Memorable Messages: Networks of Meaning in Breast Cancer

1. Memorable Messages: Networks of Meaning in Breast Cancer Professor Cynthia Stohl Department of Communication University of California Santa Barbara Presented to the Psychology Department, University of Canterbury Christchurch New Zealand August 19, 2009 This project was carried out as part of the NIEHS/NCI Breast Cancer and the Environment Research Centers, four centers with transdisciplinary research collaborations integrated across biologic, epidemiologic, and community outreach projects. Professor Sandi Smith of Michigan State University leads the memorable message project. http://bcerc.msu.edu/comm_resources.html

2. WHAT ARE MEMORABLE MESSAGES? Verbal messages which are remembered for extremely long periods of time and which people perceive as a major influence on the course of their lives. They are retrospective judgments. Socializing and memorable nature of the messages are enhanced by several recurrent features in their form and structure, the receptivity of the respondent, the content, and the context Knapp, M. L., Stohl, C., & Reardon, K. K. (1981). "Memorable" Messages. Journal of Communication, 31, 27-41. Stohl, C. (1986). The role of memorable messages in the process of organizational socialization. Communication Quarterly, 34, 231-249

3. Studied in a variety of contexts…

4. NOT ALWAYS ACADEMIC Memorable Messages—Hitting the target where it matters. What stops you in your tracks?
 Like Cupid's arrow, memorable messages cut through the clutter to strike at what's important to the reader. To be seen and read, they must be sharp and focused on your target's wants, needs and desires. Messages that matter are the ones that have meaning to the reader. The more personal— and personalized they are, the more they will be remembered.

5. Creating memorable messages is utilizing effective communication to move people to act. Memorable messages are the cornerstone of effective marketing messages, whether they are TV commercials, marketing campaigns or product designs, Memorable messages are those that give us confidence in some politicians, authority leaders and products, while we remain distrustful of others. Messaging is the communication of the details on a product or issue that will compel the audience to act on the information received. http://www.articlesbase.com/communication-articles/why-creating-memorable-messages-is-important-529358.html

7. Used in strategic communication contexts • Sender, creation-focused activity • Mass-media oriented • Guides immediate, short-term behavior In contrast….

8. http://catalyticconversations.blogspot.com/2008/12/science-is-hard-and-other-memorable.htmlthursday, december 11, 2008 • Daniel Goleman’s Social Intelligence is a must read to really get the power of these memorable messages. Seemingly off hand comments and throw away lines can turn into mind wiring realities—particularly for those following every word of a parent, teacher, coach, or pastor. Positive and negative comments that we might see as trite or silly end up shaping the way people think for years at a time—for a lifetime for some. Indeed, in student focus groups, I’ve heard so many students talk about how they were told early and often that “math is hard,” “girls aren’t good at science,” or “you’re not college material” that I think we should have laws against these phrases ever being used again!

9. Unintentional • Receiver-focused interpretive activity • Non-mediated organizational and interpersonal contexts • Guides long term future behavior

10. STUDIED IN A VARIETY OF CONTEXTS UTILIZING A VARIETY OF METHODS INTERPERSONAL ORGANIZATIONAL NEWCOMER SOCIALIZATION VOCATIONAL SOCIALIZATION FAMILY-WORK BALANCE UNIVERSITY WOMEN BLUE COLLAR WORKERS FRATERNITY HAZING COACHING • AGING • RELATIONAL DEVELOPMENT • SELF CONCEPT DEVELOPMENT • CONTROL • MOTHERHOOD • SURVIVORS • FAMILY CONSTELLATION • MOTHER-IN LAWS

11. HEALTH COMMUNICATION Ford, L., Babrow, A. & Stohl, C. (1996). “Social support messages and the management of uncertainty in the experience of breast cancer: An application of problematic integration theory.” Communication Monographs, 63, 189-207. Ford, L. A. & Ellis, B. H. (1998). A preliminary analysis of memorable support and nonsupport messages received by nurses in acute care settings. Health Communication, 10, 37-63.  Keeley, M. P. (2004). Final conversations: Survivors' memorable messages concerning religious faith and spirituality. Health Communication, 16, 87-104. Parrott, R., Volkman, J., Ghetian, C., Weiner, J., Raup-Krieger, J., & Parrott, J. (2008). Memorable messages about genes and health: Implications for direct-to-consumer marketing of genetic tests and therapies. Health Marketing Quarterly, 25, 8-32. Smith, S. W., Atkin, C., Skubisz, C. M., Munday, S., & Stohl, C. (2009). The impact of personal and/or close relationship experience on memorable messages about breast cancer and the perceived speech acts of the sender. Journal of Cancer Education, 24, 129-134. Smith, S. W. Munday, S., LaPlante, C., Kotowski, M. R., Atkin, C., Skubisz, C. M., & Stohl, C. (2009). Topics and sources of memorable breast cancer messages and their impact on prevention and detection behaviors. Journal of Health Communication, 14, 293-307.

12. General Findings • Almost everyone can recall a memorable messages • Overwhelming number are positive/benevolent • Private, non-mediated, informal settings • Perceived as spontaneous, non strategic communication yet purposefully directed and attuned to the individual • Short and pithy • Rule structured • Transcontextual • Experiential Status– high • Organizational status-- mixed • Network Status –peer • Guide for prolonged attitudes and behaviors: Control theory, socialization, theories, discursive closure

13. Memorable messages are important because they have been found to guide both behavior and performance assessment (Ellis and Smith, 2004).

14. http://www.nzbcf.org.nz/index.php/about-nzbcf/news/hard-hitting-message-to-inspire-new-zealanders-to-acthttp://www.nzbcf.org.nz/index.php/about-nzbcf/news/hard-hitting-message-to-inspire-new-zealanders-to-act • "2500 New Zealand women are diagnosed with breast cancer and more than 600 women die from this disease every year. We share the aim of The Foundation to try and improve these statistics and we wanted to deliver work that would inspire New Zealanders to care enough about breast cancer to act" Colenso Managing Director Brent Smart says.

15. The American Cancer Society has predicted that in 2009 alone, 1,479,350 new cases would be diagnosed in the United States. It is the second most common cancer among women, and about 1 in 8 women will develop invasive breast cancer at some time during their life span, whereas other women will experience concerns related to the disease. Currently, there are over 2 million breast can survivors in the United States.

17. Study: Low-Key Anti-Smoking Messages Most Memorable May  20, 2009 • New research shows that smokers are more likely to remember factual, understated public-service announcements (PSAs) than splashy messages designed to grab attention with flashy images, loud music or other techniques.Lead researcher Daniel Langleben and colleagues at the University of Pennsylvania looked at brain images of test subjects exposed to "just the facts" messages or ads packed with drama, frequent cuts, and shocking or surprising visual images. The authors found that participants' brains showed more activity in the frontal cortex and temporal cortex -- the areas associated with attention and memory, respectively -- when researchers showed them the soft-pedaled PSAs than the dramatic ones.Langleben said that the study is the first to show a neurobiological basis for measuring the impact of message sensation value (MSV) -- a concept in the health-communications field that refers to how much PSAs use attention-grabbing features. "Our findings suggest that the attention-grabbing high-MSV format may impede the learning and retention of a PSA," Langleben said. "The findings are also novel in that they offer a general approach for objectively evaluating PSAs before they are released."The National Institute on Drug Abuse (NIDA) and the National Cancer Institute supported the study, which was published in the May 15, 2009 issue of the journal NeuroImage. • http://www.jointogether.org/news/research/summaries/2009/study-low-key-anti-smoking.html

18. Who are the most memorable sources of health -related messages? • PSAs have been the focus of most health communication research and practice because of pervasiveness and persuasiveness of mass media • Network scholars suggest peers are most important sources of messages associated with health related behaviors • Interpersonal scholars focus on family and friends • For genes and health the primary mode of mm was movies, (not tv) followed by print media.

19. Sources of breast cancer messages • Doctors often are claimed to be the best sources of breast cancer messages (Atkin, Smith, Ferguson, & McFeters, 2008). • A study of cancer patients found that the most common source of information was a doctor, followed by family, nurses, friends, the Internet, other medical personnel, and other patients (Pecchioni & Sparks, 2007). • Another study reported that women favored messages by doctors followed by media, family, and friends (Meissner, Potosky, & Convissor, 1992). Dissatisfied patients go to other patients, media, celebs, friends, family. • Family members of cancer patients report being most satisfied with information obtained from the Internet (Pecchioni & Sparks, 2007). • While mothers tended to turn most often to media sources, daughters tended to turn most often to interpersonal resources like family and friends (Jones et al., 2006).

20. Effects of Messages • Mediated health communication campaigns are successful in changing the behavior of about 8% of the target population (Snyder et al., 2004). • A review of 15 media campaigns to promote physical activity, which aids breast cancer prevention, found that although the majority were recalled, there was little or no influence on behaviors (Cavill & Bauman, 2004). • In an intervention in which women received one, two, or all of the following messages: physician messages, a class on breast self-examination, and message reinforcement through a postcard and a phone call those who received all three messages reported engaging in the most breast self-examinations. NO differences among each type Strickland, and colleagues (1997)

21. Effects of Messages • Dialogue with friends and relatives increased the chances that African American women would seek screening for breast cancer (Husaini et al., 2001). • Women who were contacted by friends and encouraged them to have a mammogram showed increased mammography usage when compared with a control group (Calle, Miracle-McMahill, Moss, & Heath, 1994). • Discussion with relatives about breast cancer led to higher numbers of breast self-exams performed by college-aged women (Jones,Denham, and Springston (2006) • A study of a statewide media campaign revealed that the messages had adverse effects on women’s breast cancer detection behaviors (McCaul, Jacobson, & Martinson, 1998).

22. Studies of Memorable Messages in Context of Breast Cancer Data Collection • Participants were recruited from breast cancer awareness organizations, advocacy groups, a large Midwestern university, and a medium-sized Western university in the United States. • In sum, more than 1000 female respondents completed the survey (interviews, traditional and web surveys). • Participants ranged from 18 to 85 years old. • Caucasians composed the majority of the sample, 85%. African Americans (4%), Latinos (3%), Asian Americans (2%), Native Americans (2%), Pacific Islanders (3%), and (1%) choosing not to respond regarding their • Highest level of education, 11% reported a high school degree or less, 35% participants completed some college, technical school, or earned an associates degree, 32% earned a bachelor’s degree, and 22% had graduate schooling.

23. Smith et al.(2009) Topics and Sources of Memorable Breast Cancer Messages and Their Impact on Prevention and Detection Behaviors. Journal of Health Communication, 14:293–307, 2009Smith, S., Atkin, C., Skubisz, C., ,Nazione, S., and Stohl, C. (2009). The impact of Personal and/or Close Personal and/or Close Relationships on Memorable Messages About Breast Cancer and the Perceived Speech Acts of the Sender Journal of Cancer Education,24:2,129 — 134 • 60% of respondents recalled a memorable message (n=359, N=457) • Prevention and Detection Behaviors Ranged from 0-4 • Four Topics detection (37.3%), awareness/experience (30.9%) treatment (25.8%) prevention (6%) • Five Source Categories media (35.5%) friends (22.2%) family (21.6%) medical professionals (15.2%) others (5.5%).

24. Percentages of topics of memorable messages and their sources Source BC Awareness Prevention Detection Treatment Total Family 1.9 (6%) 2.8 (46%) 11.3 (30%) 5.2 (20%) 21.1 Media 16.9 (55%) 1.9 (31%) 9.4 (25%) 7.4 (29%) 35.7 Health Care 2.8 (9%) 0.9 (15%) 9.4 (25%) 1.9 (8%) 15 Friend 7 (23%) 0.5 (8%) 5.6 (15%) 9.4 (37%) 22.5 Other 2.3 (7%) 0.0 (0%) 1.9 (5%) 1.4 (6%) 5.6 Total 31% 6.1% 37.6% 25.4% 100 Note. Percentages that come first are percentage of total and percentages in parentheses are percent of message topic in each source category.

25. Individuals who had personal and friend or relative experience with breast cancer were significantly more likely to recall memorable messages than other respondents. • Messages from family and friends account for more breast cancer memorable messages than media sources, • Messages sent by medical professionals were less likely to be associated with prevention behaviors and more likely to be associated with detection behaviors. • Women are both less likely to recall messages associated with prevention, and they are less likely to enact prevention behaviors. • Ironically, prevention efforts have been found to have a wider array of benefits compared with early detection behaviors (Kaplan, 2000).

26. The Effects of Framing of Memorable Breast Cancer Messages on Engagement in Detection or Prevention Behaviors

27. Study based on Prospect theory Daniel Kahneman and Amos Tversky (1979) "Prospect Theory: An Analysis of Decision under Risk", Econometrica, XLVII (1979), 263-291. • Tversky and Kahneman told people to assume there was disease affecting 600 people and they had two choices: Program A, where 200 of the 600 people will be saved .Program B, where there is 33% chance that all 600 people will be saved, and 66% chance that nobody will be saved. The majority of people selected A, showing a preference for certainty. They then offered them another choice: Program C,  where 400 people will die. Program D, where  there is a 33% chance that nobody will die, and 66% chance that all 600 people will die. Most people now selected D, seeking to avoid the loss of 400 people. Framing makes the difference. A and C are the same, and B and D are the same. • To get people to adopt something, focus on the gain. To get them to reject something, focus on what they might lose. If they perceive high risk, focus on loss. If they perceive low risk, focus on gain. If you want them to focus on loss or gain, then set up the perceived risk accordingly.

28. Many heath communication scholars argue that loss frames tend to be more effective at encouraging individuals to engage in risk-laden screening-related behaviors while gain framed messages provide stronger motivation for less risky prevention behaviors. Their extension of prospect theory to health outcome framing has been successfully applied to a variety of health behaviors. Gain frames have been found to be effective at encouraging prevention behaviors such as wearing sunscreen, exercising, and proper use of infant car seats (Detweiler, Bedell, & Salovey, 1999; Robberson & Rogers, 1988; Treiber, 1986), and loss frames have been found to be successful way to promote screening behaviors such as testicular cancer. • Messages constructed by researcher • Messages all relate to same scenario • Source of message consistent

29. H1: There will be a significant positive association between gain-framed messages and prevention behaviors. • H2: There will be a significant positive association between loss-framed messages and detection behaviors.

30. Dependent Variables • DETECTION BEHAVIORS “How often do you engage in breast self exams as a result of this message?” and “How often do you engage in mammograms as a result of this message?” (r=.45,, p < .01) and were summed to form a composite measure of detection behaviors that ranged from zero to two (M = 1.38, SD = 0.78). • PREVENTION BEHAVIORS “How often do you engage in eating healthy food as a result of this message?” and “How often do you engage in exercise as a result of this message?” r= .72.p< .01). Summing responses to these two questions formed a composite measure of prevention behaviors that ranged from zero to two (M = 1.43, SD = .84).

31. Independent Variables • Message framing refers to emphasizing either the benefits (gain-framed) or the costs (loss-framed) of a behavior. • Framed message can take two forms • the outcome of the behavior can be described as desirable or undesirable • the outcome can be described as being made more likely or made less likely) (Dillard & Marshall, 2003; Rothman & Salovey, 1997; Wilson, Purdon, & Wallston, 1988) O'Keefe and Jensen (2006) supplemented this disambiguation by also considering the kernel states of framed messages. In their words, "The kernel state is the basic, root state mentioned in the message's description of the consequence" (p. 7).

33. RESULTS

34. H1: There will be a significant positive association between gain-framed messages and prevention behaviors. Women who recalled a message with an undesirable kernel state that was less likely to occur engaged in prevention behaviors (M = 1.90, SD = 0.32) to a greater degree than women who did not recall that type of message (M = 1.30, SD = .86), t (55) = 2.18, p < .05, r = .28, P (.04 ≤ ρ ≤ .54) =.95. Those participants who recalled a memorable message with a desirable kernel state that was more likely engaged in fewer prevention behaviors (M = 1.09, SD = 0.89) than those not exposed to such messages (M = 1.91, SD = 0.29), t (55) = -4.20, p < .05, H2: There will be a significant positive association between loss-framed messages and detection behaviors. • Hypothesis two. NOT supported People exposed to messages that contained an undesirable kernel state that was more likely were no more likely to engage in detection behaviors (M = 1.00, SD = 0.87) than participants who were not exposed to such messages (M = 1.43, SD = 0.72), t (53) = -1.60, ns, r = -.22, P (-.47 ≤ ρ ≤ .03) =.95. Similarly, people who reported messages with a desirable kernel state that was avoided were no more likely (M = 1.67, SD = 0.58) to engage in detection behaviors than those not exposed (SD = 1.35, SD = 0.76), t (53) = 0.71, ns, r = .10, P (-.16 ≤ ρ ≤ .36) =.95.