Messages of hope work better in motivating black patients to seek early screening for cancer

Nov 12 2008

News articles that stress African-American health disparities, like higher cancer mortality rates than other groups, may discourage black patients from being screened for cancer, according to a Saint Louis University study.

Instead, they are more likely to be tested for cancer after hearing positive messages that emphasize progress made among African-American cancer patients.

While the medical community typically has publicized health disparities as a means of motivating those most at risk to seek health care and take preventive action, it seems this tactic may have the opposite result.

"Traditionally, we've assumed that the best way to reach people who are at risk is to point out the disparity," said Robert Nicholson, Ph.D., assistant professor ofneurology and psychiatry at Saint Louis University School of Medicine and School of Public Health. "However, it appears that this may actually serve to discourage some people from being screened. It may be that disparity messages reinforce existing distrust of the medical system."

In the study of 300 African-American men and women, researchers examined the effect of a message's focus and framing on participants' willingness to be screened for colon cancer. Study participants read one of four articles about risk factors for colorectal cancer, all arranged with the same data and physical layout, but each with a different emphasis. One article focused on the impact of colon cancer, as an important health issue for African-Americans, two described health care disparities between African-Americans and other groups, and a fourth emphasized the progress that is being made as African-Americans have seen decreasing death rates from colon cancer.

Researchers measured participants' emotional responses along with their desire to be screened for colorectal cancer. They found that the progress article resulted in the strongest desire to be screened for cancer, and the disparity stories in the lowest.

The study suggests that, rather than prompting preventive action, emphasizing health care disparities may reinforce negative views about the medical community and serve to discourage African-Americans from being screened.

"When we create public health messages, we need to think about the audience and who will benefit," Nicholson said. "The same approach will not work for everyone. For some, the disparities will be motivating. In this case, the people who most needed the screenings were those who didn't accept the messages.

"The good news is that people who received positive messages, even those with high levels of mistrust for the medical community, expressed a willingness to be screened," Nicholson said. "Positive messages may help overcome mistrust of the medical system."

The findings were published in the November issue of Cancer, Epidemiology, Baiomarkers, & Prevention .