Friend to Friend: Colorectal Cancer Screening Discussions Among Members of Social Networks

Colorectal cancer is a significant cause of cancer morbidity and mortality in the United States, but available screening methods continue to be underutilized. Interventions aimed at increasing cancer screening rates find that peer support can be effective at overcoming barriers, possibly because peer-workers establish screening as a normative behavior. Friend-to-friend discussion, either verbal or electronic, is a common way for community members to provide each other with support and to establish expectations regarding normative behavior.

While findings from peer-worker studies are promising, relatively few studies have focused on peer interventions that use friend-to-friend communication to improve cancer screening. This is surprising, as adults over age 50 turn frequently to family and friends for information on colorectal cancer screening and subjective norms established by a friend or a family group are strongly associated with adherence to colorectal cancer screening. With over half of adults in this age group using email on a daily basis, some of these discussions may be taking place electronically. By avoiding face-to-face discussions on what can be a difficult topic, this mode of communication could facilitate communication around colorectal cancer screening.

Given the need to increase colorectal cancer screening, the importance of peer support, and the ever-increasing use of electronic communication, this is an ideal time to explore the feasibility and acceptability of electronic cancer screening message transmission between members of a social network. As a first step, it will be essential to learn more about existing practices surrounding friend-to-friend communication on colorectal cancer screening.

To this end, we propose a pilot study with the following specific aims:

Aim 1. To describe current practices in friend-to-friend and within-family discussions of colorectal cancer screening. We will interview 80 participants from the Fallon Community Health Plan (which uses colonoscopy as a standard screening approach) and25 participants from each of 2 additional CRN sites (where FOBT is most common) (130 total). All three sites are already participating in the CRN Health Literacy and Cancer Prevention project.. Interviews will focus on the extent to which participants communicate with members of their social network about colorectal cancer screening, collecting information on both the content and the mode of these discussions (e.g., in person, email, social networking sites, etc. Aim 2. To identify potential barriers to communication about colorectal cancer screening in friend-to-friend and within-family networks. Participants will be interviewed about barriers preventing them from discussing colorectal cancer screening with friends or family members.

Aim 3. To determine participant’s preferences for (1) message content and (2) mode of transmission (e.g. in person, email, social networking sites, etc) when discussing colorectal cancer screening. After studying how participants discuss screening and why they may avoid such discussions, we will seek participants’ guidance in the creation of messages that they would find acceptable for passing along to friends or family. Participants will be given a sample message about colorectal cancer screening, written from the perspective of a close friend or relative who has just completed screening. The message will refer to the sender’s personal experience as well as to key facts about screening. Participants will be asked to react to the message and to suggest revisions that would make them more willing to pass such a message along to members of their social network.

Findings from this pilot study will provide a strong foundation for the development of an intervention testing the effectiveness of electronic friend-to-friend colorectal cancer screening messages in older adults.

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