Table 2 Messages with an overall recommendation along with a summary of the rationale and sample quotes
From: Using Facebook to promote the uptake of colorectal cancer screening
Message (Behavioural construct) | Recommendation / Notes about sociodemographic characteristics of focus groups whose participants commented on this message | Summary of rationale and sample quotes |
|---|---|---|
#1 – Did you know your risk of colon cancer increases after 50? (Perceived susceptibility) | Consider using this message (with revisions) • N = 24; 10 Men and 14 Women across 3 focus groups • Wide range of ages but skewing younger • Ethnically diverse including Caucasian, Asian, Black and West Indian • Range of educational attainment but skewing more highly educated | • Evidence that the message may be effective -Message prompted participants to ask questions about the risk of colon cancer “You have a higher chance when you get 50 years old. So, you only get this when you [turn 50]?” MP9, FG3 -Participants agreed that getting screened is a good idea “[This message] is good. It’s better to get tested.” MP6, FG3 -Message increased awareness about CRC risk and would encourage participants to seek more information (by clicking on the message) about how to lower their risk “[This message] was thought provoking. I didn’t really think about the fact that [the risk of] this terrible disease might increase over the age of 50. I probably would click on it to try to find out why would that be, and what might I do to prevent my own risk.” FP7, FG2 -Message is credible “Yes, [I knew my risk went up at age 50]. When I turned 50, the kit came right to my home. And I did it immediately and every two years now.” MP5, FG1 • Evidence that the message may be ineffective but not harmful -Message is bland and does not stand out “People are consumed with so many things in their lives like global warming, the economy. This statement is sort of bland. It’s like ‘yeah, I know, I know, I’ll get to it’ sort of attitude about it.” FP4, FG1 -Message is not scary enough to motivate someone to act “I just don’t find this strong enough. In some cases, people need to be scared to do something.” MP3, FG1 -Message does not say if risk of getting colon cancer is high enough to warrant taking preventative action “What is the incremental amount that it increases after 50? Should I get worried yet?” FP14, FG2 • Evidence that the message may be harmful -Participants saw the message as being inaccurate because you can have cancer before age 50 “Doctors should recommend [screening] when you reach 40. Is 50 too late? Like when you find out you’re at Stage 4.” FP2, FG1 • Recommendations to improve the message -Reinforce the magnitude of CRC risk increase after age 50 to make the message more persuasive |
#2 – You could have colon cancer right now – and have no clue. (Perceived susceptibility) | Consider using this message • N = 45; 20 Men and 25 Women across all 6 focus groups • Wide range of ages • Ethnically diverse including Caucasian, Black, Asian and West Indian • Range of educational attainment | • Evidence that the message may be effective -Message is credible “What I like about it is it’s telling the truth. Some people don’t have symptoms and by the time you go to the doctor because it exhibited some kind of symptoms and by the time they get tested, it’s Stage 4.” FP13, FG2 -Message tone is direct and to the point “I really like [this message]. It’s direct and to the point.” FP24, FG6 -Message promotes awareness of CRC risk “I like that, the not knowing. That resonates with me.” MP20, FG6 -Message may scare people into clicking to find out how they can protect themselves “I thought that was alarming that you could have it and not know and I’d want to click to find out what the symptoms were that I wouldn’t be aware of.” FP7, FG2 • Evidence that the message may be ineffective but not harmful -Message is true of all cancers and therefore does not communicate anything new “That’s probably true of any type of cancer so I just thought you’re not telling me anything new.” MP7, FG3 |
#3–9 out of 10 people can be cured when colon cancer is found early. (Perceived benefits) | Consider using this message • N = 45; 20 Men and 25 Women across all 6 focus groups • Wide range of ages • Ethnically diverse including Caucasian, Black, Asian and West Indian • Range of educational attainment | • Evidence that the message may be effective -Message grabs attention of audience members “I thought [this message] was interesting.” FP, FG4 -Message is memorable “I like [this message]. It’s simple. It’s easy for me to remember.” MP14, FG5 -Message has a positive, reassuring tone “I think it’s optimistic. It makes you feel a little bit better. It tends to be more positive and hopeful. Better than the last one. This one makes you feel better.” FP10, FG2 -Message is credible “As I said about my cousin being diagnosed; early detection saved her life, so this is the same thing. When you find things early it can save lives.” FP13, FG2 -Message is educational “I never knew that [9 out of 10 people could be cured if cancer was found early].” MP15, FG5 -Message may prompt audience members to click to learn more and see their doctor “[If I saw this message on my Facebook] I would go and read more about it and get information and try to talk to my family doctor.” FP12, FG2 • Evidence that the message may be ineffective but not harmful -Message is not scary enough to cause people to click on it “I thought it was a good education piece. I don’t think I would have clicked on it. I just think that it’s really got to scare you and move you on the emotional level.” FP14, FG2 -Message will not grab attention on social media “I think the idea is trying to get [people’s] attention and to try to get people to click on to it. With this statement, people will say ‘oh, yeah, that’s good.’ And then he or she will just go on to something else. They won’t click on it, in my opinion.” MP3, FG1 |
#4 – Getting checked for colon cancer is easy and can be done in the privacy of your own home. (Perceived barriers) | Strongly consider using this message • N = 45; 20 Men and 25 Women across all 6 focus groups • Wide range of ages • Ethnically diverse including Caucasian, Black, Asian and West Indian • Range of educational attainment | • Evidence that the message may be effective -Message is credible “[The message] mentions that getting checked for colon cancer is easy and can be done in the privacy of your own home. In fact, that’s a reality and that’s a real-life experience for me.” MP9, FG3 -Message has a positive tone “I found [this message] the best. I find it to be very positive and it would encourage someone I believe to continue reading.” FP24, FG6 -Message is educational and comforting “I like [this message] because I think a lot of people have the misconception that, all rubber glove and finger up the butt kind of thing at the doctor’s office. It’s comforting to know that you can do it yourself.” FP23, FG6 -Message addresses barriers to screening and may prompt audience members to take action “The text that says you can do it easily, quickly and in privacy is really important. It’s kind of hard to do a sell on the purge before colonoscopy or having a colonoscopy so this gets people more, approachable for doing this and taking action.” MP7, FG3 • No evidence that the message may be ineffective or harmful |
#7 – Colon cancer kills 9000+ Canadians every year. Don’t be one of them. (Perceived severity) | Proceed with caution • N = 45; 20 Men and 25 Women across all 6 focus groups • Wide range of ages • Ethnically diverse including Caucasian, Black, Asian and West Indian • Range of educational attainment | • Evidence that the message may be effective -Message grabs attention “The “9000″ number caught my attention.” MP13, FG4 -Message is educational “I had no idea it affected that many people. So that one really stood out.” FP21, FG5 -Message provides incentive to click and learn more “The first part is kind of depressing and sad when you hear, 9000 died. But then, the second part gives you hope. Don’t be one of them so do something about it. It makes you want to take action, be assertive.” FP10, FG2 • Evidence that the message may be ineffective but not harmful -Message may be unclear “I’m not really a numbers person. I can’t remember them or process them.” FP7, FG2 -Message is unappealing “[This message] sounds less appealing to the reader.” MP9, FG3 -Message may not stand out among other ads on social media “Well, if I were to be looking at my Facebook feed, I would ignore [this message] to be frank. They’re all trying to catch my attention and they do seem like other ads that I see.” MP21, FG6 • Evidence that the message may be harmful -Message tone is negative, discouraging, impersonal and fear mongering “I agree, the scare tactics [of this message] … it’s too alarming and it’s not personal enough.” FP14, FG2 -Message may scare people and turn them away from screening “I think for some people [this message] would put you in a depression. Some people may be scared and wouldn’t go for check-up. It may be very scary.” MP6, FG3 |
#11 – Are you 50–74 years old? Healthcare providers recommend you get checked for colon cancer every 2 years. (Social norms and cues to action) | Consider using this message • N = 30; 17 Men and 13 Women across 4 focus groups • Wide range of ages but skewing younger • Mix of ethnicities but skewing Caucasian/White • Range of educational attainment but skewing towards lower educational attainment | • Evidence that the message may be effective -Message prompted participants to ask questions about protective measures “Is [stool testing] every two years or can we request to do it every year?” MP10, FG3 -Message is clear and simple “[This message] is really clear and descript.” MP9, FG3 -Message is educational “I was reading [the message] about getting tested every two years. I didn’t know that. Every two years it said.” FP3, FG1 -Message references a trusted source “[This message is my favorite because it is] bringing in a trusted authority like your health care provider.” MP7, FG3 • Evidence that the message may be ineffective but not harmful -Message is generic “It just looks like every health pamphlet you’ve ever seen in a doctor’s office.” FP23, FG6 -Message doesn’t provide enough information about the screening test “Which test are you talking about? Because I mean you don’t have colonoscopies every two years.” FP1, FG1 |
#12 – Don’t flush it away. Test your poop for colon cancer today. It’s easy and can be done at home. (Perceived barriers and use of humour) | Proceed with caution • N = 45; 20 Men and 25 Women across all 6 focus groups • Wide range of ages • Ethnically diverse including Caucasian, Black, Asian and West Indian • Range of educational attainment | • Evidence that the message may be effective -Message grabs attention and is likely to stand out on social media “If the purpose is to try to design an attention-getting campaign on social media then [this message] I think is effective.” MP13, FG4 -Audience appreciates the funny, playful tone “It’s funny, I found it humorous. I thought it was for curiosity’s sake.” FP14, FG2 -Message is credible “A friend of mine said she looked back, and she saw the blood and that’s how she found out that there was something wrong with her, [she had] colon cancer. She didn’t flush it. So you see, it happens.” FP13, FG2 -Message increases self-efficacy “[This message] alleviates some of my concerns. It’s not the most comfortable thing to think about and this is sort of suggesting that “It’s easy and can be done at home.” And I feel less concerned about that.” MP21, FG6 -Message may prompt audience members to click to get more information about the test “I would click on there to find out how easy it is. Then I would want to see how it works and makes me open to check for more information.” FP2, FG1 • Evidence that the message may be ineffective but not harmful -Audience may ignore the message “[This message], I’d [scroll] right over that.” MP8, FG3 -Message isn’t as clever as it could be “The [messages] that talk about poop specifically stand out to me. I don’t really care for them, but, I think they could have made it a little bit more clever.” FP23, FG6 • Evidence that the message may be harmful -Message is offensive “Crap and poop and toilets and flushing. It disgusts me.” MP14, FG5 |