Abstract PL02-03: The use of cultural variables in communications promoting cancer screening among African Americans

Disparities in cancer incidence and mortality persist between African Americans and other racial/ethnic groups. Cancer communication that increases screening behaviors and improves diet may help reduce disparities. Culturally appropriate communication may provide an important opportunity to address health disparities, but the specific strategies used to realize this potential can take many forms. There is widespread agreement that communication programs and materials will be more effective when they are “culturally appropriate” for the populations they serve (Brach & Fraser, 2000); however, transmission of information does not equal effective communication. It is widely assumed that cancer communication is more effective when culturally appropriate for a given population, yet little is known about what strategies, at what levels, make materials culturally appropriate. We must understand what elements -evidence, cultural constructs, graphics- related to culture and social context affect response to health communications.

Investigators have articulated several approaches to cultural appropriateness; however, three are particularly relevant to cancer communications. Peripheral approaches package generic content in colors, fonts, images, pictures or declarative titles likely to appeal to a given group. Evidential approaches provide and discuss data specific to that group. Sociocultural approaches discuss health in the context of specific social and/or cultural characteristics of the group. This presentation will provide an overview of the findings from studies that examine perceptions of cultural appropriateness (text and graphics), differences in affective response, cognitive processing and intent to screen between targeted publications that use cultural values (spirituality, collectivism, ethnic identity, fatalism, and mistrust - SC) and publications that provide evidence (E) on colorectal cancer prevention specific to African Americans.

Preproduction testing was conducted with 30 African Americans (15 men, 15 women), with each gender-specific text and graphics, Evidential, and Sociocultural focused publication being reviewed 10 times. The process sought to test the incorporation of the formative research findings related to group preferences into the publications and determine whether strategy implementation achieved our hypothesized outcomes, specifically whether text and graphics enhanced materials increased attention and perceived attractiveness, Evidential focus increased perceived importance of information, and Sociocultural focus increased perceived personal and group relevance. The text and graphics and Sociocultural publications, respectively, scored higher than the Evidential publication on attention and attractiveness.

The Evidential publication scored higher than the text and graphics enhanced and Sociocultural publications, respectively, on the perceived importance of information. The text and graphics and Sociocultural publications, respectively, scored higher than the Evidential publication on personal and group relevance.

In the two-armed randomized trial, 761 African American participants (401 females, 360 males), 45 and older with no history of colorectal cancer were randomly assigned to one of two conditions Evidential (E) vs. Sociocultural (SC). The results from exit surveys administered to the first one hundred and twenty five participants were very skewed to the “strongly agree” or agree categories for items that address magazine liking, quality, and professionalism. This affective response persists over a two week response period. There were no differences between the E and SC groups; whether stock or localized photos were used.

Relevance, Identity, Motivation, and Attention scores are related to participant group assignment as predicted; higher relevance, identity, motivation, and attention scores among SC participants and higher cognitive processing scores among E participants). These findings remained constant at follow-up after the delivery of publication 2. Male participants reported greater intent to screen when receiving targeted publications that use a socio-cultural strategy; there were no significant differences in the responses of female participants. Effective targeted health communication may require developing the appropriate balance between evidential and socio-cultural strategies, while addressing gender preferences.