Amy McQueen

Experimental manipulations of self-affirmation: A systematic review

The objective of this systematic review of studies using self-affirmation manipulations was to identify research gaps and provide information to guide future research. We describe study characteristics, categories of manipulations, and report effects on various dependent variables. Our search strategies yielded 47 eligible articles (69 studies). Manipulations varied by affirmation domain (values or personal characteristics), attainment (participant- or investigator-identified), and procedure (scale, essay, feedback, etc.). Most dependent variables were cognitive. Strong effects of self-affirmation were found for attitudes and persuasion/bias, but future work is needed for variables with mixed results including risk cognitions, intentions, and behavior. Suggestions and considerations for future research involving self-affirmation manipulations are discussed.

Comparing narrative and informational videos to increase mammography in low-income African American women

OBJECTIVE Compare effects of narrative and informational videos on use of mammography, cancer-related beliefs, recall of core content and a range of reactions to the videos. METHOD African American women (n=489) ages 40 and older were recruited from low-income neighborhoods in St. Louis, MO and randomly assigned to watch a narrative video comprised of stories from African American breast cancer survivors (Living Proof) or a content-equivalent informational video using a more expository and didactic approach (Facts for Life). Effects were measured immediately post-exposure and at 3- and 6-month follow-up. RESULTS The narrative video was better liked, enhanced recall, reduced counterarguing, increased breast cancer discussions with family members and was perceived as more novel. Women who watched the narrative video also reported fewer barriers to mammography, more confidence that mammograms work, and were more likely to perceive cancer as an important problem affecting African Americans. Use of mammography at 6-month follow-up did not differ for the narrative vs. informational groups overall (49% vs. 40%, p=.20), but did among women with less than a high school education (65% vs. 32%, p<.01), and trended in the same direction for those who had no close friends or family with breast cancer (49% vs. 31%, p=.06) and those who were less trusting of traditional cancer information sources (48% vs. 30%, p=.06). CONCLUSIONS Narrative forms of communication may increase the effectiveness of interventions to reduce cancer health disparities. PRACTICE IMPLICATIONS Narratives appear to have particular value in certain population sub-groups; identifying these groups and matching them to specific communication approaches may increase effectiveness.

Understanding Narrative Effects: The Impact of Breast Cancer Survivor Stories on Message Processing, Attitudes, and Beliefs among African American Women

OBJECTIVE Examine the longitudinal effects of personal narratives about mammography and breast cancer compared with a traditional informational approach. METHODS African American women (n = 489) ages 40 and older were recruited from low-income neighborhoods in St. Louis, Missouri, and randomized to watch a narrative video comprised of stories from African American breast cancer survivors or a content-equivalent informational video. Effects were measured immediately postexposure (T2) and at 3- (T3) and 6-month (T4) follow-up. T2 measures of initial reaction included positive and negative affect, trust, identification, and engagement. T3 message-processing variables included arguing against the messages (counterarguing) and talking to family members about the information (cognitive rehearsal). T4 behavioral correlates included perceived breast cancer risk, cancer fear, cancer fatalism, perceived barriers to mammography, and recall of core messages. Structural equation modeling examined interrelations among constructs. RESULTS Women who watched the narrative video (n = 244) compared to the informational video (n = 245) experienced more positive and negative affect, identified more with the message source, and were more engaged with the video. Narratives, negative affect, identification, and engagement influenced counterarguing, which, in turn, influenced perceived barriers and cancer fatalism. More engaged women talked with family members more, which increased message recall. Narratives also increased risk perceptions and fear via increased negative affect. CONCLUSIONS Narratives produced stronger cognitive and affective responses immediately, which, in turn, influenced message processing and behavioral correlates. Narratives reduced counterarguing and increased cognitive rehearsal, which may increase acceptance and motivation to act on health information in populations most adversely affected by cancer disparities.

Behind closed doors: Physician-patient discussions about colorectal cancer screening

BACKGROUNDDespite the availability of multiple effective screening tests for colorectal cancer, screening rates remain suboptimal. The literature documents patient preferences for different test types and recommends a shared decision-making approach for physician-patient colorectal cancer screening (CRCS) discussions, but it is unknown whether such communication about CRCS preferences and options actually occurs in busy primary-care settings.OBJECTIVEDescribe physician-patient CRCS discussions during a wellness visit.DESIGNCross-sectional; patients audio-recorded with physicians.PARTICIPANTSA subset of patients (N = 64) participating in a behavioral intervention trial designed to increase CRCS who completed a wellness visit during the trial with a participating physician (N = 8).APPROACHTranscripts were analyzed using qualitative methods.RESULTSPhysicians in this sample consistently recommended CRCS, but focused on colonoscopy. Physicians did not offer a fecal occult blood test alone as a screening choice, which may have created missed opportunities for some patients to get screened. In this single visit, physicians’ communication processes generally precluded discussion of patients’ test preferences and did not facilitate shared decision-making. Patients’ questions indicated their interest in different CRCS test types and appeared to elicit more information from physicians. Some patients remained resistant to CRCS after discussing it with a physician.CONCLUSIONIf a preference for colonoscopy is widespread among primary-care physicians, the implications for intervention are either to prepare patients for this preference or to train physicians to offer options when recommending screening to patients.

Are There Gender Differences in Colorectal Cancer Test Use Prevalence and Correlates

Despite evidence that screening tests reduce colorectal cancer incidence and mortality, screening prevalence is low. Gender differences in test uptake have been reported, but few studies examine correlates of test use by gender. Differences, if present, may inform strategies to increase test use. We examined gender differences in the prevalence and correlates of colorectal cancer test use [fecal occult blood test (FOBT) and endoscopy] using data from the 2002 to 2003 Health Information National Trends Survey. Male (n = 999) and female (n = 1687) respondents ages ≥50 years, without a personal history of colorectal cancer, were interviewed by telephone. Age-adjusted prevalence rates were reported for lifetime, recent, and repeat use by gender and test type. Multivariable logistic regression analyses were used to identify correlates of test use stratified by gender and colorectal cancer test type. More females reported only using FOBT in lifetime and in the past year, whereas more males reported repeat endoscopy use. The use of other tests or combinations of tests did not differ by gender. Consistent positive correlates of colorectal cancer test use for both genders included age, recent physician visits, recent breast or prostate cancer screening, and knowledge of test-specific screening intervals. Correlates that differed by gender included comparative perceived risk, belief that colorectal cancer testing was too expensive, fear of finding colorectal cancer if tested, and attention to and trust in media sources of health information. Such differences, if confirmed in future studies, may inform the use of gender-specific intervention strategies or messages to increase colorectal cancer test use. (Cancer Epidemiol Biomarkers Prev 2006;15(4):782–91)

Perceived Discrimination, Psychological Distress, and Current Smoking Status: Results From the Behavioral Risk Factor Surveillance System Reactions to Race Module, 2004–2008

OBJECTIVES We examined the association between perceived discrimination and smoking status and whether psychological distress mediated this relationship in a large, multiethnic sample. METHODS We used 2004 through 2008 data from the Behavioral Risk Factor Surveillance System Reactions to Race module to conduct multivariate logistic regression analyses and tests of mediation examining associations between perceived discrimination in health care and workplace settings, psychological distress, and current smoking status. RESULTS Regardless of race/ethnicity, perceived discrimination was associated with increased odds of current smoking. Psychological distress was also a significant mediator of the discrimination-smoking association. CONCLUSIONS Our results indicate that individuals who report discriminatory treatment in multiple domains may be more likely to smoke, in part, because of the psychological distress associated with such treatment.

Correlates and Predictors of Colorectal Cancer Screening among Male Automotive Workers

Background: Most studies examining factors associated with colorectal cancer (CRC) screening (CRCS) are cross-sectional and thus temporal relationships cannot be determined. Furthermore, less attention has been paid to psychosocial predictors of CRCS. We examined both cross-sectional correlates of prior CRCS and predictors of prospective CRCS initiation and maintenance during The Next Step Trial, a 2-year worksite behavioral intervention to promote regular CRCS and dietary change. Method: The sample included 2,693 White male automotive workers at increased occupational risk for, but no history of, CRC who completed a baseline survey. Stratified analyses were conducted for three dependent variables (prior CRCS, CRCS initiation, and CRCS maintenance). We also assessed prior CRCS as a moderator in prospective analyses. Multivariable logistic regression analyses with generalized linear mixed models were used to adjust for cluster sampling. Results: Except for education, cross-sectional correlates of prior CRCS including older age, family history of CRC or polyps, personal history of polyps, self-efficacy, family support, and intention were also significant prospective predictors of increased CRCS during the trial. Despite differences in the patterns of association for CRCS initiation and maintenance in stratified analyses, the only associations with prospective CRCS that were significantly moderated by prior CRCS were family history and CRCS availability. Conclusions: Correlates of prior CRCS that also were prospective predictors of CRCS may be suitable targets for intervention. Additionally, intervention messages addressing psychosocial constructs may be relevant for both CRCS initiation and maintenance. However, studies with more diverse samples are needed to replicate the results reported here. (Cancer Epidemiol Biomarkers Prev 2007;16(3):500–9)

Women's cognitive and affective reactions to breast cancer survivor stories: A structural equation analysis

OBJECTIVE Compare the immediate affective and cognitive reactions to cancer survivor stories about mammography and breast cancer vs. a didactic, informational approach. METHODS Participants (N=489) were African American women age 40 years and older (mean=61). Most had ≤high school education (67%), annual household income ≤

Construct definition and scale development for defensive information processing: an application to colorectal cancer screening.

20,000 (77%), and a prior mammogram (89%). Participants completed surveys before and after watching the narrative or informational video. We used structural equation modeling to examine the large number of inter-related latent constructs. RESULTS Women who watched the narrative video experienced more positive and negative emotions, found it easier to understand the video, had more positive evaluations of the video, reported stronger identification with the message source (i.e., perceived similarity, trust, liking), and were more engaged with the video. CONCLUSION Narratives elicited immediate reactions consistent with theorized pathways of how communication affects behavior. Future studies should examine whether and how these immediate outcomes act as mediators of the longer term effects of narratives on affect, cognitions, and behavior. PRACTICE IMPLICATIONS Stories of other womens experiences may be more powerful than a didactic presentation when encouraging African American women to get a mammogram.

Interventions to Promote Repeat Breast Cancer Screening With Mammography: A Systematic Review and Meta-Analysis

OBJECTIVE Individuals have a large repertoire of defensive strategies for dealing with personally relevant negative feedback including health risk information. Defensive processes are covered in a diverse literature and in theoretical models such as the extended parallel process model, but outside the psychopathological domain, little attention has been paid to the conceptualization and measurement of defenses. In this study, we reviewed the broad literature and developed an integrated conceptual model of various defensive strategies to guide measurement development. In addition, we developed and tested measures of defensiveness for colorectal cancer screening, an important public health issue. METHOD We conducted 2 surveys of independent samples of screening-age adults (n = 226, 287) to iteratively test and refine measures using confirmatory factor analysis and structural equation models. RESULTS Our conceptual model informed our development of measures for 4 stages of defensive information processing (attention avoidance, blunting, suppression, and counterarguing) and the literature review identified potential measures for each stage. Final subscales ranged from 3 to 8 items, showed good internal reliability, and demonstrated expected patterns of association with other correlates of colorectal cancer screening. Items available in both surveys were found to be largely invariant across adherence status to screening guidelines. CONCLUSION Future research is planned to replicate and validate these scales. We anticipate that the conceptual model and sample measures will increase understanding of defensive processes and can be used in the design and evaluation of future interventions and cancer risk communications to potentially reach and impact more resistant individuals.