Topics and sources of memorable breast cancer messages and their impact on prevention and detection behaviors

Effect of Messaging on Support for Breast Cancer Screening Cessation Among Older US Women: A Randomized Clinical Trial

Importance

Many older women are screened for breast cancer beyond guideline-recommended thresholds. Messaging holds promise to reduce overscreening.

Objective

To investigate the effect of a message on older women's support for and intentions of stopping breast cancer screening.

Design, Setting, and Participants

A 2-wave randomized clinical online survey trial using a nationally representative online panel was performed from May 12 to June 19, 2023. Women 65 years or older without breast cancer were eligible to participate.

Intervention

A pilot-tested breast cancer screening cessation message delivered to a hypothetical older woman with serious illnesses and functional impairment. The message was described as from 1 of 3 sources (clinician, news story, or family member). Participants were randomized into 4 groups: no message (group 1 [control]), a single message from a clinician at wave 1 and no message at wave 2 (group 2), a message from a news story (wave 1) and a clinician (wave 2) (group 3), and a message from a family member (wave 1) and a clinician (wave 2) (group 4).

Main Outcomes and Measures

Support for stopping screening in the hypothetical older woman (primary) and screening intentions for oneself (secondary) were assessed on 7-point scales, with higher values indicating stronger support for and intentions to stop screening. Means were compared using analysis of variance. The message effect on screening intentions among participants 75 years or older and those with life expectancy of less than 10 years were also explored.

Results

A total of 3051 women participated in wave 1 of the trial. The mean (SD) age was 72.8 (5.9) years; 272 (8.9%) were non-Hispanic Black and 2506 (82.1%) were non-Hispanic White. Of these women, 2796 (91.6%) completed wave 2. Group 2 had significantly higher support for screening cessation in the hypothetical patient at wave 2 (mean score, 3.14 [95% CI, 2.99-3.29]) compared with group 1 (mean score, 2.68 [95% CI, 2.54-2.82]; P < .001). The effect was even stronger in group 3 (mean score, 4.23 [95% CI, 4.09-4.38]) and group 4 (mean score, 4.12 [95% CI, 3.97-4.27]) compared with both groups 1 and 2 (all P < .001). Message effects on self-screening intentions followed a similar pattern, with larger effects among participants 75 years or older or with limited life expectancy.

Conclusions and Relevance

In this randomized clinical trial, a breast cancer screening cessation message significantly increased older women's support for and intentions of screening cessation. The strongest effects were observed when the message was delivered over time from multiple sources. Future work needs to engage potential message sources to examine the feasibility and acceptability of multilevel messaging strategies and their effect on screening behavior.

Trial Registration

ClinicalTrials.gov Identifier: NCT05821023.

"We're All in This Together": Farmers' Reactions to the Farmer Suicide Crisis

Farmer suicide rates continue to increase, with levels being 1.5 times higher than the national rate. This has led agricultural and public health groups to craft and distribute farm stress and suicide messages to help farmers. However, suicide rates remain at critical levels indicating that there may be a disconnect between existing efforts and farmer sensemaking of the crisis. Utilizing the Theory of Memorable Messages (ToMM), this study explored how farmers are reacting to messages and conversations about the farmer suicide crisis. Interviews with 25 participants found most had heard about farmer suicide concerns. When asked about their memorable conversations, farmers reflected a complex sensemaking process that included themes of memorable conversation types ranging from externalization to acceptance and message themes oriented around concern for self and others within these conversation types. Overall, most farmers externalized the risk of suicide to other farmers. However, even though participants did not see themselves at risk, their responses often showed deep concern for helping other farmers. These results are discussed in light of sensemaking and memorable conversations, with practical implications for future messaging efforts around farmer suicide.

Memorable Messages About Mental Health Among International Students in the United States: A Mixed-Method Study

This study investigated the memorable messages about mental health that international students (N = 199) received from various sources since arriving on campus in the U.S. Utilizing the memorable messages framework, we examined the types of messages (normalizing, strategizing, minimizing) they received and their association with message satisfaction, mental health stigma, and attitude toward help-seeking. The most frequently recalled messages were normalizing messages (49.2%), followed by strategizing messages (31.7%), and minimizing messages (9.5%). Participants who recalled normalizing and strategizing messages reported higher satisfaction and a more favorable attitude toward help-seeking compared to those who recalled minimizing messages. These findings offer theoretical implications for memorable messages and immigrant populations, as well as practical implications for campaign messaging and design. These results can guide university officials in tailoring their efforts to meet the mental health needs of this vulnerable population.

Development and Evaluation of Messages for Reducing Overscreening of Breast Cancer in Older Women

BACKGROUND

Many older women are screened for breast cancer beyond guideline-recommended thresholds. One contributor is pro-screening messaging from health care professionals, media, and family/friends. In this project, we developed and evaluated messages for reducing overscreening in older women.

METHODS

We surveyed women ages 65+ who were members of a nationally representative online panel. We constructed 8 messages describing reasons to consider stopping mammograms, including guideline recommendations, false positives, overdiagnosis, and diminishing benefits from screening due to competing risks. Messages varied in their format; some presented statistical evidence, and some described short anecdotes. Each participant was randomized to read 4 of 8 messages. We also randomized participants to one of 3 message sources (clinician, family member, and news story). We assessed whether the message would make participants "want to find out more information" and "think carefully" about mammograms.

RESULTS

Participants (N=790) had a mean age of 73.5 years; 25.8% were non-White. Across all messages, 73.0% of the time, participants agreed that the messages would make them seek more information (range among different messages=64.2%-78.2%); 46.5% of the time participants agreed that the messages would make them think carefully about getting mammograms (range =36.7%-50.7%). Top-rated messages mentioned false-positive anecdotes and overdiagnosis evidence. Ratings were similar for messages from clinicians and news sources, but lower from the family member source.

CONCLUSIONS

Overall, participants positively evaluated messages designed to reduce breast cancer overscreening regarding perceived effects on information seeking and deliberation. Combining the top-rated messages into messaging interventions may be a novel approach to reduce overscreening.

Validating Cross-Modal Measures for Comparative Research: Message Veracity, Novelty, and Memorability

Marketing researchers are interested in the relative persuasiveness of different message modes, such as narratives and arguments. A desire to explicate and compare underlying mechanisms is central to this research, yet progress is hindered by a dearth of measures that can be used meaningfully across modes. In the current project, we identify and validate three cross-modal message perceptions - veracity, novelty, and memorability - that can mediate the relationship between different modes and outcomes. Three studies (Study 1: N = 105; Study 2: N = 322; Study 3: N = 248) confirmed the factor structure, discriminant validity, and cross-modal (narrative vs. argument) value of all three message perceptions. The results of this study provide researchers with three cross-modal measures to support comparative message effects research.

Extending the Roots of Memorable Messages: A Comprehensive Review and Forecast of Memorable Message Literature and Theory

Five years ago, we reviewed the state of memorable message scholarship in communication, with special attention to the utility of memorable message research in health communication. Since then, works advancing the theoretical and practical applicability of the construct have continued to emerge. In this article, we discuss the trends in published memorable message research over the last five years. Since 2017, thirty-four additional peer-reviewed articles focusing on memorable messages as a central concept have been published. Health communication as a subset of the field (as well as the journal Health Communication) see a higher concentration of these publications than other areas. In this review, we concentrate on the use of theory within recent memorable message work. Although much of the memorable message research continues to be atheoretical, more work utilizing control theory, the theory of memorable messages, and communicated narrative sense-making characterize the recent literature. Additionally, more research has emerged that highlights the theoretically driven investigations about the nature of memorable messages. We review the scholarship utilizing these and other theories and suggest avenues for future research.

Effective health communication depends on the interaction of message source and content: two experiments on adherence to COVID-19 measures in Türkiye

OBJECTIVE

Following the COVID-19 outbreak, authorities recommended preventive measures to reduce infection rates. However, adherence to calls varied between individuals and across cultures. To determine the characteristics of effective health communication, we investigated three key features: message source, content, and audience.

METHODS

Using a pre-test and two experiments, we tested how message content (emphasizing personal or social benefit), audience (individual differences), message source (scientists or state officials), and their interaction influence adherence to preventive measures. Using fliers advocating preventive measures, Experiment 1 investigated the effects of message content and examined the moderator role of individual differences. Experiment 2 presented the messages using news articles and manipulated sources.

RESULTS

Study 1 found decreasing adherence over time, with no significant impact from message content or individual differences. Study 2 found messages emphasizing 'protect yourself' and 'protect your country' to increase intentions for adherence to preventive measures. It also revealed an interaction between message source and content whereby messages emphasizing personal benefit were more effective when they came from healthcare professionals than from state officials. However, message source and content did not affect vaccination intentions or donations for vaccine research.

CONCLUSION

Effective health communication requires simultaneous consideration of message source and content.

Women's Understanding of Windows of Susceptibility and the Role of the Environment in Breast Cancer Risk

Emerging evidence suggests women who are exposed to harmful environmental exposures, especially during certain critical periods across the lifespan, may increase their breast cancer risk. Such windows of susceptibility (WoS) occur throughout a woman's lifetime, during which she is especially vulnerable to the effects of harmful environmental exposures. This interaction makes the reduction of harmful environmental toxicants during those time periods a priority for community health promotion. Communicating about environmental exposures and their impact on women's health requires an assessment of sense-making around, and understanding of, the link between breast cancer and the environment. To that end, focus groups were conducted to assess the themes that emerge when women make sense of (a) their own breast cancer risk, (b) the environment-cancer connection, and (c) WoS. Results provide insight into how women understand these issues which can inform messaging strategies focused on reducing harmful environmental exposures. Implications are discussed within the context of communication efforts tailored to educate women, particularly mothers with daughters in the prepubertal and pubertal WoS who are particularly vulnerable to harmful environmental exposures.

S, Ward PR. Examining social class as it relates to heuristics women use to determine the trustworthiness of information regarding the link between alcohol and breast cancer risk

Background

High rates of alcohol consumption by midlife women, despite the documented risks associated with breast cancer, varies according to social class. However, we know little about how to develop equitable messaging regarding breast cancer prevention that takes into consideration class differences in the receipt and use of such information.

Objective

To explore the heuristics used by women with different (inequitable) life chances to determine the trustworthiness of information regarding alcohol as a modifiable risk factor for breast cancer risk.

Methods and materials

Interviews were conducted with 50 midlife (aged 45–64) women living in South Australia, diversified by self-reported alcohol consumption and social class. Women were asked to describe where they sought health information, how they accessed information specific to breast cancer risk as it relates to alcohol, and how they determined whether (or not) such information was trustworthy. De-identified transcripts were analysed following a three-step progressive method with the aim of identifying how women of varying life chances determine the trustworthiness of alcohol and breast cancer risk information. Three heuristics were used by women: (1) consideration of whose interests are being served; (2) engagement with ‘common sense’; and (3) evaluating the credibility of the message and messenger. Embedded within each heuristic are notable class-based distinctions.

Conclusions

More equitable provision of cancer prevention messaging might consider how social class shapes the reception and acceptance of risk information. Class should be considered in the development and tailoring of messages as the trustworthiness of organizations behind public health messaging cannot be assumed.

An Investigation into Memorable Messages about COVID-19

COVID-19 has been one of the most talked-about health threats in recent memory. Of the many messages - both good and bad - to which people are exposed, which ones are actually remembered? This study reports results of 319 people who described the COVID-19 message they found most memorable. Results indicate that people find messages about the virus, masks, and dangers of the disease most memorable. The majority of the messages came from TV news or the internet, particularly from social media. Overall, participants felt relatively positively about the messages. Memorable messages came from well-liked or trusted sources and were messages that the participant broadly agreed with (either because they already agreed or because the message changed their mind). Participants were more likely to report agreeing with the message if it produced feelings of happiness or fear and if the source of the message was seen as credible and benevolent. Future messages should focus on creating messages that provoke fear; highlight the credentials and character of the source; and are disseminated via social media and television.

The Influence of Memorable Message Receipt on Dietary and Exercise Behavior among Self-Identified Black Women

Guided by Control Theory and the memorable messages framework, the current investigation examined the relationship between receipt of a health-related memorable message and self-reported diet and exercise behavior. A cross-sectional survey methodology was utilized to evaluate the relationship between receipt of a memorable message and dietary and exercise behaviors in a sample of Black women. Over 80% of the research sample (N = 121) reported receiving a memorable health message regarding diet and/or exercise. Women receiving a memorable message reported a significantly higher number of days engaging in healthy eating and exercise behaviors each week. Messages from medical professionals had the greatest impact on healthy dietary practices, while media-based messages were most influential on the enactment of exercise behavior. Additional research is warranted to determine how the utilization and reinforcement of memorable messages impacts health outcomes among Black women.

The effects of visual formats on Facebook health-related posts: evidence from eye movement analysis

Purpose

This study aimed to provide user-centered evidence for health professionals to make optimal use of images for the effective dissemination of health information on Facebook (FB).

Design/methodology/approach

Using an eye-tracking experiment and a survey method, this study examined 42 participants' reading patterns as well as recall and recognition outcomes with 36 FB health information posts having various FB post features.

Findings

The findings demonstrated that FB posts with text-embedded images received more attention and resulted in the highest recall and recognition. Meanwhile, compared to text-embedded images, visual only images yielded less effective recall of information, but they caught the viewers' attention; graphics tended to attract more attention than photos. For effective communication, the text features in FB posts should align with the formats of the images.

Practical implications

The findings of this study provide practical implications for health information disseminators by suggesting that text-embedded images should be used for effective health communication.

Originality/value

This study provided evidence of users' different viewing patterns for FB health information posts and the relationship between FB post types and recall and recognition outcomes.

Healthcare Provider Analogies as Memorable Messages

Healthcare providers must explain medical information to patients in a way that patients can understand. Provider use of analogies is one strategy that may help patients better understand medical information. The present study, guided by a memorable message framework, investigated whether participants remembered any analogies used by their healthcare providers, and included a content analysis of the function the analogies served, the types of analogies participants remembered, and the body systems associated with the health issues that were described. Almost one-quarter of participants recalled an analogy used by a provider. The most frequently recalled analogies functioned to describe health conditions or phenomena, followed by elements of the body, and treatments or something external to the body. Analogies were most frequently used to describe health issues associated with the cardiovascular system, musculoskeletal system, digestive system, dental, eye, or skin issues, or the nervous system. The analogies were categorized as mechanical, a feeling or experience, random object, structure, food, nature, war/battle, or medical/body. Provider analogies may be a type of memorable message for some patients. Providers could consider using suitable analogies to explain health issues when communicating with patients, and be trained in effective use of analogies.

Evaluating the Feasibility of Continuing Medical Education for Disseminating Emerging Science on the Breast Cancer and Environment Connection

Developing continuing medical education (CME) training programs is a strategy for communicating emerging science to health practitioners. This research tests the feasibility of using CME modules for translating and disseminating research findings from the Breast Cancer and Environment Research Program. Recent findings have identified certain windows of susceptibility, like during puberty, in which exposure to endocrine-disrupting chemicals can increase breast cancer risk later in life. In order to reach pediatric patients and their caregivers, using a Diffusion of Innovations framework, pediatric health-care providers were identified as opinion leaders. Two CME modules informed by theory and formative research were tested with a sample of pediatricians and pediatric nurse practitioners. Participants completed knowledge, attitude, intention, and behavior items immediately before and after exposure to a randomly assigned module, and then again 3 weeks later. Quantitative and qualitative results indicate knowledge gain and strong links between practitioners' intentions to enact and implemented behavior learned from training recommendations with parents and caregivers in their practices. Results indicate that CMEs can be an effective strategy for translational activities targeted to health providers in order to change behavior within practice.

Investigation on reading behaviors and cognitive outcomes of Facebook health information

Purpose

This study aims to understand how college students' personal and health-related characteristics are related to their reading behaviors and cognitive outcomes of Facebook health information through eye tracking data and cognitive outcomes.

Design/methodology/approach

This study analyzed users' gaze movement data and results of recall and recognition tests to investigate users' reading patterns and their consequences with cognitive outcomes. The gaze movements are analyzed with eye tracking data including the average fixation count and time to first fixation.

Findings

The results of reading patterns show that Texts and Images are highly viewed and viewed immediately by participants when the posts were presented. There was no clear pattern with fixation counts to determine cognitive outcomes. However, the findings of study suggest that there is a clear pattern of reading Facebook posts with areas of interest (AOIs). Among five AOIs observed, participants viewed Images first and then Texts when a Facebook post is presented. On the other hand, they read Texts more carefully than Images. The findings of this study suggest that while images contribute to gaining users' attention, a clear and precise message needs to be delivered in text message to ensure readers' correct understanding and application of health information.

Originality/value

The user-centered evidence on reading behaviors and cognitive outcomes will make contributions to how health professionals and health organizations can make optimal use of Facebook for effective health information communication.

Peer review

The peer-review history for this article is available at: https://publons.com/publon/10.1108/OIR-05-2020-0177

Feasibility of encouraging participation in colorectal cancer screening campaigns by motivating people through the social network, Facebook

AIM

To describe the results of a feasibility phase and the expected results of a new approach to increase the participation rate in a Colorectal Cancer Organized Screening Program (CRCSP) through Facebook awareness messages.

METHOD

This approach targets people aged 50-74 years, who reside in an urban deprived area and regularly connect to Facebook. The feasibility phase ran over 2 months (December 2018 and January 2019) in six municipalities (Seine-Saint-Denis, France). The full provisional campaign will run over a year. The approach consists of sending electronic awareness messages on the importance of screening for colorectal cancer using a specific Facebook module. Subjects who consent to screening complete a test-kit application form. The eligibility of each subject to participate in screening is determined by a doctor before the kit is sent out.

RESULTS

A total of 39 900 people were reached by the feasibility phase campaign, and 9200 were able to watch at least one Facebook message/video. Of those, 4450 people logged to learn more about the CRCSP, 298 applied for a test kit, 160 test kit applicants were eligible to participate and the test completion rate was 41.9%. According to these feasibility results, 366 120 targeted people would connect regularly in the tested area, 141 541 of whom would be interested in a specific promotional message posted on Facebook. Requests could be made for 9770 kits, with 5246 people being eligible to participate in screening. The expected test-completion rate is estimated at 42%-89%. This would represent 5%-11% of the tests carried out in the area during the same period by 'classical' CRCSP.

CONCLUSION

Implementation of the Facebook strategy would significantly improve the rate of participation in the CRCSP by mobilizing people with no previous participation, including younger subjects.

Continuing Medical Education as a Translational Science Opportunity for Health Communication Researchers: The BCERP Model

Health communication researchers often work across health issues to engage in research that bridges distance between bench scientists and practitioners. This translational activity is essential to increase the likelihood that emerging science from the laboratory makes it into the hands of health professionals who can integrate it into their everyday practice with patients. An underutilized translational approach by communication researchers is the development of continuing medical education (CME) opportunities that incorporate a communication science approach to the uptake of recommended practices based on emerging science. This manuscript explains the nature of translational science, highlights the role of CME as an integral strategy for engaging in it, and then provides the exemplar of a training and evaluation project funded by the National Institute for Environmental Health Sciences for the Breast Cancer and the Environment Research Program (BCERP). Lessons learned are discussed as they relate to developing a translational opportunity for the BCERP.

Native Americans' Memorable Conversations About Living Kidney Donation and Transplant

Living kidney donation and transplant (LKDT) offers a path of hope for patients on indefinite dialysis treatment. However, identification of a living donor can be challenging; initiating these conversations is difficult. Our study analyzes memorable conversations about LKDT that occurred in response to an LKDT campaign targeted to Native Americans. Our analysis of n = 28 memorable conversations revealed that the campaign prompted conversations and increased communication efficacy about LKDT. Based on these findings, we suggest that campaign designers utilize narratives within campaigns to model communication self-efficacy and then analyze the content of postcampaign conversations as an indicator of campaign effectiveness.

Memorable Messages from Family Members About Mental Health: Young Adult Perceptions of Relational Closeness, Message Satisfaction, and Clinical Help-Seeking Attitudes

This study investigates memorable messages about mental health that young adults (YAs) recall receiving from family members. A memorable messages conceptual framework is adopted to explore message types and their associations with relevant individual and relational outcomes. Findings from a study of 193 memorable messages about mental health revealed three types of messages about mental health transmitted by family members: strategizing, normalizing, and minimizing messages. Statistical analyses indicated that memorable message types were significantly related to YA satisfaction with the message, perceptions of relational closeness between the message source and the YA message recipient, and YA attitudes about mental-health help seeking. Overall, participants who reported minimizing messages about mental health also reported the least favorable outcomes on the set of dependent variables. Implications of these findings and future directions for research are discussed.

Deeply Rooted in Memories: Toward a Comprehensive Overview of 30 Years of Memorable Message Literature

Knapp, Stohl, and Reardon's (1981) seminal work reported that some messages may be "remembered for a long time and have a profound influence on a person's life" (p. 27). While the foundational concepts of this framework have offered a meaningful contribution to memorable messages research, this article seeks to unpack the past three decades of the literature specific to the field of communication. The authors will highlight the trajectory and changes while considering its present use, episodes, and situations that transpire in individual lived experiences. Like Braithwaite, Schrodt, and Carr (2015), we note that memorable messages, though widely utilized, are largely descriptive and atheoretical or "undertheorized" (p. 15). To that end, and given its decades of successful use in health communication, organizational socialization, and education, we consider the value of a Theory of Memorable Messages (ToMM) that can support new directions for communication scholarship and serve as a catalyst for understanding dynamic relational interactions and exchanges in human communication.

Memorable Messages about the Misuse of Prescription Stimulants

The misuse of prescription stimulants among college undergraduates is a prevalent and dangerous problem on college campuses across the United States. Guided by a memorable messages framework, this research sought to examine the messages that college students recall about the misuse of prescription stimulants and examine how those messages are associated with students' intention to use stimulants. We analyzed the recalled memorable messages of 129 undergraduates. Three predominant themes emerged from the analysis: academic implications, health implications, and ethical implications. Theme, source, and valence of the memorable messages were not associated with behavioral intention to engage in the misuse of prescription stimulants. These findings contribute to the scholarly and practical understanding of undergraduates' experiences with illicit behaviors, and demonstrate a need to further investigate students' sense-making in relation to risky decisions made during their college experience.

The Role of Affect and Cognition in Processing Messages about Early Diagnosis for Alzheimer's Disease by Older People

Through early diagnosis of symptoms, the Alzheimer's disease process can be decelerated. The main concern is to encourage the population at risk to take responsible actions at the earliest stage of the onset of the disease. Persuasive communication is essential to achieve this. In an experimental study, the evaluation of awareness messages for early diagnosis containing weak and strong arguments and negative and positive images was performed on a sample of older Belgians. The mediating role of affective responses and message thoughts was explored. Strong arguments led to a more positive evaluation of the message than weak arguments directly and indirectly via the positive effect they had on message affect and thoughts, which, in turn, positively affected message evaluation. A negative message image led to a more positive message evaluation than a positive one. This effect was not mediated by either message affect or message thoughts.

Theorizing the Impact of Targeted Narratives: Model Admiration and Narrative Memorability

Communication campaigns often include components that have been designed for a specific population, a strategy referred to as targeting. Targeted narratives are story-based components of a campaign that feature a character or situation relevant to the intended audience. Though commonplace, few studies have explicated the underlying mechanisms by which targeted narratives exert influence. In a message evaluation study, 316 women aged 40-75 (M_age = 51.19, SD = 8.11) were exposed to one of two targeted narratives and asked to complete measures of model admiration, narrative memorability, and intentions to receive a mammography. Targeting was based upon affiliation with the Mormon church. The results revealed that the relationship between the targeted narratives and screening intentions was especially strong for women from the target population who admired the depicted models and found the stories memorable.

Ethics, Risk, and Media Intervention

Breast cancer incidence and mortality rates are of concern among Latin American women, mainly due to the growing prevalence of this disease and the lack of compliance to proper breast cancer screening and treatment. Focusing on Venezuelan women and the challenges and barriers that interact with their health communication, this paper looks into issues surrounding women's breast cancer, such as the challenges and barriers to breast cancer care, the relevant ethics and responsibilities, the right to health, breast cancer risk perception and risk communication, and the media interventions that affect Venezuelan women's perceptions and actions pertaining to this disease. In particular, it describes an action-oriented research project in Venezuela that was conducted over a four-year period of collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include positive indications on more effective interactions between physicians and patients, increasing satisfactions about issues of ethical treatment in providing healthcare services, more sufficient and responsible media coverage of breast cancer healthcare services and information, a widely supported declaration for a national response against breast cancer in Venezuela, and the creation of a code of ethics for the Venezuelan NGO that led the expansion of networking in support of women's breast cancer healthcare.

Media Exposure and Genetic Literacy Skills to Evaluate Angelina Jolie's Decision for Prophylactic Mastectomy

PURPOSE

To examine public preparedness to evaluate and respond to Angelina Jolie's well-publicized decision to have a prophylactic mastectomy.

METHODS

A consumer panel (n = 1,008) completed an online survey in November 2013, reporting exposure to Jolie's story, confidence applying genomic knowledge to evaluate her decision, and ability to interpret provided genetic risk information (genetic literacy skills). Linear and logistic regressions tested mediating/moderating models of these factors in association with opinions regarding mastectomies.

RESULTS

Confidence with genomics was associated with increased genetic literacy skills and increased media exposure, with a significant interaction between the two. Confidence was also associated with favoring mastectomies for women with BRCA mutations, mediating the relationship with media exposure. Respondents were more likely to form opinions about mastectomies if they had high genetic literacy skills.

CONCLUSION

These findings suggest that having higher genetic literacy skills may increase the public's ability to form opinions about clinical applications of genomic discovery. However, repeated media exposure to high-profile stories may artificially inflate confidence among those with low genetic literacy.

Health Information Seeking and Cancer Screening Adherence Rates

Effective screening tools are available for many of the top cancer killers in the USA. Searching for health information has previously been found to be associated with adhering to cancer screening guidelines, but Internet information seeking has not been examined separately. The current study examines the relationship between health and cancer Internet information seeking and adherence to cancer screening guidelines for breast, cervical, and colorectal cancer in a large nationally representative dataset. The current study was conducted using data from the Health Information National Trends Survey from 2003 and 2007. The study examined age-stratified models which correlated health and cancer information seeking with getting breast, cervical, and colorectal cancer screening on schedule, while controlling for several key variables. Internet health and cancer information seeking was positively associated with getting Pap screening on schedule, while information seeking from any sources was positively associated with getting colorectal screening on schedule. People who look for health or cancer information are more likely to get screened on schedule. Some groups of people, however, do not exhibit this relationship and, thus, may be more vulnerable to under-screening. These groups may benefit more from targeted interventions that attempt to engage people in their health care more actively.

Theorizing the Pathways From Seeking and Scanning to Mammography Screening

This study combines insights from existing theories in mass communication and health communication, and builds an integrated model accounting for the mechanisms by which an individual's acquisition of mammogram-related media information becomes associated with intentions to obtain a mammogram. Our model was largely supported by a survey with a nationally representative sample of American females between the ages of 40 and 70 years. As expected, seeking and scanning mammogram-related information from the media were both positively associated with reflective integration of media health information, which in turn was positively related to behavioral attitudes and perceived normative pressures. Attitudes and normative pressures were then positively linked to the intention to get a mammogram. Based on these findings, we offer some suggestions for future research in this area.

Ethics, Risk, and Media Intervention: Women's Breast Cancer in Venezuela

Breast cancer incidence and mortality rates are of concern among Latin American women, mainly due to the growing prevalence of this disease and the lack of compliance to proper breast cancer screening and treatment. Focusing on Venezuelan women and the challenges and barriers that interact with their health communication, this paper looks into issues surrounding women's breast cancer, such as the challenges and barriers to breast cancer care, the relevant ethics and responsibilities, the right to health, breast cancer risk perception and risk communication, and the media interventions that affect Venezuelan women's perceptions and actions pertaining to this disease. In particular, it describes an action-oriented research project in Venezuela that was conducted over a four-year period of collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include positive indications on more effective interactions between physicians and patients, increasing satisfactions about issues of ethical treatment in providing healthcare services, more sufficient and responsible media coverage of breast cancer healthcare services and information, a widely supported declaration for a national response against breast cancer in Venezuela, and the creation of a code of ethics for the Venezuelan NGO that led the expansion of networking in support of women's breast cancer healthcare.

E-mail to Promote Colorectal Cancer Screening Within Social Networks: Acceptability and Content

Effective techniques to encourage colorectal cancer screening in underscreened populations have included social support interventions and e-mail reminders from physicians. Personalized e-mail messages to promote colorectal cancer screening within social networks could be even more effective but have not been studied. The authors interviewed 387 e-mail users, aged 42-73 years in Georgia, Hawaii, and Massachusetts. Participants were asked to edit a sample message in which the sender shares a recent colonoscopy experience and urges the recipient to discuss colorectal cancer screening with a doctor. For those reporting willingness to send this message, changes to the message and suggested subject lines were recorded. Edited text was analyzed for content and concordance with original message. The majority of participants (74.4%) were willing to e-mail a modifiable message. Of those willing, 63.5% edited the message. Common edits included deletion (17.7%) or modification (17.4%) of a negatively framed sentence on colon cancer risks and addition or modification of personalizing words (15.6%). Few edits changed the meaning of the message (5.6%), and even fewer introduced factual inaccuracies (1.7%). Modifiable e-mail messages offer a way for screened individuals to promote colorectal cancer screening to social network members. The accuracy and effects of such messages should be further studied.

Surrogate decision makers and proxy ownership: challenges of privacy management in health care decision making

This study explored the communicative experiences of surrogates who served as decision makers for patients who were unable to convey health information and choices about treatment options. Drawing on assumptions from communication privacy management theory (Petronio, 2002), 35 surrogates were interviewed to explore how they navigated the role of guardian of patients' private health information while the patient was hospitalized. This research determined that not only are surrogates guardians and thereby co-owners of the patients' private health information, they actually served in a "proxy ownership" role. Surrogates described obstacles to both obtaining and sharing private health information about the patient, suggesting that their rights as legitimate co-owners of the patients' information were not fully acknowledged by the medical teams. Surrogates also described challenges in performing the proxy ownership role when they were not fully aware of the patient's wishes. Theoretical and practical implications of these challenges are discussed.

Do sororities promote members' health? A study of memorable messages regarding weight and appearance

This study examines the relationship between sorority communication practices and members' body images through the lens of organizational socialization and identification. Specifically, we analyzed 210 sorority members' memorable messages concerning weight and physical appearance using an inductive coding method. While many of the messages examined were affirming or complimentary in nature, the results of the analysis suggest that these types of messages may positively as well as negatively influence members' body images, behaviors regarding physical appearance, and social identities. These findings contribute to scholarly and practical understandings of the influences on college women's body image and health and the potentially powerful role that organizations play in shaping members' attitudes and actions concerning their eating, exercise, and other aspects of their appearance. Implications for future health communication research in other organizational contexts outside of sororities are also discussed. Additionally, the findings of the current study indicate the broad utility of a memorable messages approach and suggest the need for further examination of the ways in which differing organizational dynamics may demonstrate divergence from traditional sources of memorable messages.

The Impact of Personal Metaphors and Memorable Interpersonal Communication on Body Satisfaction

Memorable messages about body size can have profound negative psychological and emotional effects on body image and personal health. We found that both men and women recalled more negative than positive memorable messages about their body appearance and size. Participants who reported receiving negative memorable messages also revealed stronger current body dissatisfaction and poorer self-image than participants who reported positive memorable messages. Participants who received negative body comments also described their own body using negative metaphors. Negative memorable messages often occurred in front of third parties who expressed approval for the message, sometimes in the form of laughter. We discuss the mental health consequences of negative messages about body size and the implications for public health campaigns.

Breast self-examination beliefs and practices, ethnicity, and health literacy: Implications for health education to reduce disparities

OBJECTIVE

This study aimed to quantitatively and qualitatively examine breast cancer screening practices, including breast self-examination (BSE), and health literacy among patients with chronic disease.

DESIGN

A prospective, multi-method study conducted with a targeted purposive sample of 297 patients with diabetes and/or hypertension from four ethnic groups (Latino, Vietnamese, African American, White-American) at an urban community health center.

SETTING

A federally qualified health center in Western Massachusetts.

METHODS

In our four-year study, 297 participants completed cancer knowledge, beliefs, attitudes and screening utilization scales and measures of health literacy. In addition to survey data collection, we conducted in-depth interviews, focus groups, home visits, and chronic disease diaries (n=71).

RESULTS

In focus groups, African American, Vietnamese and Latina participants offered interviewers an unprompted demonstration of BSE, reported regular BSE use at particular times of the month, and shared positive feelings about the screening method. In a sample where approximately 93% of women have had a mammogram, many also had performed BSE (85.2%). Women with adequate health literacy were more likely than those with inadequate health literacy to rely on it. Despite being positively inclined toward BSE, Vietnamese women, who had the lowest health literacy scores in our sample, were less likely to perform BSE regularly.

CONCLUSIONS

BSE seemed to be an appealing self-care practice for many women in our study, but we conclude that proper BSE practices may not be reinforced equally across ethnic groups and among patients with low health literacy.

An Initial Investigation into Naturally Occurring Loss- and Gain-Framed Memorable Breast Cancer Messages

Memorable message research examines interpersonal messages "…remembered for extremely long periods of time and which people perceive as a major influence on the course of their lives" (Knapp, Stohl, & Reardon, 1981, p. 27). They can also guide actions, such as health behaviors. This exploratory research examined self-reported memorable messages about breast cancer to determine if they were framed, emphasizing either the benefits (gain-framed) or the costs (loss-framed) of a behavior. About one-fourth of the messages were framed, with most being gain-framed. The messages tended to emphasize early detection actions. Study limitations and implications for future research are discussed.

Concern as motivation for protection: an investigation of mothers' concern about daughters' breast cancer risk

The present study surveyed mothers with daughters (N = 386) to investigate how mothers' concern about their daughters' breast cancer risk influenced intentions to engage in preventive behaviors. Using protection motivation theory as a framework, self-efficacy, response efficacy, and level of concern were posited to influence protective behavioral intention in distinct ways. Results from regression analyses indicate that self-efficacy, response efficacy, and mothers' concern are significant predictors of intentions to engage in preventive behaviors with daughters. In addition, a content analysis of mothers' open-ended reasons for their concern about their daughters' breast cancer risk yield a list of specific concerns and trends that vary by concern level and individual comment valence. The authors discuss implications for incorporating mothers' concerns into breast cancer prevention messages as a novel strategy for campaign designers.

Action tendency emotions evoked by memorable breast cancer messages and their association with prevention and detection behaviors

Memorable messages about breast cancer sent by different sources, such as friends and family members, were analyzed for the action tendency emotions that they evoked. Negative emotions of fear, sadness, and anger, and positive emotions of hope and relief were analyzed for their associations with prevention and detection breast cancer behaviors. Messages that evoked fear were significantly more likely to be associated with detection behaviors, whereas messages that evoked relief were significantly less likely to be associated with detection behaviors than messages that did not evoke these emotions. These results are consistent with control theory and also show that friends and family are important sources of memorable messages about breast cancer.

Reaching the hearts and minds of illiterate women in the Amhara highland of Ethiopia: Development and pre-testing of oral HIV/AIDS prevention messages

In the style of radio programmes, we developed three episodes of audio HIV prevention education for illiterate women in Ethiopia. We used social-oriented presentation formats, such as discussion between women on HIV prevention, and expert-oriented presentation formats, such as an interview with a male doctor. The aim of this study was to assess the relation between evaluation of presentation formats and overall liking of episodes, which is important for persuasive effects. Thirty women from rural Amhara listened to the episodes and, after listening, female data collectors interviewed the women on evaluation of presentation formats, overall liking of episodes, identification with the characters and convincingness. Evaluation of social-oriented presentation formats was strongly related to overall liking of episodes, but evaluation of expert-oriented presentation formats was not. This relation was mediated through convincingness and not through identification. We conclude that social-oriented presentation formats make messages more convincing and, consequently, improve overall liking and persuasive impact.