Explaining the effects of a decision intervention on mammography intentions: The roles of worry, fear and perceived susceptibility to breast cancer.

OBJECTIVE: This study examines the effects of a mammography decision intervention on perceived susceptibility to breast cancer (PSBC) and emotion and investigates how these outcomes predict mammography intentions. DESIGN: Randomised between-subjects online experiment. Participants were stratified into two levels of risk. Within each stratum, conditions included a basic information condition and six decision intervention conditions that included personalised risk estimates and varied according to a 2 (amount of information: brief vs. extended) × 3 (format: expository vs. untailored exemplar vs. tailored exemplar) design. Participants included 2465 US women ages 35-49. MAIN OUTCOME MEASURES: PSBC as a percentage, PSBC as a frequency, worry, fear and mammography intentions. RESULTS: The intervention resulted in significant reductions in PSBC as a percentage for women in both strata and significant increases in worry and fear for women in the upper risk stratum. Of the possible mediators examined, only PSBC as a percentage was a consistent mediator of the effect of the intervention on mammography intentions. CONCLUSION: The results provide insight into the mechanism of action of the intervention by showing that PSBC mediated the effects of the intervention on mammography intentions.

Comparing the effectiveness of two different decision aids for stable chest discomfort.

BACKGROUND: Decision aids (DAs) have been shown to increase decision quality in randomized controlled trials. This study compared the effectiveness of two different decision aids with different modes of delivery. PARTICIPANTS AND METHODS: Patients with angiogram-proven coronary artery disease (CAD) were eligible to participate and randomly assigned to either a booklet/DVD DA or an online DA. Participants completed a survey after viewing the material that assessed patients' knowledge, treatment preferences, use of and satisfaction with the tool, and open-ended reflections on the treatment decision-making process. RESULTS: Of the 62 patients screened, 34 agreed to participate and were randomly assigned to a group. Of those, 28 (15/17 booklet/DVD and 13/17 online) participants completed the survey. Patients were more likely to report reviewing all of the booklet/DVD DA compared with the online DA (60 vs. 31%, P=0.15). Knowledge scores were significantly higher in the booklet/DVD DA group than the online DA group (67 vs. 47%, P=0.018). Participants in both arms felt it was very or extremely important that doctors give patients materials like these before a catheterization (93% for booklet/DVD DA and 85% for online, P=0.54). Patients' qualitative feedback highlighted significant gaps in knowledge about treatment options, as well as a strong desire to have educational materials in advance of diagnostic catheterizations. CONCLUSION: The pilot study suggests that both decision aids are highly valued by patients with CAD. The booklet/DVD DA was associated with higher rates of complete review and improved knowledge about the management of stable coronary disease.

Naturally good: Front-of-package claims as message cues.

Excess bodyweight is a significant public health problem in the United States, increasing the risk of adverse health conditions including hypertension, diabetes, heart disease, stroke, and cancer. Americans are consuming more calories than their bodies need each day and making purchasing decisions using heuristic cues, rather than caloric information. A recent trend in food and beverage labeling is the placement of a natural claim on a product's package. Unfortunately, the United States has not established clear requirements for natural claims and manufacturers are using this term liberally. Using models of information processing as a framework, the goal of this study was to predict the effects of natural claims on message processing and evaluations. It was predicted that natural claims would be perceived as heuristics for healthfulness. A 6 (product) x 2 (claim) experimental design was carried out. Support for the prediction that natural labeled products are evaluated as more healthful was found. Despite the fact that natural products contained the same number of calories as their regular counterparts, participants estimated that natural products contained 18% fewer calories. Implications of these findings for food labeling and public health are discussed.

Effects of a risk-based online mammography intervention on accuracy of perceived risk and mammography intentions.

OBJECTIVE: This experiment tested the effects of an individualized risk-based online mammography decision intervention. The intervention employs exemplification theory and the Elaboration Likelihood Model of persuasion to improve the match between breast cancer risk and mammography intentions. METHODS: 2918 women ages 35-49 were stratified into two levels of 10-year breast cancer risk (<1.5%; ≥1.5%) then randomly assigned to one of eight conditions: two comparison conditions and six risk-based intervention conditions that varied according to a 2 (amount of content: brief vs. extended) x 3 (format: expository vs. untailored exemplar [example case] vs. tailored exemplar) design. Outcomes included mammography intentions and accuracy of perceived breast cancer risk. RESULTS: Risk-based intervention conditions improved the match between objective risk estimates and perceived risk, especially for high-numeracy women with a 10-year breast cancer risk ≤1.5%. For women with a risk≤1.5%, exemplars improved accuracy of perceived risk and all risk-based interventions increased intentions to wait until age 50 to screen. CONCLUSION: A risk-based mammography intervention improved accuracy of perceived risk and the match between objective risk estimates and mammography intentions. PRACTICE IMPLICATIONS: Interventions could be applied in online or clinical settings to help women understand risk and make mammography decisions.

Tips from Former Smokers: A Content Analysis of Persuasive Message Features.

Years of research on message design and effects provides insight regarding the most persuasive message appeals. The purpose of this study was to evaluate the content of the messages being presented in the Centers for Disease Control and Prevention's Tips from Former Smokers campaign. A content analysis of persuasive message design features was conducted to critically examine campaign content. Campaign materials were coded for the presence of message variables including emotional appeals, evidence presentation, message framing, attitude functions, and source characteristics. Four independent coders analyzed 122 campaign messages, including video, print, and social media posts. Results from this content analysis indicate that the campaign contained more fear and guilt appeals, than other emotions. Evidence was typically presented in the form of a narrative from sources with firsthand experience. Suggestions for persuasive message design in large-scale public health communication campaigns are discussed.

Predicting visual attention to nutrition information on food products: the influence of motivation and ability.

Obesity is linked to numerous diseases including heart disease, diabetes, and cancer. To address this issue, food and beverage manufacturers as well as health organizations have developed nutrition symbols and logos to be placed on the front of food packages to guide consumers to more healthful food choices. In 2010, the U.S. Food and Drug Administration requested information on the extent to which consumers notice, use, and understand front-of-package nutrition symbols. In response, this study used eye-tracking technology to explore the degree to which people pay visual attention to the information contained in food nutrition labels and front-of-package nutrition symbols. Results indicate that people with motivation to shop for healthful foods spent significantly more time looking at all available nutrition information compared to people with motivation to shop for products on the basis of taste. Implications of these results for message design, food labeling, and public policy are discussed.

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

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

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

Often, people are able to recall a message on a particular topic for a long period of time. These memorable messages have the ability to influence behavior when they are recalled from memory long after initial exposure. Knowing the topics and sources of the messages that are remembered about breast cancer can improve the efficacy of future breast cancer outreach. To this end, 359 women completed an online survey about memorable breast cancer messages. 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.

The impact of personal and/or close relationship experience on memorable messages about breast cancer and the perceived speech acts of the sender.

BACKGROUND: Memorable messages and their speech acts (purposes of the messages) can promote protection against breast cancer and guide health behaviors. METHODS: Participants reported their personal, friends', and relatives' experiences with breast cancer and a memorable message about breast cancer if one came to mind. Those with a memorable message reported its perceived speech acts. RESULTS: Individuals who had personal and friend or relative experience with breast cancer were significantly more likely to recall memorable messages than other respondents. The most frequently perceived speech acts were providing facts, providing advice, and giving hope. CONCLUSIONS: This information should be used to form messages in future breast cancer protection campaigns.