Increasing preventive health services via tailored health communications.

OBJECTIVES: To develop a methodology that stratifies members by likelihood of completing a colorectal cancer screening (CRCS). Such information can guide the communication development and the allocation of resources for tailored communication outreaches. STUDY DESIGN: Prospective study of an insured commercial population that includes randomized assignments to a control group or a treatment group for communication interventions. METHODS: A total of 46,697 members overdue (nonadherent based on available administrative data) for a CRCS were assigned to 1 of 5 graded segments as part of an interactive voice response (IVR) call. Another 400 members per outreach segment were randomly assigned to a control group and received no communication. Primary outcome: receipt of CRCS (assessed Healthcare Effectiveness Data and Information Set [HEDIS] summary data, 3 months after IVR) for each graded segment within the control and the intervention groups. Secondary outcomes: association between the CRCS rates and the identified segments; communication cost per completed screening. RESULTS: Primary outcome: 1971 members completed the screening. Screening rates for the 5 graded segments were 2.4%, 3.6%, 5.0%, 7.2%, and 8.0%. Secondary outcome: c2 proportions test a significant association between the segment groups and the CRCS completion rates. The association between segment and screening rates follow the expected predicted range in both the intervention and holdout groups. Communication cost per screening: $14.84. CONCLUSIONS: Segmenting members by variables that are associated with CRCS completion identified graded segments that completed the CRCSs at different rates. Tailored interventions can be developed to promote a health service for each segment. The segmentation approach proves to be beneficial.

Identifying gender-preferred communication styles within online cancer communities: a retrospective, longitudinal analysis.

BACKGROUND: The goal of this research is to determine if different gender-preferred social styles can be observed within the user interactions at an online cancer community. To achieve this goal, we identify and measure variables that pertain to each gender-specific social style. METHODS AND FINDINGS: We perform social network and statistical analysis on the communication flow of 8,388 members at six different cancer forums over eight years. Kruskal-Wallis tests were conducted to measure the difference between the number of intimate (and highly intimate) dyads, relationship length, and number of communications. We determine that two patients are more likely to form an intimate bond on a gender-specific cancer forum (ovarian P = <0.0001, breast P = 0.0089, prostate P = 0.0021). Two female patients are more likely to form a highly intimate bond on a female-specific cancer forum (Ovarian P<0.0001, Breast P<0.01). Typically a male patient communicates with more members than a female patient (Ovarian forum P = 0.0406, Breast forum P = 0.0013). A relationship between two patients is longer on the gender-specific cancer forums than a connection between two members not identified as patients (ovarian forum P = 0.00406, breast forum P = 0.00013, prostate forum P = .0.0003). CONCLUSION: The high level of interconnectedness among the prostate patients supports the hypothesis that men prefer to socialize in large, interconnected, less-intimate groups. A female patient is more likely to form a highly intimate connection with another female patient; this finding is consistent with the hypothesis that woman prefer fewer, more intimate connections. The relationships of same-gender cancer patients last longer than other relationships; this finding demonstrates homophily within these online communities. Our findings regarding online communication preferences are in agreement with research findings from person-to-person communication preference studies. These findings should be considered when designing online communities as well as designing and evaluating psychosocial and educational interventions for cancer patients.

Identifying Temporal Changes and Topics that Promote Growth Within Online Communities: A Prospective Study of Six Online Cancer Forums.

In this paper the authors have extended the methodology for temporal analysis of online forums and applied the methodology to six online cancer forums (melanoma, prostate cancer, testicular cancer, ovarian cancer and breast cancer). The goal was to develop, apply and improve methods that quantify the responsiveness of the interactions in online forums in order to identify the users and topics that promote use and usefulness of these online medical communities. The evolutional stages that gauge when a forum is expanding, contracting, or in a state of equilibrium were considered. The response function was thought to be an approximation of a discussion group's utility to its members. By applying the evolutionary phase algorithm, it was determined that two out of six of the forums are in contracting phases, while four are in their largest growth phase. By analyzing the topics of the influential threads, the authors conclude that cancer treatment discussions as well as stage IV cancer discussions promote growth in the forums. It is observed that the discussion of treatment rather than diagnosis is important to help a cancer forum thrive.

Social network analysis of an online melanoma discussion group.

We have developed tools to explore social networks that share information in medical forums to better understand the unmet informational needs of patients and family members facing cancer treatments. We define metrics that demonstrate members discussing interleukin-2 receive a stronger response from the melanoma discussion group than a typical topic. The interleukin-2 network has a different topology than the melanoma network, has a higher density, and its members are more likely to have a higher intimacy level with another member and a lower inquisitiveness level than a typical melanoma user. Members are more likely to join the interleukin-2 network to answer a question than in the melanoma network (probability =.2 ±.05 p-value=.001). Within the melanoma network 20% of the questions posed to the community do not get an answer. In the interleukin-2 network, 1.3% of the questions (one question) do not get a response.