Normative Messages to Promote Colorectal Cancer Screening Uptake among African Americans

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Project Summary/Abstract Colorectal cancer (CRC) remains one of the leading causes of cancer mortality in the United States for both men and women. Despite gains in CRC survival, African Americans (AAs) still fare worse in CRC incidence and mortality compared to European Americans (EA). Given that CRC incidence and mortality are directly related to CRC screening, this disparity can be attributed to the corresponding screening disparity wherein AAs are less likely to attend CRC screening compared to EAs. It follows that interventions to increase CRC screening intentions and subsequent CRC screening behaviors among AAs are instrumental in addressing the disparities in CRC incidence and mortality. Video-based interventions have been used effectively in a number of CRC screening interventions aimed at AAs’ CRC screening knowledge and behaviors. Additionally, interventions that target individuals’ perceptions of behavioral norms have successfully influenced people’s engagement across a number of health behaviors; however, despite their promise, norm- based messages have not been utilized for CRC screening interventions with AAs. For the current study we will use an experimental design to examine the extent to which injunctive and descriptive norm messages about CRC screening influence AAs’ normative perceptions and CRC screening intentions. We will also examine the extent to which racial identity and group-based medical mistrust moderate the effects of norm messages. Finally, we will explore the effects of norm messaging on CRC screening uptake. We will test the following specific aims: Aim 1: To (a) examine the unique effects of injunctive norm and descriptive norm messages on normative perceptions, CRC screening intentions, and (b) to explore whether the norm-messages foment stronger association between normative expectations and CRC screening intentions among a cohort of screen eligible AAs. We will recruit participants who are non-compliant with CRC screening. Aim 2: To (a) examine the moderating roles of racial identity and group-based medical mistrust and (b) explore the moderating role of perceptions of barriers and behavioral control on the effects of normative messaging. We will examine whether norm-based messages lead to more favorable normative perceptions and stronger effects of normative perceptions, among participants who more strongly identify as AAs, who harbor greater group-based medical mistrust and who perceive fewer behavioral impediments. Aim 3: To explore the effects of injunctive and descriptive norm messages on CRC screening uptake. We will explore whether participants who receive the norm-based interventions are more likely to request a CRC screening kit, and more likely to return the CRC screening kit, compared to participants who do not receive the intervention.