Successful Appeals for Breast Self-Examinations: The Vital Role of Coping Information
Steven Prentice-Dunn, PhD
University of Alabama
Rachel B. Fry, PhD
UAB Department of Preventive Medicine
Breast cancer is the most prevalent form of cancer among American women and the second highest cause of cancer mortality in women. Although the disease does not usually develop until after age 45, its age of onset is decreasing. The American Cancer Society encourages mammograms and clinical breast examinations to detect early-stage cancer. However, these guidelines do not apply equally to all women as differences in breast tissue density make mammograms virtually ineffective for younger women. One breast cancer survivor group, the Young Survival Coalition, points out that breast self-examination (BSE) is the only method of early cancer detection for young women. In a study of how its current members discovered their breast cancer, 83% reported finding the lump themselves. Unfortunately, BSEs are still not practiced regularly by the majority of American women.
Many educational methods have been used to teach breast cancer detection at its earliest stages. One method involves using persuasive messages that are based on convincing women of their risk of developing breast cancer. In some studies, higher perceived risk led to performing preventive measures; however, in other studies higher risk created anxiety and led to avoidance of the topic of breast cancer.
Our prior work suggests that threat can indeed motivate people to act. However, they react in a variety of ways. Those reactions may be adaptive, such as seeking more information about the topic or intending to change their unhealthy behavior. However, their reactions may also defensive, such as denying the seriousness of the health threat or even being fatalistic about it.
In this study we tested a method for promoting productive responses to health information. Female college students read a 9-page essay containing threatening information about breast cancer. The essay described young women’s risk for breast cancer and included photos of cancerous breasts and vivid descriptions of chemotherapy treatments. Half the participants also read coping information, which stressed the importance of early detection, the effectiveness of performing BSEs, and the high cure rate associated with early detection. Coping information also was conveyed by pointing out that women are able to perform effective monthly BSEs and are able to detect changes in their own breasts from month to month. The remaining half of the participants read no coping information.
• Providing people with coping information decreases their unhealthy reactions to information about breast cancer. Participants who received coping information had fewer defensive responses such as avoiding thinking about cancer, believing that it was hopeless to try to avoid breast cancer, and resorting to a fatalistic use of religion to help them cope.
• Close knowledge of someone with breast cancer (friend, relative, or mother) affects how individuals interpret information about breast cancer. Those with previous exposure perceived greater threat than did those without close knowledge. As a result, participants with previous exposure sought more information about cancer and BSE. They also had stronger plans to begin practicing BSEs and used fatalistic religious beliefs to cope, compared to individuals without previous exposure.
Our results suggest that coping information plays a vital role in decreasing defensive reactions to potential health threats. They add to an increasing body of research suggesting that health promotion efforts are more likely to succeed when individuals are convinced that recommended actions will be effective and easily enacted.
Previous exposure to breast cancer also appears to affect how individuals react to information about breast cancer. Prior experience increases the perceived threat of breast cancer, which, in turn, energizes the individual to act in a variety of ways. Our study suggests that most of those reactions may be adaptive in nature, but some responses may be defensive. An example of the latter is using a form of religiosity that promotes taking no action to prevent breast cancer and instead relies exclusively on God for protection.
Our findings have implications for persuasive health messages that appear in the mass media. Increasingly, educators have only a brief time to present their message. Many have resorted to attempts to simply startle or create fear. However, such attempts to persuade may backfire unless sufficient attention is given to coping information.
As more women become sensitized to the dangers of breast cancer, they will act to address their vulnerability. Greater knowledge of coping information is likely to channel their motivation into productive attitudes, intentions, and behaviors.
Fry, R. B., & Prentice-Dunn, S. (2005). The effects of coping information and value affirmation on responses to a perceived health threat. Health Communication, 17, 133-147.
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Fry, R. B., & Prentice-Dunn, S. (in press). Effects of a psychosocial intervention on breast self-examination attitudes and behaviors. Health Education Research.
Rogers, R. W., & Prentice-Dunn, S. (1997). Protection motivation theory. In D. Gochman
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