Comparison of Print and Web Communication on Cancer Screening

The second leading cause of cancer death in the United States is colorectal cancer (CRC). According to researchers, <60% of the average-risk population for colorectal cancer (CRC) follows current CRC screening recommendations, indicating a need for new methods to enhance CRC screening rates.

To date, the majority of the studies of education intervention to increase screening rates have focused on written materials, in combination with videos, computer programs, and group education sessions. Those methods have proven moderately successful, with 10% to 20% absolute effect compared with no intervention.

Noting that electronic communication utilizing the proliferation of web-based applications has potential to improve delivery of the message of the importance of screening for CRC, researchers conducted a prospective, randomized, controlled trial to compare the effect of health communications delivered via web or print on CRC screening. They reported results in JAMA Internal Medicine [2013;173(2):122-129].

Participants were randomized to a web or print arm and were assigned with equal likelihood to receive communications reflecting high- or low-monitoring Cognitive-Social Health Information Processing (C-SHIP) content. The researchers included a usual care arm to control for secular screening trends. Participants’ attentional style was measured at study entry, allowing a test of the hypothesis that concordance between attentional style and tailored communication form would result in greater screening uptake.

The researchers identified women at average risk for CRC who had not been screened at obstetrics and gynecology practices in 2 large healthcare systems. Eligibility criteria were (1) female sex; (2) ≥50 years of age; (3) average risk for CRC defined as no personal history of colorectal polyps or adenocarcinoma, inflammatory bowel disease, or CRC in >1 first-degree relative; (4) nonadherence with CRC screening recommendations at the use of index appointment (no at-home fecal occult blood test in the past 12 months and no barium enema, flexible sigmoidoscopy, or colonoscopy in the past 5 years); and (5) web access at home and/or work.

The primary outcome measure was CRC screening participation at 4 months.

For the primary outcome measure, 865 women were included in the analysis. Most (96.6%) were white, ≤59 years of age (91.2%), had at least some college education (65.3%), and were married or cohabitating (74.4%). There were no significant differences in demographic characteristics across study groups and mammography use was similar in all 3 groups.

At 4 months, CRC screening rates were similar across intervention arms (web, 12.2%; print, 12.0%; control, 12.9%) The preferred screening mechanism was colonoscopy (75.5%); there was no difference in screening use by intervention arm. The overall screening rates were higher at 12 months (21.0% vs 12.3%), but when stratified by intervention, no differences were seen for control versus print or web or for web versus print.

Attentional type had no effect on screening uptake for any group.

The researchers then collapsed the study groups to determine whether any participant factors were associated with greater screening at 4 or 12 months. There was a significant, positive relationship between increasing income and likelihood of screening (P=.03 at 4 months and P<.001 at 12 months).

State of change at baseline tended to predict subsequent actual screening participation: those who stated they planned screening within the next 1 to 6 months were more likely to pursue it than those who had no plan or were not thinking about it (P<.001).

Participants with a greater baseline knowledge about screening demonstrated a strong trend toward more screening at 4 months than those with lower knowledge scores (P=.054). Participants whose physician recommended screening were 1.4 times more likely to be screened at 4 months (P<.001).

In conclusion, the researchers stated, “A web-based educational intervention was no more effective than a print-based one or control (no educational intervention) in increasing CRC screening rates in women at average risk of CRC. Risk messages tailored to attentional style had no effect on screening uptake. In average-risk populations, use of the Internet for health communication without additional enhancement is unlikely to improve screening participation.”