1. Poster produced by Faculty & Curriculum Support (FACS), Georgetown University School of Medicine
Persuasive Messages to Increase Cancer Screening:
A Content Analysis of the CDC’s Screen for Life Campaign
Background
Christine Skubisz, Carissa Burton, Kimberly DeMattia, Kayla McGowan, & Larissa Frei
School of Communication Emerson College
Study Objectives
Persuasive Message Features
Conclusions Recommendations
Results
Method
Colorectal cancer is the second leading cause of cancer death in the United
States. Current screening guidelines recommend that people start regular
screening at age 50. Colorectal cancer screening tests check for blood in the
stool (fecal occult blood tests) or use an instrument to look at the lining of the
colon and rectum (sigmoidoscopy and colonoscopy).
The Screen for Life (SFL) campaign was launched by the Centers for Disease
Control and Prevention in 1999. SFL is a public health campaign designed to
inform men and women age 50 and older about the importance of having regular
colorectal cancer screening tests. Previous research has examined SFL message
exposure and screening rates but, to date, no research has examined the
persuasive appeals present in the campaign messages.
The purpose of this study was to evaluate the content of the messages being
distributed in the SFL campaign. The behavioral goal of this campaign is to encourage
target audience members to participate in screening.
The types of persuasive appeals present in campaign messages were identified and
classified. Persuasive message design theory provides guidance regarding the most
effective ways to change attitudes and behaviors. This project was a systematic
analysis of persuasive message design features.
Persuasive message design features include: Emotional appeals (guilt, anger, fear,
hope, disgust, humor, warmth), evidence type (quantitative, qualitative, visual),
message sidedness, efficacy, norms, attitude functions, message frame, and
characteristics of the source (age, race, sex, expertise, familiarity).
Research Questions
RQ1: What types of emotional appeals are present in SFL?
RQ2: How is evidence presented in SFL?
RQ3: What language cues and visual cues are present in SFL?
RQ4: How are efficacy and norms communicated in SFL?
RQ5: What type of message framing is used in SFL?
RQ6: What attitude functions are present in SFL?
RQ7: What are the characteristics of campaign messengers in SFL?
SFL campaign messages published between 1999 and 2013 were collected.
Messages included: 10 print materials (e.g., brochures, mailers, fact sheets), 11 print
PSAs, 21 video PSAs, 9 audio PSAs or podcasts, 6 web banners, and 7 pieces of
website content (e.g., buttons, badges, and personal narratives).
Four independent coders evaluated the 64 campaign materials. To establish inter-
coder reliability, all coders evaluated 15% of campaign materials. A Cohen’s kappa
score of 0.94 and pairwise percent agreement coefficient of 98.33 were obtained.
Emotional Appeals Evidence Type
Efficacy
56 messages (87.5%) communicated self-efficacy
55 messages (85.9%) communicated response efficacy
Norms
13 messages (20.3%) communicated descriptive norms
Message Framing 61 messages (95.3%) communicated injunctive norms
59 messages (92.2%) 12 message (18.8%)
Gain Frame Loss Frame
Type of Appeal % of Messages Frequency
Fear
Severity
Susceptibility
68.8%
38.6%
91%
44
17
40
Hope 70.3% 45
Warmth 32.8% 21
Humor 9.4% 6
Guilt 10% 7
Disgust 0 0
Anger 0 0
Type of Evidence % of Messages Frequency
Quantitative 73.4% 47
Qualitative 25% 16
Verbal Expressions of
Risk
31.3% 20
Statement of Fact 82.8% 53
Visual 12.5% 8
1. Response Efficacy: Unlike screening tests for some other cancers, colonoscopies
are used to identify and immediately remove pre-cancerous polyps during the exam.
Messages should explicitly state response efficacy. For example: “Screening finds
pre-cancerous polyps so they can be removed before they turn into cancer” and
“Screening can find colorectal cancer early, when treatment is most effective.”
2. Fear: Fear is cited as a main barrier to colorectal cancer screening (e.g., Lasser,
Ayanian, Fletcher, & Good, 2008). Yet, many SFL messages are fear appeals,
including: “You might look and feel fine, but you need to get the inside story.” The
interaction between a fear appeal and feelings of uncertainty should be examined.
3. Norms: Just 20% of messages in the SFL campaign mention that screening is a
typical behavior. Messages should communicate that screening is the standard of
care.
This content analysis provides a comprehensive overview of message features
present in the SFL campaign. Little research has systematically evaluated the
breadth of message characteristics present in large scale behavior change
initiatives. This analysis provides a complete understanding of the types of
persuasive appeals being utilized in public health interventions.
Screening among those age 50 and older has increased in the last decade.
Moreover, there is evidence that SFL messages are being viewed. Program
evaluation data through 2013 shows that SFL messages have generated more
than 13 billion audience impressions (CDC, 2013). Nevertheless, 1 in 3 adults is
not up to date with recommended screenings. There is an opportunity for message
designers to utilize persuasion and message design theory to increase message
effectiveness.