing effective pamphlets. Further, given the evidence that pamphlets in themselves can affect knowledge, attitudes and behavior, pamphlet producers should direct their attention towards identifying other avenues for increasing the effectiveness of pamphlets, such as the promotion of implementation intentions (Sheeran et al., 2000) or the inclusion of behavioral strategies.
Note
This paper was prepared by the Cancer Council NSW Cancer Education Research Program team, directed by Associate Professor A. Girgis. The views expressed are not necessarily those of The Cancer Council NSW.
Numbers of women in each experimental group who were mailed a pamphlet and who were interviewed by telephone
| Experimental group | Pamphlet allocated | Mailed a pamphlet (n) | Interviewed | |
|---|---|---|---|---|
| Randomly selected for interview (n) | Completed interview (n) | |||
| 1 | high score 1 | 1079 | 150 | 135 |
| 2 | high score 2 | 1079 | 150 | |
| 3 | content only | 1087 | 150 | 130 |
| 4 | design only | 1077 | 150 | |
| 5 | low score 1 | 1082 | 150 | 123 |
| 6 | low score 2 | 1077 | 150 | |
| 7 | no pamphlet (control) | 1087 | 300 | 121 |
| Experimental group | Pamphlet allocated | Mailed a pamphlet (n) | Interviewed | |
|---|---|---|---|---|
| Randomly selected for interview (n) | Completed interview (n) | |||
| 1 | high score 1 | 1079 | 150 | 135 |
| 2 | high score 2 | 1079 | 150 | |
| 3 | content only | 1087 | 150 | 130 |
| 4 | design only | 1077 | 150 | |
| 5 | low score 1 | 1082 | 150 | 123 |
| 6 | low score 2 | 1077 | 150 | |
| 7 | no pamphlet (control) | 1087 | 300 | 121 |
Attitudinal outcomes for the pamphlet groups
| Item | Pamphlet group (%) | χ2 | d.f. | P | ||
|---|---|---|---|---|---|---|
| ‘High score’(n = 135) | ‘Content and design’ (n = 130) | ‘Low score’(n = 123) | ||||
| Cervical cancer completely or moderately preventable | 91.2 | 93.8 | 97.2 | 3.441 | 2 | >0.05 |
| Very or moderately important to have regular Pap test | 67.7 | 88.7 | 74.6 | 16.290 | 2 | <0.001 |
| Very or moderately important to join PTRS | 42.1 | 61.5 | 47.5 | 9.890 | 2 | >0.005 |
| Likely or very likely to join PTRS | 22.4 | 28.2 | 27.8 | 1.315 | 2 | >0.05 |
| Item | Pamphlet group (%) | χ2 | d.f. | P | ||
|---|---|---|---|---|---|---|
| ‘High score’(n = 135) | ‘Content and design’ (n = 130) | ‘Low score’(n = 123) | ||||
| Cervical cancer completely or moderately preventable | 91.2 | 93.8 | 97.2 | 3.441 | 2 | >0.05 |
| Very or moderately important to have regular Pap test | 67.7 | 88.7 | 74.6 | 16.290 | 2 | <0.001 |
| Very or moderately important to join PTRS | 42.1 | 61.5 | 47.5 | 9.890 | 2 | >0.005 |
| Likely or very likely to join PTRS | 22.4 | 28.2 | 27.8 | 1.315 | 2 | >0.05 |
Knowledge for pamphlet versus the no-pamphlet groups
| Knowledge item | Group (%) | χ2a | d.f. | P | |
|---|---|---|---|---|---|
| Pamphlet (n = 388) | No pamphlet (n = 121) | ||||
| aYates’ continuity adjusted χ2 used for all 2×2 χ2. | |||||
| Heard of PTRS | 47.1 | 17.4 | 33.999 | 1 | <0.001 |
| Know how to join PTRS | 30.9 | 2.5 | 38.290 | 1 | <0.001 |
| Total PTRS score >5/9 | 47.4 | 24.0 | 19.900 | 1 | <0.001 |
| Knowledge item | Group (%) | χ2a | d.f. | P | |
|---|---|---|---|---|---|
| Pamphlet (n = 388) | No pamphlet (n = 121) | ||||
| aYates’ continuity adjusted χ2 used for all 2×2 χ2. | |||||
| Heard of PTRS | 47.1 | 17.4 | 33.999 | 1 | <0.001 |
| Know how to join PTRS | 30.9 | 2.5 | 38.290 | 1 | <0.001 |
| Total PTRS score >5/9 | 47.4 | 24.0 | 19.900 | 1 | <0.001 |
The number of women in each group who registered with the PTRS in the 4-week monitoring period.
The number of women in each group who registered with the PTRS in the 4-week monitoring period.
References
Author notes
The Cancer Council NSW Cancer Education Research Program (CERP), Wallsend, NSW 2287, 1National Breast Cancer Centre. Kings Cross, NSW 1340 and 2Faculty of Health, University of Newcastle, Callaghan, NSW 2308, Australia. E-mail: Chris.Paul@newcastle.edu.au
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