Publications by authors named "Janice L Krieger"

70 Publications

A Pilot Study Examining the Efficacy of Delivering Colorectal Cancer Screening Messages via Virtual Health Assistants.

Am J Prev Med 2021 Apr 19. Epub 2021 Apr 19.

Department of Computer & Information Science & Engineering, College of Engineering, University of Florida, Gainesville, Florida.

Introduction: Patients are more likely to complete colorectal cancer screening when recommended by a race-concordant healthcare provider. Leveraging virtual healthcare assistants to deliver tailored screening interventions may promote adherence to colorectal cancer screening guidelines among diverse patient populations. The purpose of this pilot study is to determine the efficacy of the Agent Leveraging Empathy for eXams virtual healthcare assistant intervention to increase patient intentions to talk to their doctor about colorectal cancer screening. It also examines the influence of animation and race concordance on intentions to complete colorectal cancer screening.

Methods: White and Black adults (N=1,363) aged 50-73 years and not adherent to colorectal cancer screening guidelines were recruited from Qualtrics Panels in 2018 to participate in a 3-arm (animated virtual healthcare assistant, static virtual healthcare assistant, attention control) message design experiment. In 2020, a probit regression model was used to identify the intervention effects.

Results: Participants assigned to the animated virtual healthcare assistant (p<0.01) reported higher intentions to talk to their doctor about colorectal cancer screening than participants assigned to the other conditions. There was a significant effect of race concordance on colorectal cancer screening intentions but only in the static virtual healthcare assistant condition (p=0.04). Participant race, age, trust in healthcare providers, health literacy, and cancer information overload were also significant predictors of colorectal cancer screening intentions.

Conclusions: Animated virtual healthcare assistants were efficacious compared with the static virtual healthcare assistant and attention control conditions. The influence of race concordance between source and participant was inconsistent across conditions. This warrants additional investigation in future studies given the potential for virtual healthcare assistant‒assisted interventions to promote colorectal cancer screening within guidelines.
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http://dx.doi.org/10.1016/j.amepre.2021.01.014DOI Listing
April 2021

A Subjective Culture Approach to Cancer Prevention: Rural Black and White Adults' Perceptions of Using Virtual Health Assistants to Promote Colorectal Cancer Screening.

Health Commun 2021 Apr 20:1-12. Epub 2021 Apr 20.

STEM Translational Communication Center, University of Florida.

In the US, Black adults are less likely than White adults to be screened for colorectal cancer (CRC). This study uses a subjective culture approach to describe and compare perceptions of a CRC screening intervention delivered via virtual health assistants (VHAs) among rural Black and White study participants. We analyzed 28 focus groups with Black ( = 85) and White ( = 69) adults aged 50-73. Participants, largely recruited through community engagement efforts, tested the VHA intervention on mobile phones provided by the research team. Moderated discussions were recorded, transcribed, and analyzed using thematic analysis. All groups preferred the VHA to be friendly. Other important cues included trustworthiness, authority, and expertise. Black participants expressed a preference for receiving information about their CRC risk from the VHA compared with White adults. Black participants also expressed the importance of sharing the intervention and the CRC screening messages with younger members of their networks, including family members who could benefit from screening messages before reaching the recommended age for screening. The key similarities and differences between Black and White adults' perceptions of the intervention that were identified in this study can help inform future efforts to develop effective communication strategies and reduce cancer screening inequities.
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http://dx.doi.org/10.1080/10410236.2021.1910166DOI Listing
April 2021

Perspectives of Pregnant and Breastfeeding Women on Participating in Longitudinal Mother-Baby Studies Involving Electronic Health Records: Qualitative Study.

JMIR Pediatr Parent 2021 Mar 5;4(1):e23842. Epub 2021 Mar 5.

Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States.

Background: Electronic health records (EHRs) hold great potential for longitudinal mother-baby studies, ranging from assessing study feasibility to facilitating patient recruitment to streamlining study visits and data collection. Existing studies on the perspectives of pregnant and breastfeeding women on EHR use have been limited to the use of EHRs to engage in health care rather than to participate in research.

Objective: The aim of this study is to explore the perspectives of pregnant and breastfeeding women on releasing their own and their infants' EHR data for longitudinal research to identify factors affecting their willingness to participate in research.

Methods: We conducted semistructured interviews with pregnant or breastfeeding women from Alachua County, Florida. Participants were asked about their familiarity with EHRs and EHR patient portals, their comfort with releasing maternal and infant EHR data to researchers, the length of time of the data release, and whether individual research test results should be included in the EHR. The interviews were transcribed verbatim. Transcripts were organized and coded using the NVivo 12 software (QSR International), and coded data were thematically analyzed using constant comparison.

Results: Participants included 29 pregnant or breastfeeding women aged between 22 and 39 years. More than half of the sample had at least an associate degree or higher. Nearly all participants (27/29, 93%) were familiar with EHRs and had experience accessing an EHR patient portal. Less than half of the participants (12/29, 41%) were willing to make EHR data available to researchers for the duration of a study or longer. Participants' concerns about sharing EHRs for research purposes emerged in 3 thematic domains: privacy and confidentiality, transparency by the research team, and surrogate decision-making on behalf of infants. The potential release of sensitive or stigmatizing information, such as mental or sexual health history, was considered in the decisions to release EHRs. Some participants viewed the simultaneous use of their EHRs for both health care and research as potentially beneficial, whereas others expressed concerns about mixing their health care with research.

Conclusions: This exploratory study indicates that pregnant and breastfeeding women may be willing to release EHR data to researchers if researchers adequately address their concerns regarding the study design, communication, and data management. Pregnant and breastfeeding women should be included in EHR-based research as long as researchers are prepared to address their concerns.
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http://dx.doi.org/10.2196/23842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080167PMC
March 2021

An Electronic Tool to Support Patient-Centered Broad Consent: A Multi-Arm Randomized Clinical Trial in Family Medicine.

Ann Fam Med 2021 Jan-Feb;19(1):16-23

Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida.

Purpose: Patients are frequently asked to share their personal health information. The objective of this study was to compare the effects on patient experiences of 3 electronic consent (e-consent) versions asking patients to share their health records for research.

Methods: A multi-arm randomized controlled trial was conducted from November 2017 through November 2018. Adult patients (n = 734) were recruited from 4 family medicine clinics in Florida. Using a tablet computer, participants were randomized to (1) a standard e-consent (standard), (2) an e-consent containing standard information plus hyperlinks to additional interactive details (interactive), or (3) an e-consent containing standard information, interactive hyperlinks, and factual messages about data protections and researcher training (trust-enhanced). Satisfaction (1 to 5), subjective understanding (0 to 100), and other outcomes were measured immediately, at 1 week, and at 6 months.

Results: A majority of participants (94%) consented to future uses of their health record information for research. No differences in study outcomes between versions were observed at immediate or 1-week follow-up. At 6-month follow-up, compared with the standard e-consent, participants who used the interactive e-consent reported greater satisfaction (B = 0.43; SE = 0.09; <.001) and subjective understanding (B = 18.04; SE = 2.58; <.001). At 6-month follow-up, compared with the interactive e-consent, participants who used the trust-enhanced e-consent reported greater satisfaction (B = 0.9; SE = 1.0; <.001) and subjective understanding (B = 32.2; SE = 2.6, <.001).

Conclusions: Patients who used e-consents with interactive research details and trust-enhancing messages reported higher satisfaction and understanding at 6-month follow-up. Research institutions should consider developing and further validating e-consents that interactively deliver information beyond that required by federal regulations, including facts that may enhance patient trust in research.
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http://dx.doi.org/10.1370/afm.2610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7800739PMC
January 2020

A feasibility trial of parent HPV vaccine reminders and phone-based motivational interviewing.

BMC Public Health 2021 01 9;21(1):109. Epub 2021 Jan 9.

Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.

Background: We assessed the feasibility and acceptability of a sequential approach of parent-targeted HPV vaccine reminders and phone-based Motivation Interviewing (MI).

Methods: In 2016, we selected all 11- to 12-year-old boys and girls seen in one clinic whose vaccine records did not include the HPV vaccine (n=286). By gender, we individually randomized parents of adolescents to an interactive text message (74 girls and 45 boys), postcard reminder (46 boys and no girls because of previously demonstrated efficacy), or standard care group (75 girls and 46 boys). Reminders were sent with medical director permission and a HIPAA waiver. Two months after reminders, among the adolescents whose vaccine records still did not include the HPV vaccine, we selected a gender-stratified random sample of 20 parents for phone-based MI. We assessed the percentage of deliverable messages, the percentage of parents' responding to the interactive text message, parent acceptability of receiving a text message, and MI parent responsiveness and interviewer competence (MI Treatment Integrity Coding system).

Results: Nearly all messages were deliverable (98% of postcards and 74% of text messages). Six of the 88 parents (7%) receiving text messages scheduled an appointment through our interactive system. The acceptability survey response rate was 37% (38/102). Respondents were favorable toward vaccine reminders for all parents (82%). Among 20 sampled parents, 17 were reached by phone of whom 7 completed MI, 4 had or were getting the HPV vaccine for their child, and 5 expressed disinterest. Across the 7 MI calls, the interviewer was rated 100% MI adherent and scored an average 4.19 rating for Global Spirit.

Conclusion: Without providing explicit consent to receive vaccine-related messages, parents nonetheless found postcards and interactive text messages acceptable. Centralizing MI to phone calls with trained staff was acceptable to parents and resulted in highly MI-adherent interviews.
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http://dx.doi.org/10.1186/s12889-020-10132-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797089PMC
January 2021

Communication strategies for designing Facebook advertising campaigns to recruit rural participants to develop healthcare delivery interventions.

J Clin Transl Sci 2020 Jan 16;4(5):398-407. Epub 2020 Jan 16.

STEM Translational Communication Center, University of Florida, Gainesville, FL, USA.

Background: Little is known about designing research recruitment campaigns that connect with underserved, geographically isolated rural populations. A theoretically informed process is needed to assist research teams and practitioners in their evaluation of Facebook's feasibility as a recruitment tool and development of online materials for recruiting rural adults into healthcare delivery intervention development studies.

Methods: We drew from research and theory in communication and incorporated process analysis techniques to develop replicable procedures for designing and evaluating Facebook campaigns for rural recruitment. We describe our process and illustrate using two case studies.

Results: Campaigns received approximately 1000 link clicks from the target rural demographic and successfully enrolled participants using Facebook as a primary method of recruitment. The rural tobacco intervention development study received a total of 477 link clicks, cost only $155.80, and enrolled three (23%) of its 13 participants from Facebook. The rural mental health intervention development study received a total of 518 link clicks, cost only $233.28, and enrolled 178 participants.

Conclusions: Our process yielded two successful recruitment campaigns. Facebook was an affordable and efficacious strategy for enrolling adults in behavioral research studies on tobacco and mental health. Future work should apply these theoretical techniques to additional study topics and evaluate specific message features associated with recruitment.
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http://dx.doi.org/10.1017/cts.2020.5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7681130PMC
January 2020

Promoting Clinical Conversations about Lung Cancer Screening: Exploring the Role of Perceived Online Social Support.

J Health Commun 2020 08 29;25(8):650-659. Epub 2020 Oct 29.

Department of Biostatistics, University of Florida , Gainesville, FL, USA.

The perceived availability of online social support may contribute to patient-provider conversations about lung cancer screening. This study examines how the perceived availability of instrumental and emotional online social support is associated with patient-provider communication about lung cancer screening among adults who meet U.S. Preventive Services Taskforce (USPSTF) eligibility criteria and live with a COPD diagnosis. In April 2018, 575 adults completed an online survey after being recruited from a large southeastern academic medical center's broad research registry and website listing. Nearly half of the participants were 55-to-80 years old (41%), a current or former smoker who had quit smoking within the past 15 years (42%), and reported a smoking prevalence of 30 pack years or more (PPY; 41%). Results demonstrate that having a COPD diagnosis, identifying as male, and being a current or former tobacco smoker resulted in greater odds of having a clinical conversation about lung cancer screening. Conversely, meeting the 30 PPY smoking and 55-to-80 age thresholds lowered the odds of having these conversations. A high degree of instrumental and emotional online social support was associated with a greater incidence of annual patient-provider conversations about screening. This combination of perceived online social support was especially useful for patients with COPD.
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http://dx.doi.org/10.1080/10810730.2020.1836087DOI Listing
August 2020

A Qualitative Study of Pregnant Women's Perspectives on Antibiotic Use for Mom and Child: Implications for Developing Tailored Health Education Interventions.

Antibiotics (Basel) 2020 Oct 15;9(10). Epub 2020 Oct 15.

Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA.

The overutilization of antibiotics during pregnancy and early life are associated with adverse health outcomes for mothers and infants. In this study, we explored pregnant women's opinions and concerns of antibiotics and how perceptions may affect their health-related decision-making. We conducted 18 in-depth, semi-structured interviews with pregnant women and used the Health Belief Model (HBM) as a framework to analyze the data. We found that mothers generally understood the benefits of antibiotics and were aware that antibiotics are clinically effective for treating bacterial infections. Importantly, perceived barriers related to antibiotic use included concerns regarding the impact of antibiotics on breastfeeding efficacy, microbial health, and societal factors such as antimicrobial resistance. The prescription of antibiotics by a healthcare provider was a cue to action for women, as they trusted providers to recommend medications that were safe for them and their infants. Overall, mothers shared that receiving education on the effects of antibiotics would improve their self-efficacy and decision-making surrounding the use of antibiotics for treating illness. Implications for tailored perinatal health education interventions to enhance antibiotic use, knowledge, and decision-making are discussed.
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http://dx.doi.org/10.3390/antibiotics9100704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602878PMC
October 2020

Tailoring virtual human-delivered interventions: A digital intervention promoting colorectal cancer screening for Black women.

Psychooncology 2020 12 15;29(12):2048-2056. Epub 2020 Sep 15.

STEM Translational Communication Center, College of Journalism & Communications, University of Florida, Gainesville, Florida, USA.

Objective: Despite efforts to reduce cancer disparities, Black women remain underrepresented in cancer research. Virtual health assistants (VHAs) are one promising digital technology for communicating health messages and promoting health behaviors to diverse populations. This study describes participant responses to a VHA-delivered intervention promoting colorectal cancer (CRC) screening with a home-stool test.

Methods: We recruited 53 non-Hispanic Black women 50 to 73 years old to participate in focus groups and think-aloud interviews and test a web-based intervention delivered by a race- and gender-concordant VHA. A user-centered design approach prioritized modifications to three successive versions of the intervention based on participants' comments.

Results: Participants identified 26 cues relating to components of the VHA's credibility, including trustworthiness, expertise, and authority. Comments on early versions revealed preferences for communicating with a human doctor and negative critiques of the VHA's appearance and movements. Modifications to specific cues improved the user experience, and participants expressed increased willingness to engage with later versions of the VHA and the screening messages it delivered. Informed by the Modality, Agency, Interactivity, Navigability Model, we present a framework for developing credible VHA-delivered cancer screening messages.

Conclusions: VHAs provide a systematic way to deliver health information. A culturally sensitive intervention designed for credibility promoted user interest in engaging with guideline-concordant CRC screening messages. We present strategies for effectively using cues to engage audiences with health messages, which can be applied to future research in varying contexts.
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http://dx.doi.org/10.1002/pon.5538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7821126PMC
December 2020

PrEP awareness among people living with HIV in Florida: Florida Cohort study.

AIDS Care 2021 04 21;33(4):428-433. Epub 2020 Jan 21.

Department of Epidemiology, Florida International University, Miami, FL, USA.

In 2017, Florida ranked 2nd nationally in prevalence and incidence rates of HIV infections in the United States. Due to the high burden of HIV and low viral suppression in Florida, it is of increased importance to study methods of HIV prevention such as preexposure prophylaxis(PrEP) in this state. Our study aimed to examine correlates of PrEP awareness among PLWH in Florida and describe patterns of PrEP awareness/information sources. Using data collected from the Florida Cohort study between 2014 and 2018, 530 PLWH answered items that were hypothesized to be correlated with PrEP awareness. Of our sample, 53.8% were aware of PrEP. Urban location of recruitment, sexual partner's use of PrEP, use of viral suppression as an HIV prevention strategy, and engagement in transactional sex were all significantly associated with higher odds of PrEP awareness. Care providers and HIV/AIDS support groups were the most frequently listed sources of PrEP awareness, sources of future PrEP information, and most trusted sources for PrEP information. Findings from this study could inform future interventions that aim to increase PrEP awareness among PLWH to increase PrEP awareness and uptake among their HIV-negative social and sexual networks.
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http://dx.doi.org/10.1080/09540121.2020.1717421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371495PMC
April 2021

Audience segmentation as a strategy for enhancing the use of research registries for recruiting patients into clinical trials.

Contemp Clin Trials Commun 2020 Mar 24;17:100510. Epub 2019 Dec 24.

STEM Translational Communication Center, University of Florida, Gainesville, USA.

Introduction: Health research registries have great potential to increase awareness of research opportunities among diverse patient populations and reduce disparities in clinical trial accrual. However, little research has focused on patients' intentions to participate in clinical trials once they are enrolled in the registry and their intentions to remain in the registry over time.

Methods: Patients ( = 312) enrolled in a university-based health research registry (i.e., Consent2Share) in the southeastern region of the US participated in an online survey.

Results: Health research registry knowledge, perceived values, self-efficacy, trust, having chronic health concerns, and consent recall were positively correlated with intentions to remain enrolled in the research registry and participate in future clinical trials. Health research registry consent recall had significant positive associations with registry knowledge, perceived values, trust, registry retention, and participating in future trials.

Conclusion: The process of consenting patients to the health research registry is important for recruitment, registry retention, and participation in future clinical trials. We identified key points of emphasis to expand participation in research registries as a strategy to increase clinical trial enrollment, such as deploying precision messages and tailored interventions.
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http://dx.doi.org/10.1016/j.conctc.2019.100510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957865PMC
March 2020

The Perceived Availability of Online Social Support: Exploring the Contributions of Illness and Rural Identities in Adults with Chronic Respiratory Illness.

Int J Environ Res Public Health 2019 12 29;17(1). Epub 2019 Dec 29.

Department of Health Education and Promotion, East Carolina University, Greenville, NC 27858, USA.

Joining an online social support group may increase perceived membership to a community, but it does not guarantee that the community will be available when it is needed. This is especially relevant for adults with Chronic Obstructive Pulmonary Disease (COPD), many of whom reside in rural regions and continually negotiate their illness identity. Drawing from social support literature and communication theory of identity, this cross-sectional study explored how COPD illness and geographic identities interact to influence patients' perceived availability of online social support. In April 2018, 575 adults with a history of respiratory symptoms completed an online survey. Patients with a COPD diagnosis reported greater availability of online support. This was partially mediated by a positive degree of COPD illness identity (i.e., being diagnosed with COPD, a history of tobacco use, severe respiratory symptoms, high disease knowledge, and low income but high education). The relationship between COPD illness identity and the availability of online support was strongest among those with low rural identity; however, at lower levels of COPD illness identity, participants with high rural identity reported the greatest degree of available online support. Results have important implications for tailored education approaches across the COPD care continuum by illness and geographic identities.
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http://dx.doi.org/10.3390/ijerph17010242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982215PMC
December 2019

Computer-Mediated Experiences of Patients with Chronic Obstructive Pulmonary Disease.

Am J Health Educ 2019 26;50(2):127-134. Epub 2019 Feb 26.

Kinesiology Department, California Polytechnic State University, San Luis Obispo CA 93407.

Background: The Internet is an important tool for empowering patients with Chronic Obstructive Pulmonary Disease (COPD) to learn about and self-manage their condition.

Purpose: To understand which aspects of the online experience facilitates or hinders the perceived ability of patients with COPD to achieve their information and self-management goals.

Methods: Semi-structured interviews were conducted with medically underserved patients with COPD ( = 25) who access the Internet for health. A conventional content analysis approach was applied and data were analyzed with the constant comparative method.

Results: The following themes were derived: (1) desire to associate with "in-group" members; (2) relationship building with other online users; (3) security of information and identity; (4) source and channel credibility appraisal; (5) user assistance and tutorials; and (6) strategies to adapt technological functions.

Discussion: Success in using the Internet was dependent on the functional use of technology and the ability and resilience to engage with similar online users to build meaningful and trustworthy connections.

Translation To Health Education Practice: Prior to directing patients with COPD to a disease-specific online support platform, certified health education specialists must assess patients' information goals and their skills to critically appraise and communicate with other online users.
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http://dx.doi.org/10.1080/19325037.2019.1571963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805128PMC
February 2019

Transactional eHealth Literacy: Developing and Testing a Multi-Dimensional Instrument.

J Health Commun 2019 4;24(10):737-748. Epub 2019 Oct 4.

College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS, USA.

Theoretically informed measures of eHealth literacy that consider the social affordances of eHealth are limited. This study describes the psychometric testing of a multi-dimensional instrument to measure functional, communicative, critical, and translational eHealth literacies, as informed by the Transactional Model of eHealth Literacy (TMeHL). A 3-phase rating scale construction process was conducted to engage eHealth experts and end-users. In Phase 1, Experts ( = 5) and end-users ( = 25) identified operational behaviors to measure each eHealth literacy dimension. End-users ( = 10) participated in think-aloud interviews to provide feedback on items reviewed and approved by experts. A field test was conducted with a random sample of patients recruited from a university-based research registry ( = 283). Factor analyses and Rasch procedures examined the internal structure of the scores produced by each scale. Pearson's correlations provided evidence for external validity of scores. The instrument measures four reliable (ω = .92-.96) and correlated (= .44-.64) factors: functional (4 items), communicative (5 items), critical (5 items), and translational (4 items). Researchers and providers can use this new instrument as a theory-driven instrument to measure four eHealth literacies that are fundamental to the social affordances of the eHealth experience.
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http://dx.doi.org/10.1080/10810730.2019.1666940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366705PMC
September 2020

Recruitment in online research for COPD: leveraging social media and research registries.

ERJ Open Res 2019 Apr 8;5(2). Epub 2019 Apr 8.

STEM Translational Communication Center, University of Florida, Gainesville, FL, USA.

http://ow.ly/gQQt30o6Bcw.
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http://dx.doi.org/10.1183/23120541.00167-2018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452045PMC
April 2019

Does an interactive trust-enhanced electronic consent improve patient experiences when asked to share their health records for research? A randomized trial.

J Am Med Inform Assoc 2019 07;26(7):620-629

Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA.

Objective: In the context of patient broad consent for future research uses of their identifiable health record data, we compare the effectiveness of interactive trust-enhanced e-consent, interactive-only e-consent, and standard e-consent (no interactivity, no trust enhancement).

Materials And Methods: A randomized trial was conducted involving adult participants making a scheduled primary care visit. Participants were randomized into 1 of the 3 e-consent conditions. Primary outcomes were patient-reported satisfaction with and subjective understanding of the e-consent. Secondary outcomes were objective knowledge, perceived voluntariness, trust in medical researchers, consent decision, and time spent using the application. Outcomes were assessed immediately after use of the e-consent and at 1-week follow-up.

Results: Across all conditions, participants (N = 734) reported moderate-to-high satisfaction with consent (mean 4.3 of 5) and subjective understanding (79.1 of 100). Over 94% agreed to share their health record data. No statistically significant differences in outcomes were observed between conditions. Irrespective of condition, black participants and those with lower education reported lower satisfaction, subjective understanding, knowledge, perceived voluntariness, and trust in medical researchers, as well as spent more time consenting.

Conclusions: A large majority of patients were willing to share their identifiable health records for research, and they reported positive consent experiences. However, incorporating optional additional information and messages designed to enhance trust in the research process did not improve consent experiences. To improve poorer consent experiences of racial and ethnic minority participants and those with lower education, other novel consent technologies and processes may be valuable. (An Interactive Patient-Centered Consent for Research Using Medical Records; NCT03063268).
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http://dx.doi.org/10.1093/jamia/ocz015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6562160PMC
July 2019

Measuring health information seeking challenges in chronic disease: A psychometric analysis of a brief scale.

Chronic Illn 2021 Jun 19;17(2):151-156. Epub 2019 Mar 19.

School of Human Development and Organizational Studies in Education, University of Florida, Gainesville, USA.

Information seeking is a cornerstone of patient activation in chronic disease self-management. To date, there are few brief and literacy-sensitive tools to measure intrinsic barriers of health information seeking. The Health Information National Trends Survey includes four items from the Information Seeking Experiences scale to measure frustration, effort, concern, and comprehension of information sought during a recent medical/health information search. Limited evidence exists for its construct validity and use in primary data collection in chronic disease. This measurement study examines the psychometric properties of the scale. Qualtrics Panelists with at least one chronic disease ( = 684) participated in an online survey. The average score was  = 12.85 ( = 3.97), indicating a moderate degree of health information seeking challenges. Confirmatory factor analysis of data collected using this scale supported unidimensionality (RMSEA = .03; CFI/TLI = .99/.99). There was adequate scale (ω = .83) and item (value = .98) reliabilities. Rasch analyses showed optimal measurement error and response predictability with item-fit (values = .80-1.20). Response option "agree" was less likely to be selected than any other response option, although not posing a threat to scale reliability. Results demonstrate that this brief scale has sufficient measurement properties for its use as a measure of intrinsic health information seeking barriers among patients with chronic disease.
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http://dx.doi.org/10.1177/1742395319836476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752979PMC
June 2021

A Pilot Study Determining Comprehension and the Acceptability of a Cancer Research Study Website for Cancer Patients and Caregivers.

J Cancer Educ 2020 06;35(3):589-598

STEM Translational Communication Center, University of Florida, Gainesville, FL, USA.

The purpose of this pilot study was to determine if a cancer research study website increased comprehension among patients and caregivers and if website evaluations differed across patient and caregiver groups. Participants (N = 200) were cancer patients and caregivers living in the USA. Comprehension was determined by the number of correct responses to a series of questions about key characteristics of cancer research studies that are frequently unknown or misinterpreted by patients and/or caregivers. Quantitative and qualitative analyses were conducted to determine participant evaluations across four domains: perceived website credibility, perceived website attractiveness, perceived information effectiveness, and perceived information clarity. Patients and caregivers perceived the website as highly credible and attractive and the information as both easy to understand and moderately effective in helping them make decisions about CCTs. Qualitative feedback underscores the importance of testimonials to website credibility. However, the range in the number of correct responses of certain items across participants coupled with discrepancies in comprehension between patients and caregivers suggests the need for stronger mechanisms evaluating knowledge outcomes.
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http://dx.doi.org/10.1007/s13187-019-01501-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015148PMC
June 2020

Calories in Context: Conceptual Metaphors and Consumers' Perception and Use of Calorie Information.

J Health Commun 2018 9;23(8):783-790. Epub 2018 Oct 9.

b College of Journalism and Communications , University of Florida , Gainesville , FL , USA.

The U.S. Food and Drug Administration (FDA) recently made changes to the nutrition facts label so that calories will be emphasized over all other nutrient information (U.S. Food and Drug Administration (FDA), 2016a, August 3). In light of calories' increased visibility, strategic health communicators need to understand both how individuals perceive calorie information and how calories influence consumption decisions. Therefore, a qualitative study was conducted to analyze the metaphors that structure consumers' thoughts about calorie information and food choices. In-depth interviews were conducted with 34 women from diverse racial/ethnic and socioeconomic backgrounds. Through the interviews and subsequent thematic analysis, metaphors were gathered that explained perceptions of different kinds of calories and how calories function in the diet. Five conceptual metaphors were uncovered. The metaphors individuals used varied based on their eating paradigms, and the metaphors were related to different approaches to consumption decisions. The implications of using these different calorie metaphors for translational communication interventions are further discussed.
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http://dx.doi.org/10.1080/10810730.2018.1527876DOI Listing
August 2019

Proposing a Transactional Model of eHealth Literacy: Concept Analysis.

J Med Internet Res 2018 10 2;20(10):e10175. Epub 2018 Oct 2.

Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States.

Background: Electronic health (eHealth) literacy was conceptualized in 2006 as the ability of internet users to locate, evaluate, and act upon web-based health information. Now, advances in eHealth technology have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures of eHealth literacy have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. This paper describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is described as an intrapersonal skillset hypothesized as being dynamic; reciprocal; and shaped by social, relational, and cultural contexts.

Objective: The objective of our study was to systematically examine eHealth literacy definitions, models, and measures to propose a refined conceptual and operational definition based on the TMC.

Methods: Walker and Avant's concept analysis method was used to guide the systematic review of eHealth literacy definitions (n=10), rating scales (n=6), models (n=4), and peer-reviewed model applications (n=16). Subsequent cluster analyses showed salient themes across definitions. Dimensions, antecedents, and consequences reflected in models and measures were extracted and deductively analyzed based on codes consistent with the TMC.

Results: Systematic review evidence revealed incongruity between operational eHealth literacy included in definitions compared with literacies included within models and measures. Theoretical underpinnings of eHealth literacy also remain dismal. Despite the transactional capabilities of eHealth, the role of "communication" in eHealth literacy remains underdeveloped and does not account for physical and cognitive processing abilities necessary for multiway transactions.

Conclusions: The Transactional Model of eHealth Literacy and a corresponding definition are proposed. In this novel model, eHealth literacy comprises a hierarchical intrapersonal skillset that mediates the reciprocal effect of contextual factors (ie, user oriented and task oriented) on patient engagement in health care. More specifically, the intrapersonal skillset counteracts the negative effect of "noise" (or impediments) produced by social and relational contexts. Cutting across health and technology literacies, the intrapersonal skillset of eHealth literacy is operationalized through four literacies that correspond with discrete operative skills: (1) functional (ie, locate and understand); (2) communicative (ie, exchange); (3) critical (ie, evaluate); and (4) translational (ie, apply).
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http://dx.doi.org/10.2196/10175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231800PMC
October 2018

Designed Cultural Adaptation and Delivery Quality in Rural Substance Use Prevention: an Effectiveness Trial for the Keepin' it REAL Curriculum.

Prev Sci 2018 11;19(8):1008-1018

STEM Translational Communication Center, University of Florida, Gainesville, FL, 32611, USA.

This study examined how cultural adaptation and delivery quality of the school-based intervention keepin' it REAL (kiR) influenced adolescent substance use. The goal of the study was to compare the effectiveness of the multi-cultural, urban (non-adapted) kiR intervention, a re-grounded (adapted) rural version of the kiR intervention and control condition in a new, rural setting. A total of 39 middle schools in rural communities of two states in the USA were randomly assigned to one of three conditions (i.e., control, non-adapted urban kiR, and adapted rural kiR). Data included adolescent self-reported lifetime substance use and observers' ratings of delivery quality from video recordings of lessons. Ratings of delivery quality were used to create four comparison groups (i.e., low/high delivery quality in non-adapted/urban kiR condition and low/high quality in adapted/rural kiR condition). Controlling for substance use in the 7th grade, findings compared 9th graders' (N = 2781) lifetime alcohol, cigarette, marijuana, and chewing tobacco use. Mixed model analyses revealed that rural youth receiving the culturally adapted/rural curriculum reported significantly less cigarette use than rural youth in the control condition regardless of delivery quality. In the non-adapted/urban condition, youth receiving high delivery quality delivery reported less marijuana use than those receiving low delivery quality condition. However, substance use outcomes of youth receiving high and low delivery quality in the non-adapted intervention did not differ significantly from those the control group. Findings support the effectiveness of the culturally adapted/rural keepin' it REAL curriculum for rural youth.
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http://dx.doi.org/10.1007/s11121-018-0937-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202132PMC
November 2018

Electronic Health Literacy Across the Lifespan: Measurement Invariance Study.

J Med Internet Res 2018 07 9;20(7):e10434. Epub 2018 Jul 9.

Department of Health Education and Behavior, University of Florida, Gainesville, FL, United States.

Background: Electronic health (eHealth) information is ingrained in the healthcare experience to engage patients across the lifespan. Both eHealth accessibility and optimization are influenced by lifespan development, as older adults experience greater challenges accessing and using eHealth tools as compared to their younger counterparts. The eHealth Literacy Scale (eHEALS) is the most popular measure used to assess patient confidence locating, understanding, evaluating, and acting upon online health information. Currently, however, the factor structure of the eHEALS across discrete age groups is not well understood, which limits its usefulness as a measure of eHealth literacy across the lifespan.

Objective: The purpose of this study was to examine the structure of eHEALS scores and the degree of measurement invariance among US adults representing the following generations: Millennials (18-35-year-olds), Generation X (36-51-year-olds), Baby Boomers (52-70-year-olds), and the Silent Generation (71-84-year-olds).

Methods: Millennials (N=281, mean 26.64 years, SD 5.14), Generation X (N=164, mean 42.97 years, SD 5.01), and Baby Boomers/Silent Generation (N=384, mean 62.80 years, SD 6.66) members completed the eHEALS. The 3-factor (root mean square error of approximation, RMSEA=.06, comparative fit index, CFI=.99, Tucker-Lewis index, TLI=.98) and 4-factor (RMSEA=.06, CFI=.99, TLI=.98) models showed the best global fit, as compared to the 1- and 2-factor models. However, the 4-factor model did not have statistically significant factor loadings on the 4th factor, which led to the acceptance of the 3-factor eHEALS model. The 3-factor model included eHealth Information Awareness, Search, and Engagement. Pattern invariance for this 3-factor structure was supported with acceptable model fit (RMSEA=.07, Δχ=P>.05, ΔCFI=0). Compared to Millennials and members of Generation X, those in the Baby Boomer and Silent Generations reported less confidence in their awareness of eHealth resources (P<.001), information seeking skills (P=.003), and ability to evaluate and act on health information found on the Internet (P<.001).

Results: Young (18-48-year olds, N=411) and old (49-84-year olds, N=419) adults completed the survey. A 3-factor model had the best fit (RMSEA=.06, CFI=.99, TLI=.98), as compared to the 1-factor, 2-factor, and 4-factor models. These 3-factors included eHealth Information Awareness (2 items), Information Seeking (2 items), and Information and Evaluation (4 items). Pattern invariance was supported with the acceptable model fit (RMSEA=.06, Δχ=P>.05, ΔCFI=0). Compared with younger adults, older adults had less confidence in eHealth resource awareness (P<.001), information seeking skills (P<.01), and ability to evaluate and act upon online health information (P<.001).

Conclusions: The eHEALS can be used to assess, monitor uniquely, and evaluate Internet users' awareness of eHealth resources, information seeking skills, and engagement abilities. Configural and pattern invariance was observed across all generation groups in the 3-factor eHEALS model. To meet gold the standards for factor interpretation (ie, 3 items or indicators per factor), future research is needed to create and assess additional eHEALS items. Future research is also necessary to identify and test items for a fourth factor, one that captures the social nature of eHealth.
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http://dx.doi.org/10.2196/10434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056742PMC
July 2018

The Influence of Patient Identification and Narrative Transportation on Intentions to Participate in Cancer Research.

J Cancer Educ 2019 Aug;34(4):725-734

Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL, USA.

Cancer decision-making interventions commonly utilize narratives as a persuasive strategy to increase identification with the message source, promote involvement with the topic, and elicit greater willingness to adopt recommended behaviors. However, there is little empirical research examining the mechanisms underlying the effectiveness of this strategy in the context of cancer research participation. Data for the current manuscript were collected as part of a larger study conducted with cancer patients (N = 413) from the USA, UK, and the Republic of Ireland. Participants viewed and evaluated video-recorded vignettes, illustrating different strategies for discussing clinical trials participation with family members. Results showed nationality was a significant predictor of identification with the main character (i.e., patient) in the vignette. Unexpectedly, these cross-national differences in identification disappeared when patients currently undergoing treatment had higher perceived susceptibility of their cancer. Identification with the main character in the vignettes was a significant predictor of intentions to participate in cancer research, but only when the mediating role of narrative transportation was considered. The findings demonstrate the importance of considering how individual and social identities influence identification with characters in cancer narratives and yield practical guidance for developing arts-based interventions to increase cancer research participation.
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http://dx.doi.org/10.1007/s13187-018-1364-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055730PMC
August 2019

A content analysis of Clinical and Translational Science Award (CTSA) strategies for communicating about clinical research participation online.

J Clin Transl Sci 2017 Dec;1(6):340-351

STEM Translational Communication Center, University of Florida, Gainesville, FL, USA.

Introduction: There is a dearth of literature providing guidance on how to effectively communicate about clinical research (CR).

Methods: Using the transactional model of communication, a content analysis of the investigator (n=62) and participant (n=18) Web sites of institutions funded through the National Institutes of Health Clinical and Translational Science Award (CTSA) was conducted to identify their strategies (e.g., messages) for communicating about CR participation.

Results: CTSAs targeted investigators with CR participation content across the main Web sites, although most CTSAs (n=55; 88.7%) also included CR participation content for participants. In total, 18 CTSAs (29%) hosted participant Web sites. Participant sites included 13 message types about CR participation (e.g., registry enrollment) and 5 additional channels (e.g., email, phone number) to communicate about CR. However, many CTSA participant Web sites excluded information explaining the CR process and offered CR content exclusively in English.

Conclusion: CTSAs should identify their target audience and design strategies (e.g., messages, channels) accordingly.
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http://dx.doi.org/10.1017/cts.2018.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915806PMC
December 2017

Evaluating the Efficacy of a Registry linked to a Consent to Re-Contact Program and Communication Strategies for Recruiting and Enrolling Participants into Clinical Trials.

Contemp Clin Trials Commun 2017 Dec 24;8:62-66. Epub 2017 Aug 24.

Clinical and Translational Science Institute (CTSI), University of Florida.

Introduction: Although registries can rapidly identify clinical study participants, it is unknown which follow up methods for recruiting are most effective. Our goal is to examine the efficacy of three communication strategies for recruiting and enrolling patients who were identified via a contact registry (i.e., registry linked to a consent to re-contact program).

Methods: Patients who met the study criteria were identified via the contact registry and targeted for recruitment. In condition 1, patients established in the university hepatology specialty clinics were contacted one time via phone call by the study coordinator and asked to participate (C1). In condition 2, non-established specialty clinic patients were mailed an IRB-approved letter with study information and instructions for calling the study coordinator to participate (C2). Condition 2A included patients who called within two weeks of receiving the letter (C2A); condition 2B included patients who did not call after receiving the letter but were subsequently contacted via phone call.

Results: A registry identified 1,060 patients, of which 661were eligible and targeted for recruiting. All 37 patients were reached in C1 and 17 (45.9%) were recruited. Nineteen of the 624 patients in C2A were reached and 10 were recruited whereas 120 of the 605 patients in C2B were reached and 53 (8.7%) were recruited. Seventy patients enrolled with C2B being the most effective (total, cost) recruitment strategy ( = 50) ( < .001).

Conclusion: The efficacy of enrolling patients identified via a contact registry into clinical trials varies based on the communication strategies used for recruiting.
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http://dx.doi.org/10.1016/j.conctc.2017.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831259PMC
December 2017

Trends of Parent-Adolescent Drug Talk Styles in Early Adolescence.

Health Commun 2019 07 20;34(8):801-810. Epub 2018 Feb 20.

d STEM Translational Communication Center , College of Journalism and Communications.

The present study seeks to understand how parents as prevention agents approach substance use prevention messages during the period of early adolescence. Students ( = 410) in a drug prevention trial completed surveys from 7th to 9th grade. Using longitudinal data, a series of latent transition analyses was conducted to identify major trends of parent-adolescent drug talk styles (i.e., never talked, situated direct, ongoing direct, situated indirect, and ongoing indirect) in control and treatment conditions. Findings demonstrate a developmental trend in drug talk styles toward a situated style of talk as youth transitioned from 7th grade to 9th grade. Findings also show that even though the drug prevention trial did not specifically target parental communication, parents in the treatment condition provide more ongoing substance use prevention messages to their adolescent children than do parents in the control condition. The present study discusses relevant developmental issues, potential intervention effects, and future research directions for communication research in substance use prevention.
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http://dx.doi.org/10.1080/10410236.2018.1437522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277230PMC
July 2019

Patient preferences toward an interactive e-consent application for research using electronic health records.

J Am Med Inform Assoc 2018 Mar;25(3):360-368

Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA.

Objective: The purpose of this study was to assess patient perceptions of using an interactive electronic consent (e-consent) application when deciding whether or not to grant broad consent for research use of their identifiable electronic health record (EHR) information.

Materials And Methods: For this qualitative study, we conducted a series of 42 think-aloud interviews with 32 adults. Interview transcripts were coded and analyzed using a modified grounded theory approach.

Results: We identified themes related to patient preferences, reservations, and mixed attitudes toward consenting electronically; low- and high-information-seeking behavior; and an emphasis on reassuring information, such as data protections and prohibitions against sharing data with pharmaceutical companies. Participants expressed interest in the types of information contained in their EHRs, safeguards protecting EHR data, and specifics on studies that might use their EHR data.

Discussion: This study supports the potential value of interactive e-consent applications that allow patients to customize their consent experience. This study also highlights that some people have concerns about e-consent platforms and desire more detailed information about administrative processes and safeguards that protect EHR data used in research.

Conclusion: This study contributes new insights on how e-consent applications could be designed to ensure that patients' information needs are met when seeking consent for research use of health record information. Also, this study offers a potential electronic approach to meeting the new Common Rule requirement that consent documents contain a "concise and focused" presentation of key information followed by more details.
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http://dx.doi.org/10.1093/jamia/ocx145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992814PMC
March 2018

Missing the mark for patient engagement: mHealth literacy strategies and behavior change processes in smoking cessation apps.

Patient Educ Couns 2018 05 12;101(5):951-955. Epub 2017 Nov 12.

STEM Translational Communication Center, University of Florida, Gainesville FL, USA; Department of Health Outcomes & Policy, University of Florida, Gainesville FL, USA; Department of Advertising, University of Florida, Gainesville FL, USA.

Objective: To examine how Transtheoretical Model (TTM)'s processes of change and mHealth literacy strategies are employed in mobile smoking cessation apps.

Methods: A purposive sample of 100 iTunes apps were coded to assess descriptive (price, type, developer, user-rating) and engagement metrics, including processes of change and mHealth literacy strategies (plain language, usability, interactivity). One-way ANOVAs and independent samples t-tests examined associations between descriptive and engagement metrics.

Results: Over half of the apps included 7 (78%) processes of change. Fewer included self-liberation (36%) and reinforcement management (34%). Most apps incorporated plain language, but few integrated usability and interactivity strategies. Hypnotherapy and informational apps included more behavioral processes of change than apps incorporating a combination of features, including gaming, cigarette trackers, and motivational coaching (p<0.01).

Conclusion: Apps included behavior change processes but rarely incorporated usability and interactivity features to promote patient engagement. Engagement metrics did not vary by app user-ratings, price-to-download, or developer, including for-profit organizations or government and educational institutions.

Practice Implications: Providers should acknowledge the popularity of smoking cessation apps as potential cessation aids and communicate their benefits and drawbacks to patients. Future efforts to improve smoking cessation apps should focus on enhancing the quality of tailored and interactive content.
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http://dx.doi.org/10.1016/j.pec.2017.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911212PMC
May 2018

Parent Prevention Communication Profiles and Adolescent Substance Use: A Latent Profile Analysis and Growth Curve Model.

J Fam Commun 2017 6;17:15-32. Epub 2017 Jan 6.

Department of Biobehavioral Health, Pennsylvania State University.

This current study identifies distinct parent prevention communication profiles and examines whether youth with different parental communication profiles have varying substance use trajectories over time. Eleven schools in two rural school districts in the Midwestern United States were selected, and 784 students were surveyed at three time points from the beginning of 7th grade to the end of 8th grade. A series of latent profile analyses were performed to identify discrete profiles/subgroups of substance-specific prevention communication (SSPC). The results revealed a 4-profile model of SSPC: Active-Open, Passive-Open, Active-Silent, and Passive-Silent. A growth curve model revealed different rates of lifetime substance use depending on the youth's SSPC profile. These findings have implications for parenting interventions and tailoring messages for parents to fit specific SSPC profiles.
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http://dx.doi.org/10.1080/15267431.2016.1251920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650115PMC
January 2017

Beyond Words: Amplification of Cancer Risk Communication on Social Media.

J Health Commun 2017 10 28;22(10):849-857. Epub 2017 Sep 28.

a College of Journalism and Communications , University of Florida , Gainesville , Florida , USA.

Social media provide a unique channel for disseminating evidence-based information to diverse audiences and organizational and private stakeholders, thus facilitating a dialog about health and health risks. Guided by the social amplification of risk framework, the goal of this study was to assess the level of audience engagement with messages posted on the National Cancer Institute (NCI) Facebook page and evaluate the differences in the audience information behavior toward risk-related and non-risk posts. Data included 1,975 posts published on the NCI Facebook page as well as the corresponding 4,537 comments, 77,298 shares, and 145,462 likes. Links and images were the top two most frequent types of content for both risk-related and non-risk posts, but risk-related messages were more amplified through comments, shares, and likes. Comparing the modality of risk-related messages, videos, contrary to the prediction, were not more effective in attracting audience engagement than images. Finally, comments to risk-related posts did not repeat risk-related language suggesting that future studies should examine risk signal recognition and dissemination as separate behaviors. This study's findings emphasize the importance of focused investigation of message design strategies and message effects on the dissemination and amplification of communication related to health risks.
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http://dx.doi.org/10.1080/10810730.2017.1367336DOI Listing
October 2017