Systematic review of Spanish language cancer educational materials: A first step in improving message reach and effectiveness

The U.S. Hispanic population experiences excessive cancer mortality, attributed in part to lower screening rates and higher incidence of late-state disease. Spanish-language health educational materials are an important resource for efforts to improve cancer screening behaviors among Hispanics. We evaluated the suitability of Spanish language cancer educational materials, an important first step in improving their cultural and linguistic appropriateness, reach, and effectiveness. Twenty-five published Spanish language cancer educational materials were identified and evaluated using the Suitability Assessment of Materials (SAM) instrument. To assess Spanish reading levels, we used the SOL equation and FRASE graph. The mean SAM score was 56% (range = 29-70), which is considered adequate. Only one material received 70%, a borderline superior score, and three were not suitable. Of the six SAM evaluation factors, most materials received a low graphics score (M = 41%, 0-75), followed by content (49%, 25-75), learning stimulation and motivation (55%, 0-100), cultural appropriateness (61%, 0-100), literacy demand (63%, 30-90), and layout and typography (64%, 17-100). The mean SOL readability score was 7.8 (range = 5.6-10.8) and the mean FRASE score fell between the beginning and intermediate categories. The findings indicated Spanish language cancer education materials lack cultural, linguistic, and educational appropriateness. Implications for public health practice include tailoring messages for specific audiences by incorporating culturally specific and appropriate images and graphics, focused information, and opportunities for reader interaction suitable for low-literacy audiences. The aim of such Spanish-language materials should be to positively impact cancer-screening behaviors among the target population.