STUDY 3

Project Name:
The Elimika Project ("elimika" is Swahili for "to get knowledge") 2003-2008.

Project overview:
Surprisingly little is known about how to achieve cultural appropriateness, whether it enhances communication effectiveness, and if using different approaches leads to different effects. Peripheral approaches seek to enhance effectiveness of cancer communication by packaging generic content in colors, fonts, images, pictures, or declarative titles likely to appeal to a given group. Evidential approaches provide and discuss data specific to that group. Sociocultural approaches discuss cancer in the context of specific social and/or cultural characteristics of the group. This study compared the effects of these three approaches to cultural appropriateness. We are currently analyzing date to determine the effects, if any, of combinations of these approaches on colorectal cancer screening and dietary change through a randomized trial among African American men and women ages 45-75 living in urban St. Louis, Missouri (N=772). This study will provide the first evidence for which communication effects can be expected, from which cultural approaches, at which intervals in a 6-month time period. It will thus contribute to establishing a theory of cultural cancer communication and guidelines for cancer educators and practitioners.

Formative work:
Data from focus groups, structured interview groups, key informant interviews, cognitive response interviews, survey test/re-test and sorting tasks are used to inform our intervention survey and materials. Formative work on each of the three approaches is complete.

Preliminary data analysis from the first phase of the peripheral approach testing (Create-a-Magazine) has yielded the following results:

Distinct differences emerged between the visual preferences of male and female participants. All participants preferred bold, bight colors, but each gender group selected different color schemes. The men chose blue, black, red, green and yellow; the women selected yellow, red, pink, and orange. Women participants explained their selections through emotional appeal, while the men participants indicated a link between their color choices and identification (the colors of the African American national flag). The men mostly chose pictures of food and recipes, while the women focused on pictures of families.

Both men and women wanted simple and directly presented information. They both chose fonts layouts that were large and easy to read, but each gender group indicated a preference for different layout strategies. The men favored the use of airy layouts with plenty of "white space." The women focused on structuring the information in outlines or in "Q&A" format. Both genders selected diagrams of the colon for explaining colorectal cancer information. While the women liked the idea of including distractors (puzzles and games), the men did not respond as favorably to them.

Finally, there were differences that emerged between well-educated African American men and those less educated, with regard to the use of graphs. Those less educated felt the use of graphs was a helpful for communicating complex information without excessive reading; those with more education wanted more supporting text for the graphs.

Intervention:
This study used a 2-arm randomized controlled trial among 772 African American men and women. We tracked the progression of affective, cognitive and behavioral effects, as described in McGuire’s Communication/Persuasion Model, that result from exposure to three colorectal cancer risk reduction publications distributed over a six month period. Participants were randomly assigned to receive either Evidential + Peripheral, or Evidential + Peripheral + Socio-cultural publications. The Social Cognitive Theory informed the communication inputs necessary for behavior change.

All participants completed by phone follow-up surveys at 0-, 2-, 12- and 22-weeks post-enrollment to evaluate participants’ reactions to the publications, as well as colorectal cancer knowledge and beliefs, consumption of fruits, vegetables and intent and use of screening. Analyses will determine the relative effectiveness of these three different approaches to cultural appropriateness in cancer communication for African Americans.

Staff that participated in the completion of this study:

Vetta Sanders Thompson, PhD, Principal Investigator;
Debra Haire-Joshu, PhD, Co-Principal Investigator;
Matt Kreuter, PhD, MPH, Co-Investigator and Intervention Director Eddie Clark, PhD, Investigator;
Robert Nicholson, PhD, Investigator- Pilot Study;
Anjali Deshpande, PhD, MPH, Junior Faculty Career Development Awardee;
Nikki Caito, MPH, MS, RD, Project Manager;
Brittany Story, Recruiter;
Amy Loudd, Recruiter;
Sherita Love, Recruiter; Tayo Afuwape, BA, Recruiter;
Jenny Gratzke, BA, MPH Research Assistant;
Kimberly Tate, BA, MPH Research Assistant;
Christine Dao, MPH, Research Assistant;
Lauren Garfield, MPH, Research Assistant;
Richard Horton, Recruiter;
Angela Evans, BA, Recruiter;
Ryan Robinson, Recruiter;
Tauron Alexander, Recruiter

For more information about Comparing three approaches to cultural appropriateness please contact:

Nikki Caito, Project Manager
4C: Center for Cultural Cancer Communication
Campus Box 1009
700 N. Rosedale Ave.
St. Louis, MO 63112
Phone: (314) 935.3706
Fax: (314) 935.3757
E-mail: ncaito@gwbmail.wustl.edu