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National Cancer Institute
Behavioral Research - Cancer Control and Population Sciences

Saint Louis University

View Presentation from CECCR I final grantee conference

Principal Investigator: Dr. Matthew W. Kreuter
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View presentation from May 2006 symposium

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  • Overview
  • Project 1
    Capture on videotape the stories of 80 African-American breast cancer survivors, examine the effectiveness of these stories in promoting mammography in 900 African- American women, and test a new explanatory model of narrative cancer communication effects
  • Project 2
    Conduct the first ever national study of Black newspapers to determine the frequency and nature of their coverage of cancer-related stories, then develop and test a computer-based intervention to enhance cancer coverage in Black newspapers by providing them with community-specific stories and data on cancer
  • Project 3
    Compare the effectiveness of three different approaches to cultural appropriateness on affective, cognitive, and behavioral responses to a series of colorectal cancer risk reduction messages

Overview
The goal of the St. Louis University Center of Excellence in Cancer Communications Research is to enhance the effectiveness of cancer communication among African Americans. The proposed research will help identify strategies for integrating cancer communication within the cultural norms, values, and beliefs of various groups of African Americans, evaluate the effects of these strategies, and explain the mechanisms through which they influence cancer-related beliefs and practices. The Center consists of three major studies, four core components, and a pilot research program. Project 1 will capture on videotape the stories of 80 African-American breast cancer survivors, examine the effectiveness of these stories in promoting mammography in 900 African- American women, and test a new explanatory model of narrative cancer communication effects. Experience-based communication through storytelling is deeply rooted in the culture of African- American women and is promising for cancer communication. Project 2 will conduct the first ever national study of Black newspapers to determine the frequency and nature of their coverage of cancer-related stories, then develop and test a computer-based intervention to enhance cancer coverage in Black newspapers by providing them with community-specific stories and data on cancer. Black newspapers are largely untapped as a channel for cancer communication, but promising because they are read, trusted, and valued by African Americans, attentive to issues in the local Black community, and provide information and perspectives that are largely missing from the general media. Project 3 will compare the effectiveness of three different approaches to cultural appropriateness on affective, cognitive, and behavioral responses to a series of colorectal cancer risk reduction magazines. Learning more about these three approaches - peripheral, evidential, and sociocultural - will help develop a theory of cultural cancer communication and assist practitioners in developing more effective programs and materials.

Core A provides career development for junior faculty, African-American doctoral students, and an interdisciplinary seed grant program. Core B provides content development, graphic design, computer programming, and translation and dissemination services. Core C provides research methods support including formative research, measurement and data collection, and biostatistics and data management. Core D provides scientific leadership, research oversight and evaluation, and administrative and budgetary support. The Pilot Research Program will solicit, identify, and support innovative cancer communication research ideas. The Center is highly interdisciplinary in its organizational structure, faculty, collaborators, and theme.

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Project 1
Knowledge that is gained through personal experience and communication through storytelling are both deeply rooted in the culture of African-American women. Yet personal, experience-based stories are largely absent from most cancer communication, even that developed specifically for African-American women. This project seeks to enhance the effectiveness of breast cancer communication for African-American women by capturing and sharing their lived experience with breast cancer through personal stories told in their own words. The study will evaluate the effectiveness of personal narratives in promoting breast cancer and mammography-related beliefs and behaviors, and at the same time test an explanatory model of how stories may achieve these effects. In the study, investigators will professionally videotape the stories of 80 African-American breast cancer survivors elicited through qualitative interviews about five breast cancer topic areas. Stories to be included in four 15-minute professionally produced videos will be selected by a community advisory board and expert panel of African-American women. In a longitudinal trial, 900 African-American women from low-income neighborhoods will be randomly assigned to receive either these story videos, other breast cancer videos using a general, rational, informational, and didactic (GRID) approach, or be assigned to a delayed intervention control group. The primary research goal is to assess the effectiveness of story videos compared to GRID videos and to a control condition in increasing breast cancer and mammography knowledge and beliefs, mammography-related behaviors, and mammography adherence at 3-, 9-, and 18-month follow-ups. In addition, the study will test the new proposed model of narrative cancer communication effects in African-American women. To date, no study has compared the effects of story-based cancer communication to non-story approaches, nor has any study provided evidence for the mechanism by which stories are effective. Developing a better understanding of if and how culturally based approaches to cancer communication work will enhance efforts to reduce racial disparities in breast cancer.

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Project 2
Black newspapers are read, trusted, and valued by African Americans. Their coverage is especially attentive to issues that affect local Black communities, and provides information and perspectives that are largely missing from general media. For these reasons, Black newspapers are often viewed as a voice of the local Black community and accorded the same status as other social institutions like schools and churches. To date, Black newspapers have been largely untapped as a channel for cancer communication, but are well-positioned to be a valuable resource in helping eliminate health disparities. This project will conduct the first ever national descriptive study of cancer communication in Black newspapers to describe the frequency and nature of their cancer coverage. Investigators will then develop and test a computer-based intervention to enhance this coverage by providing Black newspapers with locally-relevant and race-specific cancer stories and data. This intervention approach draws heavily on principles of data-driven cancer communication researchers have pioneered and shown to be effective, but for the first time applies these principles to communities rather than individuals. In a community randomized trial, 8 U.S. cities, 8 standard metropolitan areas, and 8 predominantly Black counties will be selected from a national sampling frame. By random assignment within each type of community, half the Black newspapers will receive the intervention and half will serve as controls. Black newspapers in intervention communities will receive weekly news releases called "Cancer Cover Stories" along with community-specific "Local Angle Lead-ins." Community-based cancer organizations in these communities will partner in the intervention, receiving "Media Action Alerts" to contact their local Black newspaper and offer help in preparing the cancer story. Effects of the intervention will be determined by tracking changes in cancer coverage in intervention versus control newspapers, and by examining changes in cancer awareness, perceived importance of cancer, and cancer-related beliefs and behaviors in an annual panel survey among 840 African- American adults from intervention versus control communities. If effective, this computer-based cancer information system could be offered to all Black newspapers nationally, and adapted for use by other Black media, and other special population newspapers and media.

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Project 3
There is widespread agreement that cancer communication programs and materials will be more effective when they are "culturally appropriate" for the populations they serve. Yet surprisingly little is known about how best to achieve cultural appropriateness, what (if any) communication effects can be attributed to cultural appropriateness, and whether different approaches to cultural appropriateness will have different effects. Investigators have identified three basic approaches currently used to achieve cultural appropriateness. Peripheral approaches seek to enhance effectiveness of cancer communication by packaging generic content in colors, fonts, images, pictures or declarative titles (e.g., "A guide for African Americans") likely to appeal to a given group. Evidential approaches provide and discuss data specific to that group (e.g., "Between 1973-1992, colorectal cancer in African American men increased 40 percent"). Sociocultural approaches discuss cancer in the context of specific social and/or cultural characteristics of the group (e.g., "Being there for family, friends, and community is an African-American tradition."). No study has yet compared the effects of these approaches, and in particular the effects of combined approaches, as they are more commonly used. This study will do so using a 3-arm randomized controlled trial among 1,200 African-American men and women. Investigators will track for one year the progression of affective, cognitive, and behavioral effects described in McGuire's Communication/Persuasion Model that result from 3 exposures to colorectal cancer risk reduction magazines. Participants will be randomly assigned to receive either peripheral, peripheral+evidential, or peripheral+sociocultural materials. All groups will be followed-up at 4-, 28-, and 52-weeks post-enrollment. This study will provide the first evidence for which communication effects can be expected, from which cultural approaches, at which intervals in a 12-month time period. It will thus contribute to establishing a theory of cultural cancer communication, guidelines for cancer educators and practitioners, and meeting the Healthy People 2010 goal of eliminating health disparities.

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Last Updated: March 15, 2011

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