Colorectal cancer (CRC) is an important cause of morbidity and mortality in the US. Despite multiple recommended screening options, CRC screening (CRCS) rates are suboptimal. More effective interventions are needed to increase CRCS uptake. Narrative communications that depict events and consequences may have advantages over informational communication styles that present reasons and arguments. The inclusion of patient narratives in interventions and on the Internet are becoming ubiquitous and have far outpaced empirical research regarding how and for whom narratives are effective. Frequently, narratives take the form of role model stories or testimonials that promote behavior change. Breast cancer survivors'testimonials have positively influenced women's mammography use for early detection. However, survivors'stories also may be perceived as inherently dissimilar and raise defenses among those concerned about (or in avoidance of) their cancer risk. For CRC, focusing on survivors also may undermine the message of preventing CRC through screening. Most people who are screened for CRC do not find any cancer and these "screeners" may be more influential role models. To improve future interventions that incorporate narratives, we need to identify the best role models ("survivors" vs. "screeners") for increasing CRCS intentions and behaviors, and examine mechanisms of their influence. For the proposed 3 arm pilot intervention with 1 month follow-up, we will randomize 400 adults age 50-75 who are not adherent to CRCS guidelines and have no history of cancer to one of three groups: 1) CRCS information only, 2) CRCS information plus a photo and text narrative of a CRC survivor, or 3) CRCS information plus a photo and text narrative of a CRC screener. Photos will be tailored on the participant's sex, age (+/-65) and race/ethnicity. Participants will complete surveys online before and after exposure to intervention materials. Exposing individuals to this information online mimics the real-world experience of reading health information on the Internet.
Our aims are: (1) Examine the direct effects of narratives on intentions and steps to CRCS behavior (main outcomes), (2) Examine mediators of narratives'effects, and (3) Estimate potential moderating effects of audience characteristics. Steps to CRCS include information seeking, discussing CRCS with others, making plans, and doing the prep. Based on our conceptual model, we will examine mediators such as message elaboration and known CRCS determinants, and estimate potential moderators such as demographic and psychological factors. This study is significant because if successful, our results may question the overwhelming focus on survivor (vs. screener) narratives for promoting preventive cancer screening. We will identify if, and how, screener and survivor narratives differentially influence CRCS intentions and behaviors to inform future narratives. Next steps will test dissemination strategies for narratives via the Internet and patients'electronic medical record portals, which have high reach, low cost, and appeal to diverse audiences.

Public Health Relevance

Despite multiple recommended screening options, colorectal cancer screening (CRCS) rates are suboptimal. Narratives, such as role model stories or testimonials, are widely used to influence behavior, but research is needed to identify the best role models for CRCS and examine how and for whom they work.

National Institute of Health (NIH)
Exploratory/Developmental Grants (R21)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1)
Program Officer
Blake, Kelly D
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Washington University
Internal Medicine/Medicine
Schools of Medicine
Saint Louis
United States
Zip Code