Evaluating Psychological Traits, Communication, and the Persuasiveness of Screening-Related Health Messages

Abstract

Preventable diseases account for up to 40% of deaths in the U.S., however, preventive services such as immunization and screening remain underutilized. Lung cancer and hepatitis C virus (HCV) screening—despite their known mortality benefit—are two examples of this underutilization. We first examine lung cancer screening and the role knowledge, attitudes, and beliefs play among those at high-risk for the disease. We then examine the role of health-related communications in both lung cancer and HCV screening. Psychological theories suggest that health-related communications are more persuasive when aligned with an individual’s character traits—for instance, someone who prefers the “forest” rather than the “trees” (e.g. high construal) and is motivated by a desire to improve health (e.g. promotion focus) may prefer messages consistent with these psychological states. However, it is unknown whether these theories hold among individuals at high-risk for lung cancer or HCV. We first used crowdsourcing to survey the knowledge, attitudes, and beliefs regarding lung cancer screening among individuals the United States Preventive Services Task Force (USPSTF) considers high-risk. In a follow-up study we randomized these individuals to view a lung cancer screening advertisement image consistent with one of four psychological states arising from a combination of two types of construal levels and two types of regulatory focus (high construal/promotion focus; high construal/prevention focus; low construal/promotion focus; and low construal/prevention focus). We assessed participants’ likelihood of undergoing lung cancer screening after viewing the image and determined each participant’s character traits using validated instruments. In a separate study we identified individuals eligible for HCV screening by Centers for Disease Control birth cohort criteria (1945-1965) and randomized them to view an HCV screening advertisement image consistent with one of four psychological states arising from combinations of high/low construal level and promotion/prevention regulatory focus. We assessed willingness to undergo HCV screening after viewing the image and measured participants’ character traits. We used Amazon’s crowdsourcing platform—Mechanical Turk (MTurk)—to recruit subjects for all three studies. Of 240 USPSTF screen-eligible respondents that qualified for our first study (median age 60, 62% current smoker, median 42 pack-years smoked), 106 (44%) reported knowledge of a screening test. However, only 36 of them (35%) correctly identified low-dose computed tomography as the appropriate test. Two hundred twenty-two respondents (93%) reported believing in the notion that early-detection of lung cancer saves lives and 165 (69%) were willing to undergo lung cancer screening if it was recommended by their physician. In our follow-up lung cancer screening study, the high construal/promotion focus image led to a greater likelihood of screening compared to images representing other psychological states (p-value=0.04). High construal/promotion focus was the most prevalent character trait (40%), whereas low construal/prevention focus was least prevalent (17%). Among the 307 HCV screen-eligible individuals in our final study (median age 63 years, 68% female), we found the low construal/promotion focus image led to the greatest willingness to screen (p-value=0.04). High construal/promotion focus was the most prevalent character trait (40%). Low construal/promotion and low construal/prevention focus were least prevalent (16%). Although few individuals at high-risk for lung cancer are aware of lung cancer screening, the majority believe early-detection of lung cancer saves lives and would pursue screening if recommended by their primary physician. Health systems may increase lung cancer screening rates by developing patient and physician educational interventions. When developing patient educational interventions for preventive health behaviors such as lung cancer or HCV screening, the psychological focus of health-related messages is important. Lung cancer screen-eligible individuals tend to prefer messages that provide a broad overview of screening and focus on its benefits. HCV screen-eligible individuals also prefer a focus on health benefits but desire more detailed messages. This knowledge may inform the design of more effective patient-facing communications that lead to higher rates of screening.