Original title: Optimizing invitation letters for national cancer screening programs: Qualitative usability testing
Zeena Harakeh, Jessica Nieweg, Renske van Asten, Joris van Leenders +2 · September 2026
Fewer people in the Netherlands are joining the three national screening programs that check for breast, cervical, and colorectal cancer. This drop is especially high among underserved groups. To fix this, researchers worked to improve the official invitation letters sent to citizens. They wanted to make the letters easier to understand so people could make informed choices. The researchers created two new letter designs based on past advice and tested them directly with everyday adults. In these tests, people read the drafts out loud and shared their thoughts. Readers found the revised letters clearer, shorter, and better organized than the original versions. They liked having key facts in bold and clear contact details to make the letters easier to follow. However, added icons did not help understanding and felt unnecessary. Participants also asked for a more personal tone and more details on screening benefits.
Imagine a store redesigns its shopping list to help you find items faster. The store tests the new list with shoppers, and one thing becomes clear: highlighting the aisle numbers in bold helps people find things, but adding little pictures of the items just confuses them. In this paper, the researchers did the same with cancer screening invitation letters: they tested revised versions with the people who receive them, and found that bold key facts and clear contact details helped, while icons did not.
Cancer screening saves lives, but only if people actually get the invitation and understand it. In the Netherlands, participation is dropping, especially among groups with less education, lower income, or a migration background. Testing revised letters with those readers showed simple changes—bold key facts, clear contact info, no icons—make the letters clearer and more usable.
The abstract doesn't say whether the revised letters actually increase screening participation—it reports only that participants found them clearer and more accessible. The sample was 27 Dutch adults, so findings may not generalize broadly, and the analysis is qualitative rather than measuring outcomes.
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Optimizing invitation letters for national cancer screening programs: Qualitative usability testing — Zeena Harakeh, Jessica Nieweg, Renske van Asten et al. — PEC innovation — doi:10.1016/j.pecinn.2026.100502
Abstract licence: CC BY
Explanation generated by Synthesis from the abstract — it is not the original paper.