Women Respond Better to Multicultural, Loss-Framed Messages Rather Than Ethnic Targeting in Campaign to Encourage Mammograms

A research project evaluating an intervention for low income women to see what would motivate them to get a mammogram revealed that they responded more positively to multicultural messages rather than those targeted to specific ethnic groups.

A research project evaluating an intervention for low income women to see what would motivate them to get a mammogram revealed that they responded more positively to multicultural messages rather than those targeted to specific ethnic groups.

The messages that worked best were “loss framed,” meaning that they emphasized the risks of not getting mammograms. They also described the desirability of mammography for all women, not just those with the same ethnicity as the target of the message.

“The idea is to use social psychology to identify a way to motivate people who may not get mammograms to get them regularly,” said Peter Salovey, chair of the Yale University Department of Psychology and senior investigator on the study to be published in the journal Health Psychology. The study was funded by a grant from the National Cancer Institute.

His team recruited 752 women over the age of 40 from community health clinics and public housing developments in New Haven. Salovey said he selected this pool of women for recruitment because although the incidence of breast cancer is greater among wealthier than lower income women, wealthier women have lower rates of mortality from breast cancer.

Forty three percent of the participants were African American; 27 percent were Anglo; 25 percent were Latina; two percent were American Indian; one percent were Asian, and three percent were from other ethnic groups.

The women were asked to fill out two questionnaires and were assigned randomly to view one of four videos, which were gain or loss framed and were targeted ethnically or were multicultural in focus. Health appeals that emphasize the positive outcomes associated with adopting healthy behaviors are labeled as “gain framed” messages. Loss framed messages emphasize the risks or costs associated with not adopting the healthy behaviors. The two kinds of messages contain the same substantive content, but differ in emphasis.

Six and 12 months after viewing the videos, the women were queried as to whether they had obtained a mammogram. Sixty one percent of the women who viewed the most persuasive video reported obtaining a mammogram by the 12-month follow up. The rate of mammography among low income women is traditionally about 45-50 percent annually, and this is what it was for women who viewed the other three videos.

“We found that loss-framed messages were best at persuading low-income women to obtain mammograms, as we have in the past, particularly among Anglo and Latina women, but this was only the case for the multicultural, not the targeted videos,” Salovey said. “Although the women found the ethnically targeted video more relevant than the multicultural message, it did not motivate breast cancer screening behavior.”

The study is based on the prospect theory, which addresses how people make choices between options that involve risk or uncertainty and options that are safe, sure bets.

“Prospect theory suggests to us that people are more willing to make a choice that involves risk or uncertainty if you present the negative consequences of not making that choice,” Salovey said. “And the decision to get a mammogram involves uncertainty and risk, the risk that you will find out some unpleasant news.”

He said he wanted to test an intervention based on prospect theory, as well as a popular notion in the health communications field that messages should be ethnically targeted to be effective. “We believed that messages emphasizing the cultural diversity of the target audience would be even better,” Salovey said. “And in fact, the message that worked the best was the loss framed multicultural message. While targeted messages work better than generic ones, which often assume everyone is white and middle class, targeted messages sometimes make people feel singled out, that they are uniquely vulnerable and no one else is.”

He said raising the rate of mammography from about 50 percent to 60 percent may not seem like a huge difference, until one considers the very low cost of this intervention and the ramifications of this change across a large population. The entire intervention took 15 to 20 minutes, and the only materials used were a brochure and a video, which women could watch while in a waiting room or as an infomercial on television.

“Another issue that this study demonstrates is the value of not giving up on certain segments of the population because they are so-called ‘hard to reach,’” he said. “Our team was welcomed into the common rooms of the housing developments, where you find people living in the most challenging circumstances in the city. What I really want to show is that you can take an academic theory in psychology and use it to design a community level intervention that actually changes peoples’ health behavior, and do it right in your own backyard.”

The other co-authors of the study all worked in the Health, Emotion, and Behavior (HEB) Laboratory, which Salovey directs, in the Department of Psychology. Tamera Schneider is now on the faculty at Wright State University; Anne Marie Apanovitch is now on the research staff of Bayer, Inc.; Judith Pizarro is a research associate in the HEB Laboratory; Danielle McCarthy, an alumna of Yale College is now a graduate student at the University of Wisconsin; Janet Zullo is a graphic designer at the Yale Art Gallery. and Alexander Rothman, who received his Ph.D. from Yale, is now on the faculty at the University of Minnesota.

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