Prevention and Wellness

1. “I Got Mine,
Have You Gotten Yours?”
Email to Promote
Colorectal Cancer Screening
among Members
of a Social Network
Sarah L. Cutrona, MD, MPH

2. • Terry S. Field, DSc
• Andrew E. Williams, PhD
• Douglas W. Roblin, PhD
• Sarah M. Greene, MPH
• Bridget Gaglio, PhD
Co-authors
• 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

3. • 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

4. 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/

5. 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.

6. “I got mine, have you gotten yours?”
Will people share cancer screening
experiences in order to promote
screening in friends and family?

7. “I got mine, have you gotten yours?”
Will people share colon cancer
screening experiences in order to
promote screening in friends and
family?

8. “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?

9. Methods

10. Methods: In-person interview
• 386 people ages 50-70 (MA, Hawaii, Georgia)

11. 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)

12. Interview Goals
Assess Respondents’
• Willingness to encourage CRC screening
among friends/family by sharing their own
screening experiences

13. 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

14. 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

15. 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)

16. 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)

17. 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)

18. 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)

19. 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

20. 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? Mode
-by other e-communication?”

21. Willingness to…
#2: Pass along a specific self-edited Message
“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.
Please help us design a message
you’d be willing to pass along to friends
and family members over age 50… Mode
either by email or postcard

23. 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?

24. Reach

25. Reach:
Social
Network
Please use your worksheet to estimate
how many people you’d send this to:
•Email
•Mail or hand-delivered postcards

26. Results

27. Would you be willing to share your colon
cancer screening experience with others?
BY EMAIL BY OTHER
IN n=265 E-COMMUNICATION
CONVERSATION n= 166
Mode: n=301
Questions on email and e-communication
were asked only of users
87% = email users
54% = other e-communication users
Limited to those who self-report having had colonoscopy, n=305

28. Would you be willing to share your colon
cancer screening experience with others?
BY EMAIL BY OTHER E-
IN n=265* COMMUNICATION
CONVERSATION n= 166*
n=301
Very 75% 43% 28%
Might Be 22% 36% 25%
Not 2% 21% 48%
Questions on email and e-communication were asked only of users.
All respondents reported having had colonoscopy.

29. Would you be willing to share your colon
cancer screening experience with others?
BY EMAIL BY OTHER E-
IN n=265* COMMUNICATION
CONVERSATION n= 166*
n=301
Very
97% 79% of 53% of
Might Be email other e-
users users
Not 2% 21% 48%
*Questions on email and e-communication were asked only of those who
previously indicated they use these forms of communication

30. Willingness to
pass along
self-edited message*
*Limited to those who self-report having had colonoscopy, n=305

31. Willingness to
pass along
self-edited message*
•89% willing
70% would use email (or both)
19% would use only postcard
*Limited to those who self-report having had colonoscopy, n=305

32. Willingness to
pass along
self-edited message*
•89% willing
70% would use email (or both)
19% would use only postcard
Whoopee!
Colonoscopy
(Suggested subject heading
for email written by participant)

33. Take Care of You
Please open,
Guess
this might save your
What I Did
life
Yesterday?
I care about
you, consider this
Pooper
Bottoms
Scooper up!
Selected email subject headings
written by study participants

34. Estimated impact of
receiving message

35. Estimated impact of
receiving message
On self: 73% said would likelihood of
discussing CRC screening with provider.

36. 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

37. 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

38. 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

39. Due to others
hearing from you…
• 23% report friend/family has completed
cancer screening
• 2% of respondents report friend/family has
avoided cancer screening
Your impact on
others

40. Ever had a conversation with your doctor
about CRC screening?
(n=386)

41. Ever had a conversation with your doctor
about CRC screening?
(n=386)
49 people (13%) answered No or Not sure.

42. 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.

43. Limitations
• Generalizability
• Report of willingness is not demonstration of
action.

44. Conclusions
Almost 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.

45. Conclusions
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.

46. Whoopee!
Colonoscopy…
Thank you.
Sarah L. Cutrona
Meyers Primary Care Institute
Sarah.Cutrona@umassmemorial.org