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.

This article investigates the topics and sources of the messages that are remembered about breast cancer that can improve the efficacy of future breast cancer outreach. Most women (60%) recalled a memorable message, described it, identified its source, and noted whether it had resulted in prevention or detection behaviors. Four categories of message topics emerged: early detection (37.3%), awareness (30.9%), treatment (25.8%), and prevention (6%). Furthermore, five categories of sources of these memorable messages were found: media (35.5%), friends (22.2%), family (21.6%), medical professionals (15.2%), and others (5.5%). The media were a major source of all four topics of messages although family members, friends, and the medical community were major sources for particular message topics, as well. Memorable messages originating from medical professionals were substantially more likely to motivate detection behaviors than prevention behaviors. This research demonstrates that message topic and source both play roles in determining message recall as well as in determining how memorable messages impacted behavior.

This presentation begins with an overview of the memorable messages framework by defining memorable messages, discussing the contexts in which they are found and studied, and highlighting the general findings of such studies.Then, Stohl discusses how memorable messages have been studied in the context of breast cancer.These studies have shown that many women of all ages recall memorable messages about breast cancer, and that such messages come from a variety of sources and are about different topics (e.g. prevention, detection, etc.). She also highlights research that examines the gain- or loss-framing of memorable messages, and the association the different forms of the messages have with prevention or detection behaviors.

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Abstract:It may seem obvious that communication targets are able to recall some messages much longer after initial exposure to the message than others. These memorable messages are remembered for long periods and have the ability to influence behavior when targets recall them from memory long after initial exposure to the message. It is not immediately obvious, however, why only some messages become memorable. Knowing which messages become memorable can improve the long-term efficacy of future breast cancer outreach. To this end, 359 women completed an online survey about memorable messages they recalled about breast cancer. Most women (60%) recalled a memorable message, described it, identified its source, and noted whether it had resulted in prevention or detection behaviors. Four categories of messages emerged: early detection (37.3%), awareness (30.9%), treatment (25.8%), and prevention (6%). Furthermore, five categories of sources emerged (media (35.5%), friends (22.2%), family (21.6%), medical professionals (15.2%), and others (5.5%)). The media were a major source of all four types of messages although family members, friends, and the medical community were major sources of these message types as well. Furthermore, memorable messages originating from medical professionals were substantially more likely to motivate detection behaviors than prevention behaviors. Overall, this research demonstrates that not only do message type and source both play roles in determining message recall they also both play roles in determining how the memorable message will impact behavior.

Abstract: Memorable messages can to be guides to actions such as practicing health behaviors. Message framing suggests that gain framed messages are well suited to promote disease prevention behaviors, whereas loss-framed messages are better for promoting detection behaviors. A set of self-reported memorable messages about breast cancer was examined. About one-fourth of the reported messages were framed, and most of them were gain-framed. Gain-framed messages were found to be significantly associated with prevention behaviors.

Abstract: 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 while 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 show that friends and family are important sources of memorable messages about breast cancer.

View the slides from the ICA Presentation (PPT file)

Abstract: Healthy People 2010 identified increasing access to the internet as an objective due to the internet’s role as a popular channel for health information. However, this access is meaningless if individuals are not able to operate and learn from health websites. This inability to maximize use of health websites results from a myriad of barriers including low literacy levels, lack of internet skills, and diverse cultural backgrounds. Unfortunately, most studies evaluating health websites to date have superficially focused on basic design tenets. The few studies measuring other assets of health websites have yielded poor results demonstrating that these websites are not friendly to a diverse array of audiences. In an attempt to launch a robust means to assess the plethora of issues surrounding optimal use of health websites we have developed four evaluation sheets to grade design, literacy, health and information content qualities of health websites.

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Abstract:

Background: A growing numbers of individuals affected by breast cancer are turning to the web for information. The internet has unique capabilities for supplying health information, including the use of targeting specific populations and employing specific evidence strategies to create more effective messages.

Objective: This research sought to address the presence of information targeting low literacy, racially diverse, non-English speaking, and age diverse audiences. In addition, this study documented the utilization of evidence strategies for these four audiences. Specifically, the likelihood that those websites which target one of these four audiences are to make use of statistical or storytelling evidence was compared to websites that do not target one of these four audiences.

Method: This research examined these relationships on 157 breast cancer websites through content analysis.

Results: Nearly half of the websites did not target the groups of interest here. Websites with multiple languages were found to be more likely to use statistical evidence and websites with low literacy sections were found to be less likely to do so, as compared to websites that did not target these groups. Websites with ethnic or racial diversity and age diversity sections were more likely to use first person storytelling about breast cancer, as compared to websites that did not target these groups.

Conclusions: Current breast cancer websites demonstrate promising use of targeting specific audiences and employing evidence strategies prescribed as effective by past research. Future research examining these issues will benefit with direct input from website users.

Abstract: Introduction: Healthy People 2010 identified increasing access to the internet as an objective due to the internet's role as a popular channel for health information. However, this access is meaningless if individuals are not able to operate and learn from health websites. This inability to maximize use of health websites results from a myriad of barriers including low literacy levels, lack of internet skills, diverse cultural backgrounds, and knowing English as a second language. Unfortunately, most studies evaluating health websites to date have superficially focused on basic design tenets. The few studies measuring other assets of health websites have yielded poor results demonstrating that these websites are not friendly to a diverse array of audiences.

In an attempt to launch a robust means to assess the plethora of issues surrounding optimal use of health websites, this study developed four evaluation sheets to grade design, literacy, health and information content qualities of health websites after conducting a thorough literature review on website evaluation studies which have been completed to date. The proposed evaluation methodology was tested on five breast cancer websites.

Results & Discussion: The five websites evaluated with this preliminary tool faired best on the design tenets evaluation sheet while having very few of the assets required by the literacy, health content, and information content sheets.

Conclusions & Lessons Learned: In order to create more effective health websites various types of literacy involved in using a website, information content, and health content need to be inline with guidelines that have been laid out by research which has been completed to date. This tool will enable creators of health websites to equip their websites with the resources necessary to enable all users to benefit equally from visiting a site, regardless of such background elements as literacy level or cultural heritage.

Abstract:

Background: The internet is increasingly being utilized by people seeking health information. As a result, a myriad of studies regarding the evaluation of websites have been completed. However, the majority of these studies are superficial in depth by focusing mainly on design tenets, despite the fact that research has established the crucial role of other pertinent aspects of health websites, such as a variety of literacy issues, health content, and informational content.

Objective: In an attempt to launch a robust means to assess the plethora of issues surrounding optimal use of health websites, this study sought to: 1) develop four evaluation worksheets that measure design tenets, literacy issues, health content, and information content for health websites, including those for breast cancer, and 2) test the proposed evaluation methodology on five breast cancer websites.

Methods: An extensive literature review on website evaluation and the different types of literacy required to use health websites was performed. This review led to the creation of four evaluation worksheets for health websites, which assess: basic design tenets like proper format and usability; health content related to whether the website motivates users to perform health tasks and contains social support material; literacy types such as readability of the site and cultural diversity present on the site; and finally, informational content such as whether the site displays references and authors of material. The proposed evaluation methodology was then tested on five breast cancer websites, including: www.cbcrp.org, http://www.intelihealth.com/IH/ihtIH/WSIHW000/8293/8293.html, http://www.lifetimetv.com/breastcancer/petition/signpetition.php, http://www.drgreene.com/21_625.html, and http://cancer.uchc.edu/patients_families/treatment_types/breast/index.html.

Results: The five websites evaluated with this preliminary tool scored highest on the design tenets evaluation sheet while having very few of the assets required by the literacy, health content, and information content sheets.

Conclusions: In order to create more effective breast cancer websites, various types of literacy involved in using a website, information content, and health content need to parallel guidelines that have been identified by current research . This tool will allow organizations to first evaluate their website and then improve it through offering tailored guidelines based on responses given to the four areas of assessment.

Abstract:

Background: Websites with health information have become very popular destinations for individuals who use the internet. One population that has been researched for their use of such websites are individuals who have been impacted by breast cancer.

Objective: To determine if the most frequented breast cancer websites are tailored to groups of different ethnicities or races, ages, languages, disability statuses, and literacy levels and to determine if those websites that do tailor to these diverse audiences are more or less likely to use statistics or first-person storytelling about breast cancer as past studies have shown cultural preference for storytelling versus use of statistics.

Methods: An in-depth analysis of the 157 most frequented breast cancer websites was completed. These websites were analyzed for basic design tenets and theoretical tenets. After reliability was obtained, trained coders independently coded the 157 websites and inputted the data into SPSS. For this portion of the study, the specific variables of ethnicity/race, age, language, disability, and literacy level were examined in analysis using frequencies and crosstabs.

Results: Thirty percent of websites contained information available in multiple languages, the most popular of which were Spanish (26%) and French (7%). Fourteen percent of websites had sections that were tailored toward specific minority groups, mostly for African Americans (12%) and Hispanics (10%). Regarding literacy, 23% of the websites contained material that could be read by an individual at a 9th grade reading level or below. Only 1 website made accommodations for individuals with disabilities and 17% of websites had information specifically for individuals of different age groups.

Websites which tailored toward individuals of diversity were found to differ in their likelihood of using statistics and first person storytelling as compared to websites that did not tailor toward individuals of diversity. Websites with sections tailored toward minorities were found to be significantly more likely to employ first person stories about breast cancer on their websites compared to those websites that did not have sections for minorities (p=003), as were websites that were tailored toward different age groups (p<.000). Websites with multiple languages were more likely to make use of statistics regarding breast cancer than were those websites that only gave material in English (p=.043). The same was found to be true for lower-literacy websites (p=.004) and those with sections for minority groups (p=.034).

Conclusions: Tailored information is one of the most beneficial aspects of interactive communication yet it appears that breast cancer websites are failing to make use of this tool for diverse audiences. Additionally, website tailoring toward diverse audiences has a relationship with storytelling and statistics use. Future efforts should be made to include more tailored communication on breast cancer websites and to further examine the effects of tailoring to diverse audiences on other website content.

View the slides from the ICA Presentation (PDF file)

Abstract:

Introduction: The internet is a prominent source of health information for the public. This research evaluated both basic use and design tenets and the presence of theoretical components to motivate healthy breast cancer behavior for users of the most frequented breast cancer websites.  

Methodology: Each website was evaluated with two sets of questions. The first attends to the basic use and design tenets of the website. The second coding form assessed the websites use of three behavior change theories.

Results: The majority of the websites fared well with regards to their use of basic tenet and design principles. Theoretical components were used sparingly on the majority of websites.

Discussion: The most frequented breast cancer websites are currently well equipped with basic use and design tenets. However, their lack of behavioral change components is likely to impede users’ motivations to protect themselves against breast cancer.

Abstract: The internet is a prominent source of health information for the public. This research evaluated both basic use and design tenets and the presence of theoretical components to motivate healthy breast cancer behavior for users of the most frequented breast cancer websites. Methodology: Each website was evaluated with 2 sets of questions. The first attends to the basic use and design tenets of the website. The second coding form assessed the websites use of 3 behavior change theories. Results: The majority of the websites fared well with regards to their use of basic tenet and design principles. Theoretical components were used sparingly on the majority of websites. Discussion: The most frequented breast cancer websites are currently well equipped with basic use and design tenets. However, their lack of behavioral change components is likely to impede users’ motivations to protect themselves against breast cancer.

Click to listen to Pam Whitten on the Walt Sorg Show - 10/20/2008

This article by Charles K. Atkin, Sandi W. Smith, Courtnay McFeters, and Vanessa Ferguson was published in The Journal of Health Communication.  The abstract is as follows: Breast cancer has a high profile in the news media, which are a major source of information for cancer patients and the general public. To determine the nature of breast cancer news coverage available to audiences, particularly on the topics of environmental risks and prevention, this content analysis measured a broad array of dimensions in 231 stories appearing in nine leading newspapers, newsmagazines, and television networks in 2003 and 2004. One fourth of all stories reported on various risks such as hormone replacement therapy (HRT) use. Very few items specifically addressed risks related to controllable lifestyle practices such as prepubertal obesity or chemical contaminants in the environment. About one third of the stories included prevention content, primarily focusing narrowly on use of pharmaceutical products. Little information described risk reduction via other individual preventive behaviors (e.g., diet, exercise, and smoking), parental protective measures, or collective actions to combat contamination sites. The more traditional categories of prevalence, detection, and treatment were featured in one third, one quarter, and two fifths of the news items, respectively. There were twice as many stories featuring personal narratives as statistical figures, and two thirds of all the news items cited expert medical professionals, researchers, or organizations. Implications of these findings and directions for future research are addressed.

An article titled “Adolescent females and their mothers: Examining perceptions of the environment and breast cancer” has been accepted by the Journal of Health Psychology. It is authored by Julie Volkman and Kami Silk. The manuscript was also presented at the 2006 annual meeting of the Eastern Communication Association in Philadelphia, PA. The abstract of this article is as follows:

This poster was created by COTC researchers and advocates, including Kami Silk, Charles Atkin, Doshik Yun, Nicholas Bowman, Jo Ann Johnson, Janet Osuch, and Karen Pierce. It is titled, “Persuading mothers to perform breast cancer prevention practices with their pre-adolescent daughters: A pilot message study.” The poster was presented at the Breast Cancer Environment Research Centers annual meeting in Cincinnati, OH.

Breast cancer prevention messages have traditionally targeted the behavior of adult females, recommending regular mammograms, breast self exams, and adopting a healthy lifestyle as key message components. Recent research associating pediatric overweight and exposures to certain estrogen-like chemicals with earlier onset of puberty, as defined by breast development, has extended the need to develop breast cancer prevention messages for pre-adolescent girls (Adzersen et al., 2003). However, as young girls are not equipped with enough resources to reduce breast cancer risk themselves, mothers play an important role in influencing lifestyle factors for their daughters ( Austin, 1995). As a result, early messaging is recommended to mothers of pre-adolescent girls. The study used a 2 (message source: researcher vs. physician) x 2 (involvement: high vs. low) x 3 (message type: lifestyle vs. chemical vs. developmental) between-subjects factorial design. Women (N = 59) were recruited to voluntarily participate in a w eb-based survey. Participants were directed to a website that contained one of 12 possible message conditions and all study questions; they were asked to read the message and complete post-test measures related to message perceptions, attitude, efficacy, behavioral intention to engage in behaviors recommended by the message, and demographics. Preliminary pilot data suggest that attitude toward breast cancer prevention messages was positively related to intentions to seek more information and to talk with friends and family; it was not a good predictor of intention to talk with doctors. Also, having a daughter increases mother' intentions to seek information and to talk with family, friends, and doctors about the message content. For the larger study, researchers should aim to strengthen the source manipulation, clarify measurement of efficacy constructs, remove the graphics behind the message, and maintain a 9th grade literacy level throughout all of the messages.

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This powerpoint presentation was delivered at the 2007 interim meeting of the BCERC in Bethesda, MD. The presentation provided a preliminary glimpse of the BCERC Message Testing Study proposed by the COTC. It also provided an overview of results from a website content analysis, Communication Assessments of Top Breast Cancer Websites: Evaluation of Design and Theoretical Criteria, conducted by Pamela Whitten, Sandi Smith, Samantha Munday, & Carolyn LaPlante of Michigan State University.

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This presentation, Merging Scientific and Advocate Communities: The Transdisciplinary Research Model in the BCERC, was created by Kami Silk. The presentation was based on feedback from COTC members regarding the BCERC model of conducting research. It was presented at the 2007 Centers for Disease Control and Prevention (CDC) Health Communication, Media, & Marketing Conference, Atlanta, GA.

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The Third Annual Healthy Kids Summit provided an opportunity for researchers and health practitioners to communicate with parents about obesity related issues among adolescents. Kami Silk served as panelist at this 2007 event to provide information about the BCERC and answer parent questions about the research. The panel convened in January 2007 at the Olivet Community Schools, Olivet, MI.

This powerpoint presentation introduced COTC members to the idea of conducting a message study to test audience responses to breast cancer risk reduction messages. The powerpoint was conceptual in nature, trying to explain the purpose of the study and generate discussion of ideas for conducting the collaborative study. The powerpoint was presented at the COTC meeting for the 2006 Breast Cancer and Environment Research Centers meeting, Berkley, CA.

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Created by Pamela Whitten, Sandi Smith, Samantha Munday, and Carolyn LaPlante, this 2007 BCERC meeting poster presents guidelines for the creation and maintenance of breast cancer websites derived from a study of the most popular breast cancer websites. The sites were chosen based on searches done with Google, Yahoo, and MSN search engines with the keywords "breast cancer" and "breast cancer and the environment." Websites were evaluated with a content analysis coding scheme, which was created by using components from the Theory of Planned Behavior, the Extended Parallel Process Model, and the Transtheoretical Model. Results provided on the poster reflect data as collected from the first 80 websites coded and show that while websites seem to have important basic design tenets covered, most are weak in terms of theoretical behavior change components within their content.

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A poster and handout created by Samantha Munday, Carolyn LaPlante, Sandi Smith, and Charles Atkin for the November, 2007 Breast Cancer and the Environment Meeting in Cincinnati was titled an “Annotated bibliography of relevant journals for possible publication of advocate and communication research.” The objective of this research was to help breast cancer advocates and communication researchers find the right journals in which to submit their work for publication.

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This poster created by Sandi Smith, Samantha Munday, Carolyn LaPlante, Michael Kotowski, Charles Atkin, Christine Skubisz, and Cynthia Stohl is titled “Types and sources of memorable breast cancer messages and their impact on prevention and detection behaviors.” It was presented at the 2007 BCERC meeting in Cincinnati. A paper on this topic was also presented by the same authors at the 2007 meeting of the National Communication Association in Chicago.

Four categories and 16 subcategories of message types emerged: (1) breast cancer awareness (statistics/facts, breast cancer affects us all, campaigns/organizations), (2) prevention (health/be proactive, improve/change a health behavior, family risk), (3) detection (breast self exam, mammograms, breast self exam and mammograms, early detection), and (4) treatment (appearance, choices, survival choices, social support, womanhood, fear/pain/negative, appreciation for everyday life). The analysis showed that 39% recalled a detection message, followed by 30% for treatment, 29% for awareness, and 2% for prevention. Four categories of sources emerged accounting for 94% of all sources reported. Media constituted the most reported source across all four categories of meaningful messages (30%), followed by family members (25%), friends (22%), and doctors (17%).

The majority of participants who had an awareness message (22 total) reported its source as the media (11), followed by friend (4), family member (3), doctor/health care professional (3), and other (1). Two participants' messages were about prevention, one each from a family member and the media. In the detection category, (30 total) family members (9) were reported most often, closely followed by doctors/health care professionals (8), media (6), friends (5), and other (2). Treatment meaningful messages (23 total) came mostly from friends (8), then family members (6), media (5), doctor/health care professionals (2), and other (2).

Respondents recalled few messages about breast cancer prevention, but they did recall messages about detection. This research demonstrates the power of the media, as well as the possibility that messages from family and friends are more likely to impact women's lives than those from the medical community.

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This presentation, created by Charles Atkin, Sandi Smith, Pamela Whitten, Kami Silk, and Lauren Hamel, was presented at the 2007 conference of the International Communication Association. It discusses research investigating the current state of breast cancer messages in both traditional media and the Internet, as well as women's perceptions of breast cancer risk. The content emphasis of current breast cancer news stories is identified, with treatment being the most common topic, followed by detection and prevention. Data provided from an evaluation of the top 157 breast cancer websites are presented, and some examples of this web content are shown. Results from a 2007 survey of women are also provided, which detail women's exposure to breast cancer messages, their ideal sources for learning breast cancer information, their beliefs about the credibility of breast cancer information sources and channels, and their perceptions of the severity of breast cancer risk factors. The authors finish the presentation by discussing implications of the research, which are centered around creating "better" breast cancer websites.

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This poster, created by Samantha Munday and Carolyn LaPlante, won a first place award at the 2007 Undergraduate University Research & Arts Forum at Michigan State University. The research it presents is part of a larger study analyzing the most frequently hit breast cancer websites in terms of design and use of theoretical behavior change components (self-efficacy, consciousness raising, self-reevaluation, etc.). The focus of this research was to assess how often these theoretical components were utilized to encourage users to partake in breast cancer detection and/or prevention behaviors and to solicit donations for the website's sponsoring organization.

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Kami Silk gave a series of presentations about the BCERC project to a variety of groups in 2005 & 2006. The presentations were similar in content and were delivered to: 1) the Eaton County Breast Cancer Survivors Group at the Hayes Green Beach Memorial Hospital in Charlotte, MI; 2) the STAR breast cancer prevention clinical trial participants sponsored by the Great Lakes Cancer Institute (GLCI) and MSU Surgery at the Kellogg Center, MSU Campus, East Lansing, MI; 3) the Society of Professional Health eters at the 2006 National Communication Association conference display updated findings from the breast cancer content analysis. This presentation features more details about individual sources of all the news stories analyzed, the coverage of environmental risk factors, and the coverage of individual prevention methods. Additionally, it describes the discrepancy between narrative and statistics based stories and between treatment and prevention based stories. Also discussed are the implications of the findings, questions raised by the research, and a model persuasion strategy that could be utilized in future news stories.

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