“I Got Mine, Have You Gotten Yours?”

Sarah L. Cutrona, MD, MPH

Email to Promote Colorectal Cancer Screening

among Members of a Social Network

• Terry S. Field, DSc• Andrew E. Williams, PhD• Douglas W. Roblin, PhD• Sarah M. Greene, MPH• Bridget Gaglio, PhD• Joann L. Wagner, MSW• Paul K. J. Han, MD, MPH• Mary E. Costanza, MD• Brandi Robinson, MPH• Vinutha Vijayadeva MBBS, MPH, PhD• Kathleen M. Mazor, EdD

Co-authors

• Funding:– CRN Pilot, U19 CA79689-13, NCI– K12, UMMS Clinical Scholar Award, Center for

Clinical and Translational Science– CRN III Core Project, U19 CA079689, NCI

• Acknowledgements: Mallory Thomas, BS

• Conflict of Interest Disclosures: None

Social networks are the collections of social ties among

friends* or family.

* From the book Networks, Crowds, and Markets: Reasoning about a Highly Connected World.By David Easley and Jon Kleinberg. Cambridge University Press, 2010.Complete preprint on-line at http://www.cs.cornell.edu/home/kleinber/networks-book/

Social networks have been linked to preventive screening, but data is limited.

• Peer workers promote screening mammography1,2

• Members of a social network may influence cancer screening behavior3

1. Duan, N., et al., Maintaining mammography adherence through telephone counseling in a church-based trial. Am J Public Health, 2000. 90(9): 1468-71.2. Goelen, G., G. De Clercq, and S. Hanssens, A community peer-volunteer telephone reminder call to increase breast cancer-screening attendance. Oncol Nurs Forum, 2010. 37(4): E312-7.3. Keating NL et al. Minimal Social Network Effects Evident in Cancer Screening Behavior. Cancer. 2011;117:3045-52.

“I got mine, have you gotten yours?”

Will people share cancer screening experiences in order to promote screening in friends and family?

“I got mine, have you gotten yours?”

Will people share colon cancer screening experiences in order to promote screening in friends and family?

“I got mine, have you gotten yours?”

Will people share colon cancer screening experiences by email in order to promote screening in friends and family?

Methods

Methods: In-person interview

• 386 people ages 50-70 (MA, Hawaii, Georgia)

Methods: In-person interview

• 386 people ages 50-70 (MA, Hawaii, Georgia)

• Interviewees were part of CRN-funded Oral Health Literacy Study (PI: Kathy Mazor, EdD)– Email and e-communication use – Screening and related behavior (self report)

Interview Goals

Assess Respondents’• Willingness to encourage CRC screening

among friends/family by sharing their own screening experiences

Interview Goals

Assess Respondents’• Willingness to encourage CRC screening

among friends/family by sharing their own screening experiences

• Preferred Mode of message transmission– Spoken, postcard or email– Self-edited message

Interview Goals

Assess Respondents’• Willingness to encourage CRC screening

among friends/family by sharing their own screening experiences

• Preferred Mode of message transmission– Spoken, postcard or email– Self-edited message

• Estimated Impact of message

Interview Goals

Assess Respondents’• Willingness to encourage CRC screening

among friends/family by sharing their own screening experiences

• Preferred Mode of message transmission– Spoken, postcard or email– Self-edited message

• Estimated Impact of message• Projected # of email/postcard recipients (per

sender)

Interview Goals

Assess Respondents’• Willingness to encourage CRC screening

among friends/family by sharing their own screening experiences

• Preferred Mode of message transmission– Spoken, postcard or email– Self-edited message

• Estimated Impact of message• Projected # of email/postcard recipients (per

sender)

Interview Goals

Assess Respondents’• Willingness to encourage CRC screening

among friends/family by sharing their own screening experiences

• Preferred Mode of message transmission– Spoken, postcard or email– Self-edited message

• Estimated Impact of message• Projected # of email/postcard recipients (per

sender)

Interview Goals

Assess Respondents’• Willingness to encourage CRC screening

among friends/family by sharing their own screening experiences

• Preferred Mode of message transmission– Spoken, postcard or email– Self-edited message

• Estimated Impact of message• Projected # of email/postcard recipients (per

sender)

Interview Goals

Assess Respondents’• Willingness to encourage CRC screening

among friends/family by sharing their own screening experiences

• Preferred Mode of message transmission– Spoken, postcard or email– Self-edited message

• Estimated Impact of message• Projected # of email/postcard recipients (per

sender) Reach

Willingness to… #1: Share your screening experience

“Imagine that :

• You completed colon cancer screening,

• Everything went ok, your results were fine

• And the doctor asked you to help educate friends and family members over age 50 about colon cancer screening.

How willing would you be to share your colon cancer screening with others…

-in a conversation?-by email?

\ -by other e-communication?”

Mode

Please help us design a message you’d be willing to pass along to friends and family members over age 50…either by email or postcard

Willingness to… #2: Pass along a specific self-edited Message

Mode

“Imagine that :

• You completed colon cancer screening,

• Everything went ok, your results were fine

• And the doctor asked you to help educate friends and family members over age 50 about colon cancer screening.

Estimated impact of receiving message

• On self: Make you more likely to discuss CRC screening with your provider?

• On others: Make friends & family more likely to discuss CRC screening with their providers?

Reach

Please use your worksheet to estimate how many people you’d send this to:

• Email• Mail or hand-delivered postcards

Reach:Social

Network

Results

Would you be willing to share your colon cancer screening experience with others?

IN CONVERSATIONn=301

Questions on email and e-communicationwere asked only of users

87% = email users54% = other e-communication users

BY EMAILn=265

BY OTHER E-COMMUNICATIONn= 166

Mode:

Limited to those who self-report having had colonoscopy, n=305

BY EMAILn=265*

BY OTHER E-COMMUNICATIONn= 166*

Very 75% 43% 28%

Might Be 22% 36% 25%

Not 2% 21% 48%

Would you be willing to share your colon cancer screening experience with others?

IN CONVERSATIONn=301

Questions on email and e-communication were asked only of users.All respondents reported having had colonoscopy.

BY EMAILn=265*

BY OTHER E-COMMUNICATIONn= 166*

Very 97% 79% of email users

53% of other e-

usersMight Be

Not 2% 21% 48%

Would you be willing to share your colon cancer screening experience with others?

IN CONVERSATIONn=301

*Questions on email and e-communication were asked only of those who previously indicated they use these forms of communication

Willingness to pass along

self-edited message*

*Limited to those who self-report having had colonoscopy, n=305

Willingness to pass along

self-edited message*

*Limited to those who self-report having had colonoscopy, n=305

• 89% willing70% would use email (or both)19% would use only postcard

• 89% willing70% would use email (or both)19% would use only postcard

Whoopee! Colonoscopy

(Suggested subject heading for email written by participant)

Willingness to pass along

self-edited message*

Pooper Scooper

Take Care of You

Bottoms up!

I care about you, consider this

Guess What I Did Yesterday?

Please open, this might save your

life

Selected email subject headings written by study participants

Estimated impact of receiving message

Estimated impact of receiving message

On self: 73% said would likelihood of discussing CRC screening with provider.

Estimated impact of receiving message

On self: 73% said would likelihood of discussing CRC screening with provider.

On others: 72% said would likelihood of friends & family discussing CRC screening with providers

Reach• 159 respondents reported willingness to send

out a total of 2,341 postcards

• 255 respondents reported willingness to send out a total of 4,107 emails

Due to what you hear from friends and family…

• 24% of all respondents have ever scheduled a cancer screening test

• 7% of respondents have ever avoided a cancer screening test

Impact of others on own actions

• 23% report friend/family has completed cancer screening

• 2% of respondents report friend/family has avoided cancer screening

Due to others hearing from you…

Your impact on others

Ever had a conversation with your doctor about CRC screening?

(n=386)

49 people (13%) answered No or Not sure.

Ever had a conversation with your doctor about CRC screening?

(n=386)

49 people (13%) answered No or Not sure.

Of these, 39 (80%) reported having communicated w friends/family about CRC screening.

Ever had a conversation with your doctor about CRC screening?

(n=386)

Limitations

• Generalizability• Report of willingness is not demonstration of

action.

ConclusionsAlmost ¾ of colonoscopy completers were

willing to discuss screening experience with friends/family through a self-edited email.

2/3 thought email would influence recipients and 1 out of 4 respondents reported completing a cancer screening test in past due to influence of friends/family.

Interviewees estimated they would send average of 15 emails per person.

.

Self-edited emails in which CRC screening is promoted by members of a social network may be an inexpensive way of increasing the reach and impact of a CRC screening message.

Conclusions

Whoopee! Colonoscopy…

Thank you.

Sarah L. CutronaMeyers Primary Care InstituteSarah.Cutrona@umassmemorial.org