They read through the gist-based leaflet GSK2118436 for as long as they wanted, and completed a researcher-led comprehension test. The participant had access to the gist-based leaflet at all times. This was followed

by a brief (5–10 min) semi-structured interview (see Fig. 2 for an overview of the topic guide). The following characteristics were recorded: age, gender, marital status (married/living with partner, single/divorced/separated, widowed), English as first language (yes/no), employment (currently employed, unemployed/disabled or too ill to work, retired), education level (basic high school qualifications or less [i.e. no formal qualifications, GCSEs or basic work qualifications], advanced high school qualifications or equivalent [i.e. A-levels or advanced work qualifications], university educated), health literacy (adequate, marginal/inadequate), Quizartinib price experience with written documents (all the time, some of the time, hardly ever), previous cancer diagnosis (yes/no) and knowing someone else that has been diagnosed with cancer

(yes/no). Health literacy was assessed using the UK version of the Test of Functional Health Literacy in Adults (UK-TOFHLA) [48] which has numeracy and literacy sections. The numeracy section involves tasks relating to date and time calculation, computation of medication dosage, and patient navigation. This section takes approximately 10 min to complete. The literacy section is based on the ‘cloze’ procedure. Three passages of text (instructions on how to prepare for an X-ray, eligibility for NHS prescriptions and a consent form for surgery) of increasing difficulty are given to the participant and every fifth word is missing. Where Autophagy activator a word is missing a blank line is drawn and 4 possible words that could be used are provided. This section takes approximately 12 min to complete. A score of 100 is calculated, with each section having a maximum score of 50. Scores are converted into three groups: inadequate (0–59), marginal (60–74), and adequate (75–100) health literacy [49]. The Flesch Kincaid formula [50] was used to calculate the reading

ease of the gist-based leaflet. Scores range from 0 to 100, with higher scores indicating greater reading ease. The readability scores for version 1, 2 and 3 were 82.1, 79.4 and 81, respectively. This corresponded to a US grade level of 4–5 (equivalent to age 9–10 years). All versions of the gist-based leaflet that were tested can be found in the supplementary online material. The primary outcome was the percentage of participants correctly responding to eight true (T) or false (F) statements about CRC and CRC screening. In line with European guidelines for medicinal package testing [51], each statement had to be answered correctly by at least 80% of participants for our leaflet to be deemed legible, clear, and easy to read.