Entertainment education for prostate cancer screening: A randomized trial among primary care patients with low health literacy

Objective: To evaluate an entertainment-based patient decision aid for prostate cancer screening among patients with low or high health literacy. Methods: Male primary care patients from two clinical sites, one characterized as serving patients with low health literacy (n = 149) and the second as serving patients with high health literacy (n = 301), were randomized to receive an entertainment-based decision aid for prostate cancer screening or an audiobooklet-control aid with the same learner content but without the entertainment features. Postintervention and 2-week follow-up assessments were conducted. Results: Patients at the low-literacy site were more engaged with the entertainment-based aid than patients at the high-literacy site. Overall, knowledge improved for all patients. Among patients at the low-literacy site, the entertainment-based aid was associated with lower decisional conflict and greater self-advocacy (i.e., mastering and obtaining information about screening) when compared to patients given the audiobooklet. No differences between the aids were observed for patients at the high-literacy site. Conclusion: Entertainment education may be an effective strategy for promoting informed decision making about prostate cancer screening among patients with lower health literacy. Practice implications: As barriers to implementing computer-based patient decision support programs decrease, alternative models for delivering these programs should be explored.