Elsevier

Social Science & Medicine

Volume 104, March 2014, Pages 31-40
Social Science & Medicine

Comparing tailored and narrative worksite interventions at increasing colonoscopy adherence in adults 50–75: A randomized controlled trial

https://doi.org/10.1016/j.socscimed.2013.12.003Get rights and content

Highlights

  • Compares tailoring and narrative-based interventions.

  • Those receiving narratives were 4 times more likely to screen.

  • Tailored materials did not increase screening overall.

  • Tailored materials did increase screening for adults with high overload.

Abstract

Research has identified several communication strategies that could increase adherence to colorectal cancer screening recommendations. Two promising strategies are tailoring and narrative-based approaches. Tailoring is the personalization of information based on individual characteristics. Narrative-based approaches use stories about similar others to counter perceived barriers and cultivate self-efficacy. To compare these two approaches, a randomized controlled trial was carried out at 8 worksites in Indiana. Adults 50–75 (N = 209) received one of four messages about colorectal cancer screening: stock, narrative, tailored, tailored narrative. The primary outcome was whether participants filed a colonoscopy claim in the 18 months following the intervention. Individuals receiving narrative messages were 4 times more likely to screen than those not receiving narrative messages. Tailoring did not increase screening behavior overall. However, individuals with higher cancer information overload were 8 times more likely to screen if they received tailored messages. The results suggest that narrative-based approaches are more effective than tailoring at increasing colorectal cancer screening in worksite interventions. Tailoring may be valuable as a strategy for reaching individuals with high overload, perhaps as a follow-up effort to a larger communication campaign.

Introduction

Colorectal cancer (CRC) is the third most common cancer in men and women, and accounts for almost ten percent of cancer deaths in the United States (Siegel, Naishadham, & Jemal, 2013). These rates have been declining for two decades, due in part to increased utilization of CRC screening (Smith, Brookes, Cokkinides, Saslow, & Brawley, 2013). CRC screening has been advocated for adults aged 50–75 since the early 1980s (Vernon et al., 2011), but adherence is under 60% nationally (Smith et al., 2013). Given the health benefits of CRC screening – and its inclusion as a national public health objective – identifying strategies to increase participation in screening is a priority.

One communication strategy that has increased CRC screening adherence is tailoring (e.g., Manne et al., 2009). Tailoring is the personalization of information based on user characteristics (Kreuter, Farrell, Olevitch, & Brennan, 2000). Instead of crafting a message for everyone (stock messages) or for a particular group or demographic (targeted messages), tailoring involves the creation of unique messages for each individual (Rimer & Kreuter, 2006). For example, a targeted message might be designed for Hispanic men in general whereas a tailored message would address the attitudes, beliefs, and risk factors of a particular Hispanic man. Thus, tailoring provides information relevant to the individual rather than the group. Meta-analyses have revealed that tailored messages are more effective than untailored messages at increasing adherence to cancer screening recommendations, though the typical effect is small (r = .08, 95% CI: .06, .09) and most studies have relied on self-report measures of screening (e.g., Krebs et al., 2010, Noar et al., 2007).

An alternative strategy is to use narratives to increase CRC screening adherence (Green, 2006). Narratives are also called stories and include characters and a string of connected events (Kreuter et al., 2007). CRC screening narratives often depict individuals grieving lost loved ones, overcoming challenges, benefitting from behaviors, or using services (Dillard, Fagerlin, Dal Cin, Zikmund-Fisher, & Ubel, 2010). Narratives may be effective at changing behavior because people enjoy stories, become absorbed in the plot, and may be less likely to reject (or even notice) counter-attitudinal information (Dal Cin et al., 2004, Moyer-Gusé and Nabi, 2010, Slater and Rouner, 2002). Narratives are also effective vehicles for conveying information that is culturally aligned or centered (Larkey & Hecht, 2010). Communication researchers have noted that narratives are a promising strategy for increasing cancer screening participation, and these approaches are being used more frequently in promoting health and wellness (Kreuter et al., 2007).

To compare tailoring and narrative communication strategies, a randomized controlled trial (RCT) was developed and carried out at eight worksites. In the RCT, adults were randomly assigned to receive one of four pamphlets about CRC screening: stock, narrative, tailored, or tailored narrative. In the latter, the pamphlet was personalized to participants' characteristics and included a narrative with a protagonist from the same gender and racial/ethnic demographic. The main outcome of interest in this study was CRC screening behavior. To measure this outcome, insurance claims data were collected 18 months after the intervention for each participant to track CRC screening. Thus, the current study examines the effectiveness of two different strategies (alone and in combination) and utilizes a more objective measure of behavior (insurance claims data) than many previous studies.

Section snippets

Tailoring

Tailored messages were originally crafted by hand and evaluated via tailored letter interventions or tailored counseling (Kreuter, Strecher, & Glassman, 1999). Innovations in communication technology have facilitated tailoring efforts by replacing hand tailoring with computerized algorithms (e.g., Jensen, King, Carcioppolo, & Davis, 2012). Computerized, algorithmic-based tailoring can provide people with personalized information quickly and makes this approach more sustainable for interventions

Study design

A 2 (stock vs. tailored) × 2 (no narrative vs. narrative) message intervention was carried out in eight Indiana worksites (six hospitals and two manufacturing plants). Participants completed a pretest on a computer (Time 1) and then were randomly assigned by the computer to one of four intervention conditions: stock (no narrative, no tailoring), narrative (narrative, no tailoring), tailored (no narrative, tailored), or tailored narrative (narrative, tailored). The message intervention was

Results

Three hierarchical logistic regressions were utilized to evaluate the effectiveness of tailored and narrative message approaches. The regression was not significant for FOBT claims, Cox & Snell R2 = .09, −2 Log Likelihood = 41.86, χ2 = 19.18, df = 15, p = .206, and it was only significant at the second block for the combined category, Cox & Snell R2 = .07, −2 Log Likelihood = 133.05, χ2 = 4.26, df = 1, p = .039. Individuals with greater CIO were less likely to file a CRC cancer screening claim,

Discussion

Researchers from a number of fields have examined strategies for increasing CRC screening adherence. These efforts have yet to identify a cost-effective strategy that consistently increases screening adherence. Vernon et al. (2011) noted this following the failure of another randomized controlled trial:

To date, as a research community, we have yet to identify an intervention approach for CRC screening that is consistently more effective than usual care or minimal cues despite using the best

Acknowledgments

Jakob D. Jensen (Ph.D., University of Illinois, 2007) is an Assistant Professor in the Department of Communication and the Department of Health Promotion and Education at the University of Utah. Andy J. King is an Assistant Professor in the Department of Public Relations at Texas Tech University. Nick Carcioppolo is an Assistant Professor in the Department of Communication at the University of Miami. Melinda Krakow is a doctoral student in the Department of Communication at the University of

References (65)

  • A. Winterbottom et al.

    Does narrative information bias individual's decision making? A systematic review

    Social Science & Medicine

    (2008)
  • H. Abbott

    The Cambridge introduction to narrative

    (2002)
  • N.K. Arora et al.

    Frustrated and confused: the American public rates its cancer-related information-seeking experiences

    Journal of General Internal Medicine

    (2008)
  • A. Bandura

    Health promotion by social cognitive means

    Health Education & Behavior

    (2004)
  • H.A. Beydoun et al.

    Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States

    Cancer Causes & Control

    (2008)
  • M. Borenstein et al.

    Introduction to meta-analysis

    (2009)
  • R. Busselle et al.

    Fictionality and perceived realism in experiencing stories: a model of narrative comprehension and engagement

    Communication Theory

    (2008)
  • Centers for Disease Control and Prevention (CDC)

    Behavioral Risk Factor Surveillance System survey data

    (2010)
  • J. Cohen

    Statistical power analysis for the behavioral sciences

    (1988)
  • S. Dal Cin et al.

    Narrative persuasion and overcoming resistance

  • F. Faul et al.

    Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses

    Behavior Research Methods

    (2009)
  • K. Glanz et al.

    The role of behavioral science theory in the development and implementation of public health interventions

    Annual Review of Public Health

    (2012)
  • M.C. Green

    Narratives and cancer communication

    Journal of Communication

    (2006)
  • M.C. Green et al.

    The role of transportation in the persuasiveness of public narratives

    Journal of Personality and Social Psychology

    (2000)
  • J.M. Griffith et al.

    Should a colon cancer screening decision aid include the option of no testing? A comparative trial of two decision aids

    BMC Medical Informatics and Decision Making

    (2008)
  • J.A. Hayes

    PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling

    (2012)
  • A.F. Hayes et al.

    Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations

    Behavior Research Methods

    (2009)
  • J.D. Jensen

    Addressing health literacy in the design of health messages

  • J.D. Jensen et al.

    Dispositional cancer worry: convergent, divergent, and predictive validity of existing scales

    Journal of Psychosocial Oncology

    (2010)
  • J.D. Jensen et al.

    The delay hypothesis: the manifestation of media effects over time

    Human Communication Research

    (2011)
  • J.D. Jensen et al.

    Including limitations in news coverage of cancer research: effects of news hedging on fatalism, medical skepticism, patient trust, and backlash

    Journal of Health Communication

    (2011)
  • J.D. Jensen et al.

    The cancer information overload (CIO) scale: establishing predictive and discriminant validity

    Patient Education & Counseling

    (2013)
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