BackgroundAccess to information about prenatal screening is important particularly in light of new techniques such as non-invasive prenatal testing (NIPT). This study aimed to develop and examine the acceptability of a low literacy decision aid (DA) about Down syndrome screening among pregnant women with varying education levels and GPs.MethodsWe developed a DA booklet providing information about first-trimester combined testing, maternal serum screening, and NIPT. GPs and women participated in a telephone interview to examine the acceptability of the DA and measure screening knowledge before and after reading the DA. The knowledge measure was designed to assess whether women had understood the gist of the information presented in the decision aid. It comprised conceptual questions (e.g. screening tells you the chance of having a baby with Down syndrome) and numeric questions (e.g. the accuracy of different screening tests).ResultsTwenty-nine women and 18 GPs participated. Regardless of education level, most women found the booklet ‘very’ clearly presented (n = 22, 76%), and ‘very’ informative (n = 23, 80%). Overall, women’s conceptual and numeric knowledge improved after exposure to the DA, from 4% having adequate knowledge to 69%. Women’s knowledge of NIPT also improved after receiving the decision aid, irrespective of education. Most GPs found it ‘very’ clearly presented (n = 13, 72%), and that it would ‘very much’ facilitate decision-making (n = 16, 89%).ConclusionsThe DA was found to be acceptable to women as well as GPs. A comprehensive evaluation of the efficacy of the decision aid compared to standard information is an important next step. Strategies are needed on how to implement the tool in practice.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2135-0) contains supplementary material, which is available to authorized users.

Background: Low health literacy is associated with adverse health outcomes and raised healthcare costs. General practitioners (GPs) are the first point of access to health care services and play a key role in building patients' health literacy. This study aimed to explore: 1) GPs' understandings of health literacy, 2) the perceived challenges to addressing health literacy, and 3) the strategies used to support people with health literacy difficulties. Method: A qualitative study in South Western Sydney, New South Wales, Australia. Semistructured qualitative interviews were audio-recorded and transcribed verbatim. Interview data was analyzed using the Framework method, a matrix-based approach to thematic analysis. Results: Eighteen participants took part in the study. Four key themes were identified: 1) identifying patients with health literacy difficulties; 2) perceived consequences of low health literacy; 3) being sensitive to developing health literacy skills and; 4) strategies used to build health literacy. Intuitive skills were used to identify patient's health literacy skills through recurring encounters with patients over time. A range of communication techniques were used to build health literacy. The value of a long-term relationship with patients, and support from relatives, seem to be important in helping patients to build their health literacy skills. Conclusions: A number of barriers may hinder building patient health literacy in general practice. An increased focus on the significance of health literacy, educationally and clinically across the entire health system can be a solution to overcome these barriers.