Health Communication

Previving: How Unaffected Women with a BRCA1/2 Mutation Navigate Previvor Identity

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Evaluating Culturally-targeted Fear Appeal Messages for HPV Self-Sampling among Jamaican Women: A Qualitative Formative Research Study

Despite the disproportionate burden of cervical cancer among Caribbean women, evaluations of targeted communication interventions to increase screening behaviors are sparsely represented in extant literature. Informed by data on the cognitive, affective and sociocultural factors associated with low cervical screening in the English-speaking island of Jamaica, the current study aimed to explore how theory-based message design, coupled with innovative solutions, might increase screening. In this formative research study, we first described the process used to develop culturally-targeted fear appeal messages embedded within an HPV self-sampling kit developed by the researchers. Then, we shared the results of an evaluation of the kit, which was reviewed by 36 Jamaican women in 8 focus groups, to understand the potential impact of the messages and the utility of HPV self-sampling to increase screening behaviors in this population. The results provide data on effective messages for cervical cancer prevention among Jamaican women, which may be further applicable to underscreened women in the English-speaking Caribbean. Additionally, results from this research suggest support for HPV self-sampling to address salient cultural and structural barriers to screening, which provides an impetus for experimental research in message design to inform policy and practice.

Communicating Cervical Cancer Screening Results in Light of New Guidelines: Clinical Practices at Federally Qualified Health Centers

New guidelines for cervical cancer screening (CCS) incorporate both HPV and Pap tests, and there is a need to understand communication of these cotesting results to patients, especially in at-risk populations disproportionally affected by cervical cancer. This study used computer-assisted telephone interviews in 2017 at 51 federally qualified health centers (FQHCs) in Indiana to evaluate the characteristics of clinical communication CCS results to women. Results revealed that clinical communication practices varied on channel, timing, and content. Almost half of the clinics (

Modeling the Mediating and Moderating Roles of Risk Perceptions, Efficacy, Desired Uncertainty, and Worry in Information Seeking-Cancer Screening Relationship Using HINTS 2017 Data

Despite mixed findings in the literature, health information seeking is considered as a promising antecedent of health behavior and outcome. However, little research has been conducted to identify factors that explain the health information seeking-health behavior relationship. In the contexts of breast, cervical, and prostate cancer screening, this research utilized recently collected Health Information National Trends Survey data (HINTS 5 Cycle 1) to examine whether, among the population at risk of cancer, previous cancer information seeking influenced cancer screening via perceptions of risk and efficacy, desired uncertainty, and worry. The results indicated that previous cancer information seeking had a direct effect on cancer screening. Across the three cancer screening behaviors, desired uncertainty mediated the relationship between previous cancer information seeking and screening behavior. Worry about getting cancer moderated and mediated the relationship between cancer information seeking and cervical cancer screening. Moreover, desired uncertainty and perceived susceptibility respectively interacted with previous cancer information seeking to influence breast cancer screening. Perceptions of risk and efficacy had limited effects on cancer screening. Theoretical and practical implications are discussed.

Making Sense of Gynecologic Cancer: A Relational Dialectics Approach

This study used the relational dialectics theory (RDT) as a theoretical lens to examine how the interplay of competing discourses shaped meaning making about gynecologic cancer. A reflexive thematic analysis of the narratives of 12 survivors of cervical cancer, ovarian cancer, and uterine cancer in Arkansas showed two discursive struggles at play, including continuity of care versus change, and voicing versus repressing of feelings. The findings showed that long history of care with physicians contributed to how participants privileged the discourse of continuity of care when faced with a decision to travel for care or receive care locally. We also found that cultural discourses about concealing women's cancer-afflicted bodies, lack of supportive spaces for women to discuss side effects of cancer treatments, and appropriate communication behavior between patients and physicians shaped the interplay of the discursive struggle of voicing versus repressing. The findings extend the RDT by showing that geographic location, disease characteristics, history of care between patients and physicians, and prevailing cultural discourses can contribute to the interplay of discursive struggles in the gynecologic cancer context. Further, the findings suggest to healthcare professionals to address harmful discourses about gynecologic cancer to help create support avenues for survivors.

“This is What a Speculum Looks Like!” Effects of Medical Instrument Demonstration and Message Framing in Pap Test Videos on Social Media

The rise of social media short-form videos has led to an increase in health professionals demonstrating medical procedures online, including Pap tests for cervical cancer screening. This study uses an online experiment to investigate the effects of showing the vaginal speculum in short-form social media videos (i.e. TikTok videos) encouraging Pap tests, alongside the impact of framing the content to address common barriers to testing. The findings reveal the presence of the speculum led to significantly higher ratings of fear though the level of fear was modest. Videos framed to address knowledge barriers (i.e. providing information about the importance of Pap tests and screening guidelines) were perceived as more effective than those framed to address psychological barriers (i.e. providing information about avoiding pain and discomfort during the test) and increased the likelihood of getting a Pap test. The knowledge barrier frame also resulted in less defensive avoidance compared to the psychological barrier. Most importantly, the study's examination of the combined influence of the two-message features shows that the presence of the speculum can either help or hinder the persuasive outcomes of the message depending upon the video's framing. Likelihood of getting a Pap test was greatest when the speculum was shown in conjunction with knowledge barrier framing and lowest when the speculum was shown in videos with psychological barrier framing, suggesting a possible cognitive overload effect. These findings provide practical and theoretical insights into how emotionally evocative imagery can influence message outcomes, sometimes unintentionally eliciting fear and undermining persuasive effects.

Empowering Unvaccinated Women with Information: How Online Cancer Information Seeking and Scanning Encourage HPV Vaccination in China

Chinese women face a tremendous threat of cervical cancer alongside low rates of human papillomavirus (HPV) vaccination. Online cancer information has become a driving force of HPV vaccination, but the underlying mechanism remains unclear. Drawing upon the three-stage model of health promotion, this study examines the relationships between online cancer information seeking and scanning and HPV vaccination intention among unvaccinated Chinese women. Specifically, the mediating roles of HPV knowledge and perceived efficacy for cancer prevention and the moderating role of information elaboration were tested. Results from a national online survey (

Communicating Probabilities of Cervical Cancer Screening Results with Icon Arrays or Tree Diagrams: A Longitudinal Experiment

Simple graphical displays such as icon arrays and tree diagrams have been proposed for communicating health risks and supporting informed decisions. The UK's National Health Service (NHS) uses tree diagrams to communicate the chances of different cervical cancer screening results, but their effectiveness has not been compared to icon arrays. We conducted a well-powered longitudinal experiment involving 3,100 UK women eligible for cervical screening (25-64 years) to examine the effectiveness of icon arrays to communicate possible cervical screening results, relative to the UK NHS's tree diagram and to a numerical-only format. We also examined whether the presence (vs. absence) of explanatory text referring to different types of results (i.e. distinguishing between HPV positive results with vs. without abnormal cervical cells) moderated effects of presentation format. Presentation format did not affect verbatim or gist knowledge of probabilities at initial assessment (i.e. immediately after participants viewed the displays), but icon arrays were associated with better gist knowledge of absolute magnitudes than tree diagrams and numerical-only formats at 1-month follow-up. Participants exposed to icon arrays also perceived lower likelihood of adverse screening results and reported stronger screening intentions at initial assessment. For displays without explanatory text, icon arrays were also associated with more positive user evaluations and less negative affective reactions than tree diagrams at initial assessment. Overall, our findings suggest that icon arrays support enduring knowledge of approximate magnitudes of probabilities and are better suited than tree diagrams for communicating possible screening results.

The BRCA1/2 Previvor Information Journey: Understanding What Helps or Hinders

What Have We Missed?: The Knowledge of and Access to the HPV Vaccine and Sex Education in China

The author completed three doses of Gardasil vaccine, which helps to protect against diseases caused by HPV (genital human papillomavirus). The author, a woman born and raised in China, had no knowledge of HPV or the HPV vaccine until she came to the United States for graduate school. In this piece, she presents a personal intercultural medical story about her HPV vaccine process. She utilizes personal narratives to share with readers her experience with sex education and to convey people's attitudes toward sexuality and sex education in mainland China.