Sunday, May 18, 2025
5/18/2025
Interventions to Decrease Cancer Information Avoidance - ABSTRACT Health information avoidance is an overlooked threat to the reach and effectiveness of health communication. For a given health threat, 20%-30% of the general population tends to avoid initiating information seeking or avoid exposure to information. To fully realize the benefits of our sizeable investments in health messaging, we need to identify strategies for reducing health information avoidance. We will test a video-based strategy for promoting colorectal cancer screening designed to reduce defensive colorectal cancer information avoidance and increase message reach by increasing engagement among those who would otherwise avoid the message. Colorectal cancer is a suitable domain for developing the intervention as it is the fourth most common and second deadliest cancer in the United States, but also one of the most preventable with screening. Health communication that reaches people who otherwise avoid colorectal cancer information (about 20% of the population) has the potential to improve screening rates as people who avoid colorectal cancer information are less likely to be adherent to colorectal cancer screening guidelines. The intervention is grounded in a theoretically and empirically based conceptual model of defensive health information avoidance, and incorporates components that increase agency beliefs and positive affect. We have demonstrated its efficaciousness for increasing self-efficacy and screening intentions in a pilot study (N=710). Specific Aim 1 is to conduct a rigorous randomized controlled trial (RCT) comparing the effects of the intervention video to an attentional control video on screening intentions and uptake. It will confirm the intervention’s purported mechanisms, increasing self-efficacy and positive affect, and its relative efficacy in avoiders and non-avoiders. Participants will be people who tend to avoid colorectal cancer information (n=750) and those who do not (n=750), recruited from Ipsos’s nationally representative, probability based KnowledgePanel. Specific Aims 2 and 3 are pragmatic trials to test the effectiveness of the intervention in primary care settings. In Aim 2, we will conduct a two-arm randomized controlled trial to compare colorectal cancer screening uptake in patients (n≈2,500) who are not screening adherent and who either receive text messages inviting them to view the video intervention and request screening or no text messages. In Aim 3, we will conduct a two-arm pragmatic trial comparing screening uptake in non-adherent patients who will be sent an at-home screening Cologuard test. Patients will be randomized to receive a primer email beforehand with or without the intervention video. The research will test an empirically based strategy for reaching people who would otherwise avoid colorectal cancer screening messages that is mHealth ready, can be disseminated via text, email, patient portals or in physician offices, or disseminated via social or mass media. The intervention strategy is generalizable beyond colorectal cancer control, because health information avoidance is common across a range of health threats.
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