Predictors of Women's Awareness of the Benefits and Harms of Mammography Screening and Associations with Confusion, Ambivalence, and Information Seeking

Explaining Seeking, Scanning, and Avoidance of Information About the Mammography-Screening: Results of a Two-Wave Online Survey with a Stratified Sample of Women

Whether individuals engage with or avoid health information and which sources are used is crucial for informed decision-making about mammography. Therefore, we aim to develop a typology of mammography-related information behaviors and explore their determinants, which were derived from the Theory of Motivated Information Management (TMIM). Based on a two-wave online survey of a sample of German women aged 40 to 69 years (N = 1,138), a cluster analysis resulted in five person-centric types of information behavior that cover respondents' variety of engagement with mammography-related information: The seekers, the scanners, the avoiders, the involved, and the inactive. The types indicated that most individuals possess a high preference for one strategy of information behavior. Looking at the determinants of belonging to a particular type of information behavior, it becomes apparent that the factors of the TMIM have only limited explanatory power. The most relevant factors in distinguishing the types of information behaviors are benefit perceptions, worry, interest, avoidance efficacy, seeking, and avoidance-related outcome expectancies. Scanners and seekers had higher benefit perceptions. Seekers were further motivated by greater worries, while involved ones felt more interested and held stronger expectancies. Avoiders were more anxious and had a higher avoidance efficacy. The study suggests that inactive individuals and avoiders are highly prevalent and relevant target groups for health interventions that support informed decision-making. To facilitate informed decision-making, women should be encouraged to weigh benefits and harms of their options and to address negative emotions, such as anxiety, that may exist or arise during decision-making.

Effects of Exposure to Conflicting Health Information on Topic-Specific Information Sharing and Seeking Intentions

Despite considerable evidence that exposure to conflicting health information can have undesirable effects on outcomes including public understanding about and trust in health recommendations, comparatively little is known about whether such exposure influences intentions to engage in two communication behaviors central to public health promotion: information sharing and information seeking. The purpose of the current study is to test whether exposure to conflicting information influences intentions to share and seek information about six health topics. We analyzed data from two waves of a longitudinal survey experiment with a nationally representative sample of U.S. adults (N = 3,920). Participants were randomly assigned to either a conflict or no-conflict message condition, in which they read news stories and social media posts about three (of six) randomly selected health topics at Time 1 and the remaining three at Time 2. The dependent variables, which were measured at Time 2, asked participants whether they intended to share or seek information about the three topics they had just viewed. Linear mixed effects models showed that exposure to conflict reduced intentions to share and seek information, regardless of health topic. These findings suggest that exposure to conflicting health information discourages two important types of health information engagement, thus adding to the growing evidence base documenting the adverse consequences of conflicting information for public health.

Effects of exposure to media messages about limiting breast cancer screening: A qualitative experimental study

OBJECTIVE

Examine how women aged 35-50 respond to messages about limiting cancer screening.

METHODS

A national sample of women aged 35-50 (n = 983) were randomly assigned to read one of four media vignettes: three provided information about potential harms of mammograms using evidence, norms, or an anecdote strategy, and one provided no such information. Participants listed thoughts they had about the message, and after coding these themes, we tested for associations between the themes evoked, message exposure, and mammogram history.

RESULTS

Thematic categories included emotions (8 %); behavioral intentions (14 %); and cognitions, attitudes, and beliefs (67 %). Pro-screening attitudes, questioning, and cues to get screened were most prevalent. The anecdote message often elicited pro-screening attitudes, while the evidence message often elicited negative emotions and anger, as well as questioning or skeptical responses. Those with a history of mammograms expressed more pro-screening attitudes and disagreed with the message more often.

CONCLUSIONS

Media messaging about guideline-supported care, especially when it involves reducing a clinical service that is routine and valued by patients, may evoke counterarguing, skepticism, and other negative responses.

PRACTICE IMPLICATIONS

Clinicians should recognize the role of the media in potentially shaping women's attitudes, beliefs, and intentions when it comes to breast cancer screening.

Effects of Exposure to Conflicting Information About Mammography on Cancer Information Overload, Perceived Scientists' Credibility, and Perceived Journalists' Credibility

Conflicting recommendations about mammography screening have received ample media coverage, emphasizing scientists' debate over the value of breast cancer screening and differences in professional organizations' guidelines about the appropriate starting age and frequency of routine mammograms. Whereas past research suggests that exposure to such media coverage of conflicting recommendations can have undesirable consequences, both on topic-specific (e.g., ambivalence about mammography) and more general outcomes (e.g., backlash toward cancer prevention recommendations), experimental evidence, especially for effects on more general health cognitions, is limited. Using data from a population-based sample of U.S. women aged 35-55 years (N = 1467), the current study experimentally tested whether exposure to news stories that varied in the level of conflict about mammography (no, low, medium, and high conflict) affected three general health cognitions-cancer information overload (CIO), perceived scientists' credibility, and perceived journalists' credibility. We further tested whether these effects varied by research literacy. Results showed that exposure to conflict increased women's perceived CIO and reduced their perceptions of journalists' credibility, and that these effects tapered off at higher levels of conflict. Exposure to conflict also reduced perceptions of scientists' credibility, but only among participants with lower levels of research literacy. Directions for future research and implications for mitigating these potentially adverse effects on public health are discussed.

Prevalence and Potential Consequences of Exposure to Conflicting Information about Mammography: Results from Nationally-Representative Survey of U.S. Adults

As scientific evidence evolves and clinical guidelines change, a certain amount of conflicting health information in the news media is to be expected. However, research is needed to better understand the public's level of exposure to conflicting health information and the possible consequences of such exposure. This study quantifies levels of public exposure to one paradigmatic case: conflicting information about breast cancer screening for women in their 40s. Using a nationally-representative survey of U.S. adults aged 18-59 in 2016, we implemented four distinct types of measures of exposure to conflicting mammography information: an ecological measure based on keyword counts of local news closed-captioning, an inferred exposure measure based on a series of knowledge questions, a thought-listing exercise where respondents described their perceptions of mammography without prompting, and an explicit measure of self-assessed exposure to conflict. We examined the relationship between these exposure measures and four outcomes: confusion about mammography, backlash toward mammography recommendations, and confusion and backlash about health information more generally. We found moderate amounts of exposure to conflicting information about mammography, more among women than men. Exposure to conflicting information - across multiple measures - was associated with more confusion about mammography, more mammography-related backlash, and general health information backlash, but not general confusion about health information. These observational findings corroborate experimental-based findings that suggest potentially undesirable effects of exposure to conflicting health information. More research is needed to better understand how to mitigate these possible outcomes, in the context of a media landscape that proliferates exposure to multiple scientific perspectives.

The Impact of IT-Based Healthcare Communication on Mammography Screening Utilization among Women in the United States: National Health Interview Survey (2011-2018)

Effective patient-provider communication improves mammography utilization. Using information technology (IT) promotes health outcomes. However, there are disparities in access to IT that could contribute to disparities in mammography utilization. This study aims to assess the association between IT-based health care communication and mammography utilization and to evaluate if this effect is modified by race/ethnicity and age. To this end, this study was conducted using the National Health Interview Survey from 2011 to 2018. A total of 94,290 women aged 40 years and older were included. Multiple logistic regression models were used, and odds ratios were reported. The study found that all IT-based healthcare communication strategies were significantly associated with mammography utilization in all years from 2011 to 2018. In 2018, women who looked up health information on the internet, scheduled a medical appointment on the internet, and communicated with providers by email had a significantly higher chance to use mammography (p ≤ 0.005 for all strategies across all years). White women and women aged 50 years and older benefited the most from IT-based healthcare communication. In conclusion, facilitating access to IT may help increase mammography utilization, which may contribute to eliminating disparities in breast cancer mortality.

Conservative Media Use and Childhood COVID-19 Vaccine Information: A Test of the Contradictory Health Information Processing Model

The Contradictory Health Information Processing (CHIP) model explains individuals' processing of conflicting health claims. Tests of the model, while highly supportive, have been experimental and have relied upon low-familiar topics. Accordingly, a survey of parents with a child aged <12 years (N = 510) was conducted to test the application of the CHIP model to the controversial issue of childhood COVID-19 vaccination; such a vaccine had not yet been approved for this age group at the time of the survey. As hypothesized, reliance upon conservative news was associated with the perception that media information contradicted official guidance to vaccinate children, which led to issue uncertainty. Issue uncertainty prompted negative appraisals and decision uncertainty. Specifically, decision uncertainty partially mediated the effect of issue uncertainty on negative appraisals of vaccination, which in turn aroused threat emotions. However, threat emotions did not predict information-seeking, as specified in the model. This result may have been due to respondents having already decided to vaccinate their child, or not - a reflection of the partisan nature of the topic and the extensive coverage it had received. Theoretical and practical implications are discussed.

Engaging Women with Limited Health Literacy in Mammography Decision-Making: Perspectives of Patients and Primary Care Providers

BACKGROUND

Limited health literacy is a driver of cancer disparities and associated with less participation in medical decisions. Mammography screening decisions are an exemplar of where health literacy may impact decision-making and outcomes.

OBJECTIVE

To describe informational needs and shared decision-making (SDM) experiences among women ages 40-54 who have limited health literacy and primary care providers (PCPs).

DESIGN

Qualitative, in-depth interviews explored experiences with mammography counseling and SDM.

PARTICIPANTS

Women ages 40-54 with limited health literacy and no history of breast cancer or mammogram in the prior 9 months were approached before a primary care visit at a Boston academic, safety-net hospital. PCPs practicing at this site were eligible for PCP interviews.

APPROACH

Interviews were audio-recorded and transcribed verbatim. A set of deductive codes for each stakeholder group was developed based on literature and the interview guide. Inductive codes were generated during codebook development. Codes were compared within and across patient and PCP interviews to create themes relevant to mammography decision-making.

KEY RESULTS

The average age of 25 interviewed patients was 46.5; 18 identified as black, 3 as Hispanic, 2 as non-Hispanic white, and 2 had no recorded race or ethnicity. Of 20 PCPs, 15 were female; 12 had practiced for >5 years. Patients described a lack of technical (appropriate tests and what they do) and process (what happens during a mammogram visit) knowledge, viewing these as necessary for decision-making. PCPs were reluctant to engage patients with limited health literacy in SDM due to time constraints and feared that increased information might confuse patients or deter them from having mammograms. Both groups felt pre-visit education would facilitate mammography-related SDM during clinical visits.

CONCLUSION

Both patients and PCPs perceived a need for tools to relay technical and process knowledge about mammography prior to clinical encounters to address the scope of information that patients with limited health literacy desired.

Discussions of Potential Mammography Benefits and Harms among Patients with Limited Health Literacy and Providers: "Oh, There are Harms?"

Starting breast cancer screening at age 40 versus 50 may increase potential harms frequency with a small mortality benefit. Younger women's screening decisions, therefore, may be complex. Shared decision-making (SDM) is recommended for women under 50 and may support women under 55 for whom guidelines vary. How women with limited health literacy (LHL) approach breast cancer screening decision-making is less understood, and most SDM tools are not designed with their input. This phenomenological study sought to characterize mammography counseling experiences among women with LHL and primary care providers (PCPs). Women ages 40-54 with LHL who had no history of breast cancer or mammogram within 9 months were approached before a primary care visit at a safety-net hospital. PCPs at this site were invited to participate. Qualitative interviews explored mammography counseling experiences. Patients also reviewed sample information materials. A constant comparison technique generated four themes salient to 25 patients and 20 PCPs: addressing family history versus comprehensive risk assessment; potential mammography harms discussions; information delivery preferences; and integrating pre-visit information tools. Findings suggest that current counseling techniques may not be responsive to patient-identified needs. Opportunities exist to improve how mammography information is shared and increase accessibility across the health literacy spectrum.