Sending the message about
by Maria Anderson and Judy Purdy
Former TV anchor- woman Barbara Boyd, a breast cancer survivor, speaks out on the benefits of early detection.
what you don't know can kill you.
Take breast cancer, for instance. Mammograms are widely available, but many women who need them don't get them. In fact among African-American women 40 and older, one-third fail to take advantage of the potentially life-saving procedure, according to CDC statistics.
Jeff Springston wants to improve those odds.
The University of Georgia public relations professor studies ways to communicate risks and uses his findings to craft messages that promote healthy behaviors. For now, those messages are aimed squarely at African-American women.
In collaboration with Victoria Champion, associate dean of research at Indiana University's nursing school, Springston developed an interactive, touch-screen computer program that teaches about breast cancer and the benefits of early screening. It targets low-income African-American women who can increase their survival odds with early diagnosis. Although Caucasian women have a higher incidence of breast cancer, Champion said African Americans have a higher mortality rate.
"They are one of the most hard-hit populations," Springston said. "The fatality rate is considerably higher, and although there are probably a number of factors involved, I think the largest factor is that they are just not getting screened early enough."
Springston and Champion have compared their touch-screen system with traditional patient education programs such as pamphlets and counseling sessions with health care professionals. So far, results show women are getting the message. About twice as many women who used the computer program made mammogram appointments compared with those who received information through traditional methods.
"Even with a fairly small sample size (80 women so far) the effects have been strong enough that we are getting statistically significant findings," he said. "Our results represent quite a big jump, especially in this population. African-American women aren't as responsive to interventions of other kinds, so our results are encouraging."
Springston attributes the success rate to Champion's medical expertise in patient education, his own risk communication research and the feedback from focus groups of African-American women. In previous studies, the researchers identified barriers cost, fear of pain, childcare and transportation issues, to name a few that prevent African Americans from getting routine mammograms.
The focus groups provided additional valuable feedback on content, design and interactive use of touch-screen computers, ensuring that the message and its presentation resonated with the target audience.
One early focus group, for example, rejected the program's pastel colors. "They told us pastels are white people's colors; they like the brighter, bolder colors," he said.
The interactive touch-screen computer program, which Springston designed and built, opens with a short narrative. Questions ó including age, perceived personal risk of getting breast cancer and prior experiences with mammograms ó let women explore personal interests, concerns or misgivings.
Breast cancer survivor Barbara Boyd, a popular, recently retired Indianapolis newscaster, narrates the program, which includes videotaped testimonials of other black women.
"Barbara is fantastic," Champion said. "She has lots of visibility in Indianapolis among African-American women, and because she's had cancer, she has lots of credibility as well."
As spokeswomen like Boyd talk, interactive buttons pop up on the screen, directing viewers to more information. The pop-up buttons minimize the reading skills needed to navigate the program. Each button leads to specific risk information and personal testimonies on such factors as age and family history, among others. In all, women can explore 128 combinations of breast cancer and mammography issues.
"To me what makes it work is real women speaking to real women," said Springston, who said research shows messages hit their target more often when delivered by people who are believable.
For Springston, cancer-related research is an intensely personal mission: Both he and his father are prostate cancer survivors, thanks to early screenings, but two uncles died of the disease. While an aunt survived breast cancer, a cousin, diagnosed in her early 40s, did not.
"Some people think, 'If I don't have breast cancer in my family history, I don't have to worry,' and that's not true," Springston said. "While fear is a motivator, we don't want to give a fear message that's too strong and scares people."
Based on theories and findings from communications and behavioral studies, Springston's program reinforces the message that a mammogram is one way to detect cancer early. The program, supported by a four-year, $1.4 million grant from the NIH's National Cancer Institute, also dispels common myths and tackles barriers to action. The researchers are gearing up for more studies with new audiences to test the effectiveness of CD-ROM-based messages for breast and prostate cancer.
"There's not much question about mammogram efficacy with the target audience women over 50," Springston said. "If caught early, the five- year survival rate for breast cancer is better than 95 percent."
Springston quotes these percentages straight from the Centers for Disease Control and Prevention. While some medical experts still question the mammogram's track record in distinguishing benign versus malignant tumors, Springston said he believes people can't afford to wait for definitive answers.
"The big debate that continues is for women in the 40 to 50 age group," he said. "The American Cancer Society has stayed solid with recommending mammograms beginning at age 40. It saves some lives, and if it's your life, it makes a difference."
For more information, contact Jeff Springston at firstname.lastname@example.org or access www.grady.uga.edu/adpr/dept/faculty/springston.html.
Maria Anderson, a former intern with Research Magazine, graduated from the University of Georgia in 2003.
Judy Bolyard Purdy is the University of Georgia's director of research communications and editor of Research Magazine.
Research Communications, Office of the VP for Research, UGA
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