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Bravo CA, Walker MJ, Papadopoulos A, McWhirter JE. Social media use in HPV-, cervical cancer-, and cervical screening-related research: A scoping review. Prev Med 2024; 179:107798. [PMID: 38065338 DOI: 10.1016/j.ypmed.2023.107798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/20/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE In response to the World Health Organization's global call to eliminate cervical cancer, many countries have targets to implement human papillomavirus (HPV) primary screening. Social media may offer opportunities to promote uptake of HPV screening. We aimed to describe the extent of the scientific literature regarding social media research on HPV, cervical cancer and cervical screening. METHODS Seven databases were searched for peer-reviewed English-language studies related to social media research and HPV, cervical cancer and cervical screening published up to November 2023. One reviewer completed the title/abstract screening and two reviewers independently reviewed full-text articles. Data extraction was carried out by one reviewer and verified by a second reviewer. Information such as the research topic, social media platform of interest, participant characteristics, methods, analysis type, outcome measures, and key findings were collected. RESULTS In the 58 articles included, researchers used social media in the following ways: evaluate content, recruit participants or disseminate a survey/questionnaire, disseminate health communication content, examine the relationship between social media use and outcomes, and to conduct experiments testing the effects of social media content on outcomes. Twitter and Facebook were the most common platforms mentioned. Four articles explicitly mentioned theory. CONCLUSIONS Opportunities for research are identified such as further exploration of how newer social media platforms such as Instagram and TikTok can be used to share HPV content, examination of appropriate images for effective communication, and determining key features of social media content to promote information sharing and improve cervical screening knowledge, attitudes and behaviours.
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Affiliation(s)
- Caroline A Bravo
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - Meghan J Walker
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Evans WK, Tammemägi MC, Walker MJ, Cameron E, Leung YW, Ashton S, de Loë J, Doyle W, Bornais C, Allie E, Alkema K, Bravo CA, McGarry C, Rey M, Truscott R, Darling G, Rabeneck L. Integrating Smoking Cessation Into Low-Dose Computed Tomography Lung Cancer Screening: Results of the Ontario, Canada Pilot. J Thorac Oncol 2023; 18:1323-1333. [PMID: 37422265 DOI: 10.1016/j.jtho.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 06/26/2023] [Accepted: 07/02/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Low-dose computed tomography screening in high-risk individuals reduces lung cancer mortality. To inform the implementation of a provincial lung cancer screening program, Ontario Health undertook a Pilot study, which integrated smoking cessation (SC). METHODS The impact of integrating SC into the Pilot was assessed by the following: rate of acceptance of a SC referral; proportion of individuals who were currently smoking cigarettes and attended a SC session; the quit rate at 1 year; change in the number of quit attempts; change in Heaviness of Smoking Index; and relapse rate in those who previously smoked. RESULTS A total of 7768 individuals were recruited predominantly through primary care physician referral. Of these, 4463 were currently smoking and were risk assessed and referred to SC services, irrespective of screening eligibility: 3114 (69.8%) accepted referral to an in-hospital SC program, 431 (9.7%) to telephone quit lines, and 50 (1.1%) to other programs. In addition, 4.4% reported no intention to quit and 8.5% were not interested in participating in a SC program. Of the 3063 screen-eligible individuals who were smoking at baseline low-dose computed tomography scan, 2736 (89.3%) attended in-hospital SC counseling. The quit rate at 1 year was 15.5% (95% confidence interval: 13.4%-17.7%; range: 10.5%-20.0%). Improvements were also observed in Heaviness of Smoking Index (p < 0.0001), number of cigarettes smoked per day (p < 0.0001), time to first cigarette (p < 0.0001), and number of quit attempts (p < 0.001). Of those who reported having quit within the previous 6 months, 6.3% had resumed smoking at 1 year. Furthermore, 92.7% of the respondents reported satisfaction with the hospital-based SC program. CONCLUSIONS On the basis of these observations, the Ontario Lung Screening Program continues to recruit through primary care providers, to assess risk for eligibility using trained navigators, and to use an opt-out approach to referral for cessation services. In addition, initial in-hospital SC support and intensive follow-on cessation interventions will be provided to the extent possible.
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Affiliation(s)
- William K Evans
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
| | - Martin C Tammemägi
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Department of Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Meghan J Walker
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Erin Cameron
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Yvonne W Leung
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; College of Professional Studies, Northeastern University-Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Sara Ashton
- Administration, Lakeridge Health, Oshawa, Ontario, Canada
| | - Julie de Loë
- Health Promotion Screening Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Wanda Doyle
- Health Promotion Screening Program, Champlain Regional Cancer Program, Ottawa, Ontario, Canada
| | - Chantal Bornais
- Health Promotion Screening Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ellen Allie
- Health Promotion Screening Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Koop Alkema
- Cancer Screening Program, Northeast Cancer Centre - Health Sciences North, Sudbury, Ontario, Canada
| | - Caroline A Bravo
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Caitlin McGarry
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Michelle Rey
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Rebecca Truscott
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Gail Darling
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Linda Rabeneck
- Clinical Institutes and Quality Programs, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Walker MJ, Meggetto O, Gao J, Espino-Hernández G, Jembere N, Bravo CA, Rey M, Aslam U, Sheppard AJ, Lofters AK, Tammemägi MC, Tinmouth J, Kupets R, Chiarelli AM, Rabeneck L. Measuring the impact of the COVID-19 pandemic on organized cancer screening and diagnostic follow-up care in Ontario, Canada: A provincial, population-based study. Prev Med 2021; 151:106586. [PMID: 34217413 PMCID: PMC9755643 DOI: 10.1016/j.ypmed.2021.106586] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/16/2021] [Accepted: 04/25/2021] [Indexed: 12/14/2022]
Abstract
It is essential to quantify the impacts of the COVID-19 pandemic on cancer screening, including for vulnerable sub-populations, to inform the development of evidence-based, targeted pandemic recovery strategies. We undertook a population-based retrospective observational study in Ontario, Canada to assess the impact of the pandemic on organized cancer screening and diagnostic services, and assess whether patterns of cancer screening service use and diagnostic delay differ across population sub-groups during the pandemic. Provincial health databases were used to identify age-eligible individuals who participated in one or more of Ontario's breast, cervical, colorectal, and lung cancer screening programs from January 1, 2019-December 31, 2020. Ontario's screening programs delivered 951,000 (-41%) fewer screening tests in 2020 than in 2019 and volumes for most programs remained more than 20% below historical levels by the end of 2020. A smaller percentage of cervical screening participants were older (50-59 and 60-69 years) during the pandemic when compared with 2019. Individuals in the oldest age groups and in lower-income neighborhoods were significantly more likely to experience diagnostic delay following an abnormal breast, cervical, or colorectal cancer screening test during the pandemic, and individuals with a high probability of living on a First Nation reserve were significantly more likely to experience diagnostic delay following an abnormal fecal test. Ongoing monitoring and management of backlogs must continue. Further evaluation is required to identify populations for whom access to cancer screening and diagnostic care has been disproportionately impacted and quantify impacts of these service disruptions on cancer incidence, stage, and mortality. This information is critical to pandemic recovery efforts that are aimed at achieving equitable and timely access to cancer screening-related care.
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Affiliation(s)
- Meghan J Walker
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Olivia Meggetto
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Julia Gao
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | | | | | - Michelle Rey
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Usman Aslam
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Amanda J Sheppard
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aisha K Lofters
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontairo, Canada; IC/ES, Toronto, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Martin C Tammemägi
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Brock University, St. Catharines, Ontario, Canada
| | - Jill Tinmouth
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; IC/ES, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Kupets
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Anna M Chiarelli
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; IC/ES, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Vaisson G, Witteman HO, Chipenda-Dansokho S, Saragosa M, Bouck Z, Bravo CA, Desveaux L, Llovet D, Presseau J, Taljaard M, Umar S, Grimshaw JM, Tinmouth J, Ivers NM. Testing e-mail content to encourage physicians to access an audit and feedback tool: a factorial randomized experiment. ACTA ACUST UNITED AC 2019; 26:205-216. [PMID: 31285667 DOI: 10.3747/co.26.4829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background In Ontario, an online audit and feedback tool that provides primary care physicians with detailed information about patients who are overdue for cancer screening is underused. In the present study, we aimed to examine the effect of messages operationalizing 3 behaviour change techniques on access to the audit and feedback tool and on cancer screening rates. Methods During May-September 2017, a pragmatic 2×2×2 factorial experiment tested 3 behaviour change techniques: anticipated regret, material incentive, and problem-solving. Outcomes were assessed using routinely collected administrative data. A qualitative process evaluation explored how and why the e-mail messages did or did not support Screening Activity Report access. Results Of 5449 primary care physicians randomly allocated to 1 of 8 e-mail messages, fewer than half opened the messages and fewer than 1 in 10 clicked through the messages. Messages with problem-solving content were associated with a 12.9% relative reduction in access to the tool (risk ratio: 0.871; 95% confidence interval: 0.791 to 0.958; p = 0.005), but a 0.3% increase in cervical cancer screening (rate ratio: 1.003; 95% confidence interval: 1.001 to 1.006; p = 0.003). If true, that association would represent 7568 more patients being screened. No other significant effects were observed. Conclusions For audit and feedback to work, recipients must engage with the data; for e-mail messages to prompt activity, recipients must open and review the message content. This large factorial experiment demonstrated that small changes in the content of such e-mail messages might influence clinical behaviour. Future research should focus on strategies to make cancer screening more user-centred.
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Affiliation(s)
- G Vaisson
- Quebec: Office of Education and Professional Development, Faculty of Medicine, Laval University (Vaisson, Witteman, Chipenda-Dansokho), Research Centre of the CHU de Québec, Laval University (Vaisson, Witteman), Department of Family and Emergency Medicine, Laval University (Witteman), and Laval University Primary Care Research Centre, Laval University, Quebec City (Witteman)
| | - H O Witteman
- Quebec: Office of Education and Professional Development, Faculty of Medicine, Laval University (Vaisson, Witteman, Chipenda-Dansokho), Research Centre of the CHU de Québec, Laval University (Vaisson, Witteman), Department of Family and Emergency Medicine, Laval University (Witteman), and Laval University Primary Care Research Centre, Laval University, Quebec City (Witteman)
| | - S Chipenda-Dansokho
- Quebec: Office of Education and Professional Development, Faculty of Medicine, Laval University (Vaisson, Witteman, Chipenda-Dansokho), Research Centre of the CHU de Québec, Laval University (Vaisson, Witteman), Department of Family and Emergency Medicine, Laval University (Witteman), and Laval University Primary Care Research Centre, Laval University, Quebec City (Witteman)
| | - M Saragosa
- Ontario: Family Practice Health Centre, Women's College Hospital, Toronto (Saragosa, Desveaux, Ivers); Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto (Saragosa, Bouck, Desveaux, Ivers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bouck); Prevention and Cancer Control, Cancer Care Ontario, Toronto (Bravo, Llovet, Umar, Tinmouth); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Llovet); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Presseau, Taljaard, Grimshaw); School of Epidemiology and Public Health, University of Ottawa, Ottawa (Presseau, Taljaard); School of Psychology, University of Ottawa, Ottawa (Presseau); Department of Medicine, University of Ottawa, Ottawa (Grimshaw); Institute for Clinical Evaluative Sciences, Toronto (Tinmouth); Department of Medicine, University of Toronto, Toronto (Tinmouth); and Department of Family and Community Medicine, University of Toronto, Toronto (Ivers)
| | - Z Bouck
- Ontario: Family Practice Health Centre, Women's College Hospital, Toronto (Saragosa, Desveaux, Ivers); Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto (Saragosa, Bouck, Desveaux, Ivers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bouck); Prevention and Cancer Control, Cancer Care Ontario, Toronto (Bravo, Llovet, Umar, Tinmouth); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Llovet); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Presseau, Taljaard, Grimshaw); School of Epidemiology and Public Health, University of Ottawa, Ottawa (Presseau, Taljaard); School of Psychology, University of Ottawa, Ottawa (Presseau); Department of Medicine, University of Ottawa, Ottawa (Grimshaw); Institute for Clinical Evaluative Sciences, Toronto (Tinmouth); Department of Medicine, University of Toronto, Toronto (Tinmouth); and Department of Family and Community Medicine, University of Toronto, Toronto (Ivers)
| | - C A Bravo
- Ontario: Family Practice Health Centre, Women's College Hospital, Toronto (Saragosa, Desveaux, Ivers); Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto (Saragosa, Bouck, Desveaux, Ivers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bouck); Prevention and Cancer Control, Cancer Care Ontario, Toronto (Bravo, Llovet, Umar, Tinmouth); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Llovet); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Presseau, Taljaard, Grimshaw); School of Epidemiology and Public Health, University of Ottawa, Ottawa (Presseau, Taljaard); School of Psychology, University of Ottawa, Ottawa (Presseau); Department of Medicine, University of Ottawa, Ottawa (Grimshaw); Institute for Clinical Evaluative Sciences, Toronto (Tinmouth); Department of Medicine, University of Toronto, Toronto (Tinmouth); and Department of Family and Community Medicine, University of Toronto, Toronto (Ivers)
| | - L Desveaux
- Ontario: Family Practice Health Centre, Women's College Hospital, Toronto (Saragosa, Desveaux, Ivers); Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto (Saragosa, Bouck, Desveaux, Ivers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bouck); Prevention and Cancer Control, Cancer Care Ontario, Toronto (Bravo, Llovet, Umar, Tinmouth); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Llovet); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Presseau, Taljaard, Grimshaw); School of Epidemiology and Public Health, University of Ottawa, Ottawa (Presseau, Taljaard); School of Psychology, University of Ottawa, Ottawa (Presseau); Department of Medicine, University of Ottawa, Ottawa (Grimshaw); Institute for Clinical Evaluative Sciences, Toronto (Tinmouth); Department of Medicine, University of Toronto, Toronto (Tinmouth); and Department of Family and Community Medicine, University of Toronto, Toronto (Ivers)
| | - D Llovet
- Ontario: Family Practice Health Centre, Women's College Hospital, Toronto (Saragosa, Desveaux, Ivers); Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto (Saragosa, Bouck, Desveaux, Ivers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bouck); Prevention and Cancer Control, Cancer Care Ontario, Toronto (Bravo, Llovet, Umar, Tinmouth); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Llovet); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Presseau, Taljaard, Grimshaw); School of Epidemiology and Public Health, University of Ottawa, Ottawa (Presseau, Taljaard); School of Psychology, University of Ottawa, Ottawa (Presseau); Department of Medicine, University of Ottawa, Ottawa (Grimshaw); Institute for Clinical Evaluative Sciences, Toronto (Tinmouth); Department of Medicine, University of Toronto, Toronto (Tinmouth); and Department of Family and Community Medicine, University of Toronto, Toronto (Ivers)
| | - J Presseau
- Ontario: Family Practice Health Centre, Women's College Hospital, Toronto (Saragosa, Desveaux, Ivers); Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto (Saragosa, Bouck, Desveaux, Ivers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bouck); Prevention and Cancer Control, Cancer Care Ontario, Toronto (Bravo, Llovet, Umar, Tinmouth); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Llovet); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Presseau, Taljaard, Grimshaw); School of Epidemiology and Public Health, University of Ottawa, Ottawa (Presseau, Taljaard); School of Psychology, University of Ottawa, Ottawa (Presseau); Department of Medicine, University of Ottawa, Ottawa (Grimshaw); Institute for Clinical Evaluative Sciences, Toronto (Tinmouth); Department of Medicine, University of Toronto, Toronto (Tinmouth); and Department of Family and Community Medicine, University of Toronto, Toronto (Ivers)
| | - M Taljaard
- Ontario: Family Practice Health Centre, Women's College Hospital, Toronto (Saragosa, Desveaux, Ivers); Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto (Saragosa, Bouck, Desveaux, Ivers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bouck); Prevention and Cancer Control, Cancer Care Ontario, Toronto (Bravo, Llovet, Umar, Tinmouth); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Llovet); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Presseau, Taljaard, Grimshaw); School of Epidemiology and Public Health, University of Ottawa, Ottawa (Presseau, Taljaard); School of Psychology, University of Ottawa, Ottawa (Presseau); Department of Medicine, University of Ottawa, Ottawa (Grimshaw); Institute for Clinical Evaluative Sciences, Toronto (Tinmouth); Department of Medicine, University of Toronto, Toronto (Tinmouth); and Department of Family and Community Medicine, University of Toronto, Toronto (Ivers)
| | - S Umar
- Ontario: Family Practice Health Centre, Women's College Hospital, Toronto (Saragosa, Desveaux, Ivers); Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto (Saragosa, Bouck, Desveaux, Ivers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bouck); Prevention and Cancer Control, Cancer Care Ontario, Toronto (Bravo, Llovet, Umar, Tinmouth); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Llovet); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Presseau, Taljaard, Grimshaw); School of Epidemiology and Public Health, University of Ottawa, Ottawa (Presseau, Taljaard); School of Psychology, University of Ottawa, Ottawa (Presseau); Department of Medicine, University of Ottawa, Ottawa (Grimshaw); Institute for Clinical Evaluative Sciences, Toronto (Tinmouth); Department of Medicine, University of Toronto, Toronto (Tinmouth); and Department of Family and Community Medicine, University of Toronto, Toronto (Ivers)
| | - J M Grimshaw
- Ontario: Family Practice Health Centre, Women's College Hospital, Toronto (Saragosa, Desveaux, Ivers); Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto (Saragosa, Bouck, Desveaux, Ivers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bouck); Prevention and Cancer Control, Cancer Care Ontario, Toronto (Bravo, Llovet, Umar, Tinmouth); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Llovet); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Presseau, Taljaard, Grimshaw); School of Epidemiology and Public Health, University of Ottawa, Ottawa (Presseau, Taljaard); School of Psychology, University of Ottawa, Ottawa (Presseau); Department of Medicine, University of Ottawa, Ottawa (Grimshaw); Institute for Clinical Evaluative Sciences, Toronto (Tinmouth); Department of Medicine, University of Toronto, Toronto (Tinmouth); and Department of Family and Community Medicine, University of Toronto, Toronto (Ivers)
| | - J Tinmouth
- Ontario: Family Practice Health Centre, Women's College Hospital, Toronto (Saragosa, Desveaux, Ivers); Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto (Saragosa, Bouck, Desveaux, Ivers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bouck); Prevention and Cancer Control, Cancer Care Ontario, Toronto (Bravo, Llovet, Umar, Tinmouth); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Llovet); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Presseau, Taljaard, Grimshaw); School of Epidemiology and Public Health, University of Ottawa, Ottawa (Presseau, Taljaard); School of Psychology, University of Ottawa, Ottawa (Presseau); Department of Medicine, University of Ottawa, Ottawa (Grimshaw); Institute for Clinical Evaluative Sciences, Toronto (Tinmouth); Department of Medicine, University of Toronto, Toronto (Tinmouth); and Department of Family and Community Medicine, University of Toronto, Toronto (Ivers)
| | - N M Ivers
- Ontario: Family Practice Health Centre, Women's College Hospital, Toronto (Saragosa, Desveaux, Ivers); Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto (Saragosa, Bouck, Desveaux, Ivers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bouck); Prevention and Cancer Control, Cancer Care Ontario, Toronto (Bravo, Llovet, Umar, Tinmouth); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Llovet); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (Presseau, Taljaard, Grimshaw); School of Epidemiology and Public Health, University of Ottawa, Ottawa (Presseau, Taljaard); School of Psychology, University of Ottawa, Ottawa (Presseau); Department of Medicine, University of Ottawa, Ottawa (Grimshaw); Institute for Clinical Evaluative Sciences, Toronto (Tinmouth); Department of Medicine, University of Toronto, Toronto (Tinmouth); and Department of Family and Community Medicine, University of Toronto, Toronto (Ivers)
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Llovet D, Serenity M, Conn LG, Bravo CA, McCurdy BR, Dubé C, Baxter NN, Paszat L, Rabeneck L, Peters A, Tinmouth J. Reasons For Lack of Follow-up Colonoscopy Among Persons With A Positive Fecal Occult Blood Test Result: A Qualitative Study. Am J Gastroenterol 2018; 113:1872-1880. [PMID: 30361625 PMCID: PMC6768592 DOI: 10.1038/s41395-018-0381-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/25/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Follow-up colonoscopy rates among persons with positive fecal occult blood test results (FOBT + ) remain suboptimal in many jurisdictions. In Ontario, Canada, primary care providers (PCPs) are responsible for arranging follow-up colonoscopies. The objectives were to understand the reasons for a lack of follow-up colonoscopy and any action plans to address follow-up. METHODS Semi-structured interviews were conducted with 30 FOBT+ persons and 30 PCPs in Ontario. Eligible FOBT+ persons were identified through administrative databases and included those aged 50-74, with a 6-12 month old FOBT+, no follow-up colonoscopy, and no prior colorectal cancer diagnosis or colectomy. Eligible PCPs had ≥1 rostered FOBT+ person without follow-up colonoscopy. Transcripts were analyzed inductively using Nvivo 11 (QSR International Pty Ltd., 2015). RESULTS Reasons for lack of follow-up colonoscopy were: person and/or provider believed the FOBT + was a false positive; person was afraid of colonoscopy; person had other health issues; and breakdown in communication of FOBT+ results or colonoscopy appointments. PCPs who initially recommended follow-up colonoscopy did not change the minds of the persons who dismissed the FOBT+ as a false positive and/or who were afraid of the procedure. These FOBT+ persons negotiated an alternative follow-up action plan including repeating the FOBT or not following-up. CONCLUSIONS PCPs may not adequately counsel FOBT+ persons who believe the FOBT+ is a false positive and/or fear colonoscopy. PCPs may lack fail-safe systems to communicate FOBT+ results and colonoscopy appointments. Using navigators may help address these barriers and increase follow-up rates.
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Affiliation(s)
- Diego Llovet
- 1Cancer Care Ontario, Toronto, Canada.,2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Lesley Gotlib Conn
- 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,3Sunnybrook Research Institute, Toronto, Canada
| | | | | | - Catherine Dubé
- 1Cancer Care Ontario, Toronto, Canada.,4Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Nancy N. Baxter
- 5Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,6Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Lawrence Paszat
- 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,7Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Linda Rabeneck
- 1Cancer Care Ontario, Toronto, Canada.,8Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Jill Tinmouth
- 1Cancer Care Ontario, Toronto, Canada.,8Department of Medicine, University of Toronto, Toronto, Canada
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6
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Bravo CA, Llovet D, Witteman HO, Desveaux L, Presseau J, Saragosa M, Vaisson G, Umar S, Tinmouth J, Ivers NM. Designing Emails Aimed at Increasing Family Physicians' Use of a Web-Based Audit and Feedback Tool to Improve Cancer Screening Rates: Cocreation Process. JMIR Hum Factors 2018; 5:e25. [PMID: 30181108 PMCID: PMC6231866 DOI: 10.2196/humanfactors.9875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/25/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Providing clinical performance data to health professionals, a process known as audit and feedback, can play an important role in health system improvement. However, audit and feedback tools can only be effective if the targeted health professionals access and actively review their data. Email is used by Cancer Care Ontario, a provincial cancer agency, to promote access to a Web-based audit and feedback tool called the Screening Activity Report (SAR); however, current emails that lack behavior change content have been ineffective at encouraging log-in to the SAR. OBJECTIVE The objective of our study was to describe the process and experience of developing email content that incorporates user input and behavior change techniques (BCTs) to promote the use of the SAR among Ontario primary care providers. METHODS Our interdisciplinary research team first identified BCTs shown to be effective in other settings that could be adapted to promote use of the SAR. We then developed draft BCT-informed email content. Next, we conducted cocreation workshops with physicians who had logged in to the SAR more than once over the past year. Participants provided reactions to researcher-developed BCT-informed content and helped to develop an email that they believed would prompt their colleagues to use the SAR. Content from cocreation workshops was brought to focus groups with physicians who had not used the SAR in the past year. We analyzed notes from the cocreation workshops and focus groups to inform decisions about content. Finally, 8 emails were created to test BCT-informed content in a 2×2×2 factorial randomized experiment. RESULTS We identified 3 key tensions during the development of the email that required us to balance user input with scientific evidence, organizational policies, and our scientific objectives, which are as follows: conflict between user preference and scientific evidence, privacy constraints around personalizing unencrypted emails with performance data, and using cocreation methods in a study with the objective of developing an email that featured BCT-informed content. CONCLUSIONS Teams tasked with developing content to promote health professional engagement with audit and feedback or other quality improvement tools might consider cocreation processes for developing communications that are informed by both users and BCTs. Teams should be cautious about making decisions solely based on user reactions because what users seem to prefer is not always the same as what works. Furthermore, implementing user recommendations may not always be feasible. Teams may face challenges when using cocreation methods to develop a product with the simultaneous goal of having clearly defined variables to test in later studies. The expected role of users, evidence, and the implementation context all warrant consideration to determine whether and how cocreation methods could help to achieve design and scientific objectives.
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Affiliation(s)
- Caroline A Bravo
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Diego Llovet
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Research Centre of the CHU de Québec, Quebec City, QC, Canada
| | - Laura Desveaux
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Marianne Saragosa
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada
| | - Gratianne Vaisson
- Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Research Centre of the CHU de Québec, Quebec City, QC, Canada
| | - Shama Umar
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Jill Tinmouth
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Vaisson G, Witteman HO, Bouck Z, Bravo CA, Desveaux L, Llovet D, Presseau J, Saragosa M, Taljaard M, Umar S, Grimshaw JM, Tinmouth J, Ivers NM. Testing Behavior Change Techniques to Encourage Primary Care Physicians to Access Cancer Screening Audit and Feedback Reports: Protocol for a Factorial Randomized Experiment of Email Content. JMIR Res Protoc 2018; 7:e11. [PMID: 29453190 PMCID: PMC5834752 DOI: 10.2196/resprot.9090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/29/2022] Open
Abstract
Background Cancer Care Ontario’s Screening Activity Report (SAR) is an online audit and feedback tool designed to help primary care physicians in Ontario, Canada, identify patients who are overdue for cancer screening or have abnormal results requiring follow-up. Use of the SAR is associated with increased screening rates. To encourage SAR use, Cancer Care Ontario sends monthly emails to registered primary care physicians announcing that updated data are available. However, analytics reveal that 50% of email recipients do not open the email and less than 7% click the embedded link to log in to their report. Objective The goal of the study is to determine whether rewritten emails result in increased log-ins. This manuscript describes how different user- and theory-informed messages intended to improve the impact of the monthly emails will be experimentally tested and how a process evaluation will explore why and how any effects observed were (or were not) achieved. Methods A user-centered approach was used to rewrite the content of the monthly email, including messages operationalizing 3 behavior change techniques: anticipated regret, material incentive (behavior), and problem solving. A pragmatic, 2x2x2 factorial experiment within a multiphase optimization strategy will test the redesigned emails with an embedded qualitative process evaluation to understand how and why the emails may or may not have worked. Trial outcomes will be ascertained using routinely collected administrative data. Physicians will be recruited for semistructured interviews using convenience and snowball sampling. Results As of April 2017, 5576 primary care physicians across the province of Ontario, Canada, had voluntarily registered for the SAR, and in so doing, signed up to receive the monthly email updates. From May to August 2017 participants received the redesigned monthly emails with content specific to their allocated experimental condition prompting use of the SAR. We have not yet begun analyses. Conclusions This study will inform how to communicate effectively with primary care providers by email and identify which behavior change techniques tested are most effective at encouraging engagement with an audit and feedback report. Trial Registration ClinicalTrials.gov NCT03124316; https://clinicaltrials.gov/ct2/show/NCT03124316 (Archived by WebCite at http://www.webcitation.org/6w2MqDWGu)
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Affiliation(s)
- Gratianne Vaisson
- Department of Epidemiology, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Holly O Witteman
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Research Centre of the Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, QC, Canada
| | - Zachary Bouck
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Caroline A Bravo
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Laura Desveaux
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Diego Llovet
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Marianne Saragosa
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Shama Umar
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jill Tinmouth
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
| | - Noah M Ivers
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Bravo CA, Hoffman-Goetz L. Tweeting About Prostate and Testicular Cancers: What Are Individuals Saying in Their Discussions About the 2013 Movember Canada Campaign? J Cancer Educ 2016; 31:559-566. [PMID: 25903054 DOI: 10.1007/s13187-015-0838-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Effective and persuasive health campaigns are an important tool for promoting cancer prevention education. The 2013 Movember Canada campaign presented an opportunity to raise awareness and funds about men's health with a particular focus on prostate and testicular cancers. The Movember campaign encouraged participants to talk about men's health (including prostate and testicular cancers) and had a strong presence on social media sites such as Twitter in November 2013. The objective of this study was to analyze tweets about the 2013 Movember Canada for underlying themes in order understand what those discussions were about. A directed content analysis methodology was used to analyze 2400 tweets. Tweets were read and coded for overt and latent themes in an iterative fashion until saturation of themes occurred. The major themes identified in the tweets were fundraising as a priority (34 %), making a change to men's health (18 %), the campaign as a moustache contest rather than a charity (26 %), the use of masculine metaphors/imagery (9 %), and the role of women as moustache supporters (4 %). Findings from Twitter suggest that users rarely associate their campaign efforts with prostate and/or testicular cancer in public online conversations about the 2013 Movember Canada campaign.
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Affiliation(s)
- Caroline A Bravo
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue W, Waterloo, Ontario, N2L 5X4, Canada
| | - Laurie Hoffman-Goetz
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue W, Waterloo, Ontario, N2L 5X4, Canada.
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Bravo CA, Hoffman-Goetz L. Tweeting About Prostate and Testicular Cancers: Do Twitter Conversations and the 2013 Movember Canada Campaign Objectives Align? J Cancer Educ 2016; 31:236-243. [PMID: 25649663 DOI: 10.1007/s13187-015-0796-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Prostate cancer is the most frequently diagnosed cancer of the reproductive system in men. Mass media campaigns have long been a tool for raising awareness of important health issues and changing health behavior. The Movember campaign was launched in Canada in 2007 with the goal of creating conversations about men's health in order to raise awareness and understanding about prostate cancer. In 2012, testicular cancer was added to the Movember Canada campaign agenda. Social networking sites such as Twitter are popular platforms for conversations in the digital age. Our objective was to determine if the Movember Canada 2013 campaign accomplished the goal of creating conversations about prostate and testicular cancers on the social media platform of Twitter. We conducted a content analysis of 4222 Canadian tweets posted during the November 2013 Movember Canada campaign to investigate whether tweets were health-related or non-health-related and to determine what topics of discussion were present in the tweets. There were significantly fewer health-related (n = 673) than non-health-related (n = 3549) tweets (p < 0.05). Few tweets (0.6 % of all tweets) referenced prostate or testicular cancers. Community engagement activities as well as moustache and grooming references were the most frequent topics in the health-related (10.49 and 1.97 %) and non-health-related (32.83 and 32.76 %) categories, which were significantly different by topic (p < 0.05). Findings from Twitter suggest that the Movember Canada 2013 did not meet the stated campaign objective of creating conversations about men's health and, specifically, about prostate and testicular cancers.
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Affiliation(s)
- Caroline A Bravo
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue W, Waterloo, Ontario, N2L 5X4, Canada
| | - Laurie Hoffman-Goetz
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue W, Waterloo, Ontario, N2L 5X4, Canada.
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Bravo CA, Hoffman-Goetz L. Social Media and Men's Health: A Content Analysis of Twitter Conversations During the 2013 Movember Campaigns in the United States, Canada, and the United Kingdom. Am J Mens Health 2015; 11:1627-1641. [PMID: 26669771 DOI: 10.1177/1557988315617826] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The Movember Foundation raises awareness and funds for men's health issues such as prostate and testicular cancers in conjunction with a moustache contest. The 2013 Movember campaigns in the United States, Canada, and the United Kingdom shared the same goal of creating conversations about men's health that lead to increased awareness and understanding of the health risks men face. Our objective was to explore Twitter conversations to identify whether the 2013 Movember campaigns sparked global conversations about prostate cancer, testicular cancer, and other men's health issues. We conducted a content analysis of 12,666 tweets posted during the 2013 Movember campaigns in the United States, Canada, and the United Kingdom (4,222 tweets from each country) to investigate whether tweets were health-related or non-health-related and to determine what topics dominated conversations. Few tweets ( n = 84, 0.7% of 12,666 tweets) provided content-rich or actionable health information that would lead to awareness and understanding of men's health risks. While moustache growing and grooming was the most popular topic in U.S. tweets, conversations about community engagement were most common in Canadian and U.K. tweets. Significantly more tweets co-opted the Movember campaign to market products or contests in the United States than Canada and the United Kingdom ( p < .05). Findings from this content analysis of Twitter suggest that the 2013 Movember campaigns in the United States, Canada, and the United Kingdom sparked few conversations about prostate and testicular cancers that could potentially lead to greater awareness and understanding of important men's health issues.
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