Open Access Research article

Development of a comprehensive list of criteria for evaluating consumer education materials on colorectal cancer screening

Maren Dreier1*, Birgit Borutta1, Gabriele Seidel1, Inga Kreusel1, Jürgen Töppich2, Eva M Bitzer3, Marie-Luise Dierks1 and Ulla Walter1

Author Affiliations

1 Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany

2 Department 2, Federal Centre for Health Education (BZgA), Cologne, Germany

3 Department of Public Health and Health Education, University of Education, Freiburg, Germany

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BMC Public Health 2013, 13:843  doi:10.1186/1471-2458-13-843

Published: 13 September 2013



Appropriate patient information materials may support the consumer’s decision to attend or not to attend colorectal cancer (CRC) screening tests (fecal occult blood test and screening colonoscopy). The aim of this study was to develop a list of criteria to assess whether written health information materials on CRC screening provide balanced, unbiased, quantified, understandable, and evidence-based health information (EBHI) about CRC and CRC screening.


The list of criteria was developed based on recommendations and assessment tools for health information in the following steps: (1) Systematic literature search in 13 electronic databases (search period: 2000–2010) and completed by an Internet search (2) Extraction of identified criteria (3) Grouping of criteria into categories and domains (4) Compilation of a manual of adequate answers derived from systematic reviews and S3 guidelines (5) Review by external experts (6) Modification (7) Final discussion with external experts.


Thirty-one publications on health information tools and recommendations were identified. The final list of criteria includes a total of 230 single criteria in three generic domains (formal issues, presentation and understandability, and neutrality and balance) and one CRC-specific domain. A multi-dimensional rating approach was used whenever appropriate (e.g., rating for the presence, correctness, presentation and level of evidence of information). Free text input was allowed to ensure the transparency of assessment. The answer manual proved to be essential to the rating process. Quantitative analyses can be made depending on the level and dimensions of criteria.


This comprehensive list of criteria clearly has a wider range of evaluation than previous assessment tools. It is not intended as a final quality assessment tool, but as a first step toward thorough evaluation of specific information materials for their adherence to EBHI requirements. This criteria list may also be used to revise leaflets and to develop evidence-based health information on CRC screening. After adjustment for different procedure-specific criteria, the list of criteria can also be applied to other cancer screening procedures.

Screening; Early diagnosis; Colorectal cancer; Bowel cancer; Informed decision-making; Informed choice; Evidence-based health information; Evidence-based patient information; Risk communication; Decision aids