Improving Adherence to Colorectal Cancer Screening: A Randomized Intervention to Compare Screener vs. Survivor Narratives

Abstract

Interventions are needed to increase colorectal cancer screening (CRCS) uptake. Narratives may have advantages over didactic information. We tested different narratives for increasing CRCS intentions and behaviors, and examined their mechanisms of influence. We randomized 477 unscreened adults 50–75 years old to one of three groups: CRCS information only (1) or CRCS information plus a photo and text narrative of a CRC survivor (2) or CRC screener who did not have cancer (3). Photos were tailored on participants’ sex, age group, and race/ethnicity. Participants completed online surveys before and after intervention exposure, and 1-, 6-, and 12-months follow-up. Thirty percent of participants completed CRCS. Narrative conditions (vs. information only) were negatively associated with intention, but also positively influenced intentions through greater emotional engagement. Survivor (vs. screener) narratives were positively associated with CRCS, and had mixed effects on intention – positively through emotional engagement and negatively through self-referencing engagement to self-efficacy. Survivor narratives elicited more negative affect, which had positive and negative influences on intention. Continued research using path models to understand the mechanisms of narrative effects will inform theory development and message design. Additional measurement evaluation is needed to adequately capture and then compare the effects of different components of narrative engagement.

Acknowledgments

This research was supported by funding from the National Cancer Institute (R21 CA187608) and was registered at ClinicalTrials.gov (NCT02485561). The authors thank ResearchMatch.org, Washington University Volunteer for Health, and the thousands of volunteers who support research, especially those that participated in this study. We thank Balaji Golla for his assistance with programming the online study and Maria Perez for her feedback on an earlier draft of this manuscript. Preliminary trial results were presented at the annual Society of Behavioral Medicine conference in San Diego in March 2017. The authors have no conflicts of interests.

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Additional information

Funding

This work was supported by the National Cancer Institute [R21 CA187608].