Abstract
and difficult for most persons to understand, including individuals with low HL. In their qualitative study, Smith et al. also observed that not all low educated respondents carefully considered and integrated the information about the benefits and harms of CRC screening; the authors concluded that the content matter (i.e. expected individual benefits and harms of cancer screening participation) may be too complex and overwhelming for some of them and they were not able to engage with the material [29]. Individuals with a lower educational level and low numeracy skills seem particularly vulnerable to misinterpreting statistical inforfind this information mation including risks and, subsequently, meaningless [33]. Our respondents also seemed overwhelmed by the amount and content of information, and had not anticipated a deliberation of the pros and cons of cancer screening participation; this seems to be related to their lack of knowledge about CRC screening beforehand. the 4.1.2. Strengths and limitations for interest A strength of this study is that we combined text analyses with qualitative and quantitative data. A limitation of Study 1 is that the ELF provides an overall assessment of quality, but provides no clear cutoff criteria to evaluate specific quality. A limitation of Study 2 and 3 is that the recruitment of respondents for these studies may have resulted in selection bias. The health care panel consisted of respondents with an in health and care, perhaps specifically in CRC and/or CRC screening. It is likely that the self-selection of respondents the qualitative study also attracted individuals with an interest in screening. Moreover, individuals from a non-Dutch ethnic background were underrepresented in this study, since they were only included when able to adequately read and communicate in Dutch. Study 3 provided before and after data, resulting in differences in percentages of fill in the knowledge correct responses. Respondents were asked to fill items in the knowledge items again. Although this design is appropriate first to evaluate information material, its limitation is that the influenced knowledge measurement could have the second knowledge measurement. Moreover, we had 27% incomplete records on the second knowledge measurement. Some respondents (13%) dropped out before or during reading the information materials. Based on the results of the qualitative interviews, we believe that those respondents might have had difficulty reading the information materials or did not take time to read it because of the imply that the knowledge levels we found overestimate actual knowledge in the Dutch population with low HL. first, then read the information materials and, after that,