Background: Improving informed consent to participate in randomized clinical trials (RCTs) is a key challenge in cancer communication. The current study examines strategies for enhancing randomization comprehension among patients with diverse levels of health literacy and identifies cognitive and affective predictors of intentions to participate in cancer RCTs. Methods: Using a post-test-only experimental design, cancer patients (n = 500) were randomly assigned to receive one of three message conditions for explaining randomization (ie, plain language condition, gambling metaphor, benign metaphor) or a control message. All statistical tests were two-sided. Results: Health literacy was a statistically significant moderator of randomization comprehension (P = .03). Among participants with the lowest levels of health literacy, the benign metaphor resulted in greater comprehension of randomization as compared with plain language (P = .04) and control (P = .004) messages. Among participants with the highest levels of health literacy, the gambling metaphor resulted in greater randomization comprehension as compared with the benign metaphor (P = .04). A serial mediation model showed a statistically significant negative indirect effect of comprehension on behavioral intention through personal relevance of RCTs and anxiety associated with participation in RCTs (P < .001). Conclusions: The effectiveness of metaphors for explaining randomization depends on health literacy, with a benign metaphor being particularly effective for patients at the lower end of the health literacy spectrum. The theoretical model demonstrates the cognitive and affective predictors of behavioral intention to participate in cancer RCTs and offers guidance on how future research should employ communication strategies to improve the informed consent processes.

The impact of the COVID-19 pandemic on US adults’ smoking and quitting behaviors is unclear. We explored the impact of COVID-19 on smoking behaviors, risk perceptions, and reactions to text messages during a statewide stay-at-home advisory among primary care patients who were trying to quit. From May–June 2020, we interviewed smokers enrolled in a 12-week, pilot cessation trial providing text messaging and mailed nicotine replacement medication (NCT04020718). Twenty-two individuals (82% white, mean age 55 years), representing 88% of trial participants during the stay-at-home advisory, completed exit interviews; four (18%) of them reported abstinence. Interviews were thematically analyzed by two coders. COVID-19-induced environmental changes had mixed effects, facilitating quitting for some and impeding quitting for others. While stress increased for many, those who quit found ways to cope with stress. Generally, participants felt at risk for COVID-19 complications but not at increased risk of becoming infected. Reactions to COVID-19 and quitting behaviors differed across age groups, older participants reported difficulties coping with isolation (e.g., feeling disappointed when a text message came from the study and not a live person). Findings suggest that cessation interventions addressing stress and boredom are needed during COVID-19, while smokers experiencing isolation may benefit from live-person supports.

Introduction: Patients are more likely to complete colorectal cancer screening when recommended by a race-concordant healthcare provider. Leveraging virtual healthcare assistants to deliver tailored screening interventions may promote adherence to colorectal cancer screening guidelines among diverse patient populations. The purpose of this pilot study is to determine the efficacy of the Agent Leveraging Empathy for eXams virtual healthcare assistant intervention to increase patient intentions to talk to their doctor about colorectal cancer screening. It also examines the influence of animation and race concordance on intentions to complete colorectal cancer screening.Methods: White and Black adults (N=1,363) aged 50−73 years and not adherent to colorectal cancer screening guidelines were recruited from Qualtrics Panels in 2018 to participate in a 3-arm (animated virtual healthcare assistant, static virtual healthcare assistant, attention control) message design experiment. In 2020, a probit regression model was used to identify the intervention effects.Results: Participants assigned to the animated virtual healthcare assistant (p<0.01) reported higher intentions to talk to their doctor about colorectal cancer screening than participants assigned to the other conditions. There was a significant effect of race concordance on colorectal cancer screening intentions but only in the static virtual healthcare assistant condition (p=0.04). Participant race, age, trust in healthcare providers, health literacy, and cancer information overload were also significant predictors of colorectal cancer screening intentions.Conclusions: Animated virtual healthcare assistants were efficacious compared with the static virtual healthcare assistant and attention control conditions. The influence of race concordance between source and participant was inconsistent across conditions. This warrants additional investigation in future studies given the potential for virtual healthcare assistant-assisted interventions to promote colorectal cancer screening within guidelines.

To influence user behaviors, Internet-based virtual humans (VH) have been used to deliver health interventions. When developing Internet-based VH health interventions, the developers have to make several design decisions on VH’s appearance, role, language, or medium. The design decisions can affect the outcomes of the Internet-based VH health intervention. To help make design decisions, the current paper presents design guidelines drawn from two studies. The two studies used Internet-based VH health intervention to promote colorectal cancer (CRC) screening. The two studies examined the influence of visual design and the influence of the information medium on user intentions to pursue more health information. In the first study, the qualitative analysis of the focus group (n = 73 users in 13 focus groups) transcripts shows that the VH’s visual realism, the VH’s healthcare role, and the presence of a local healthcare provider’s logo influenced the user perceptions of the intervention. The findings from the focus groups were used to iterate the intervention and derive design guidelines. In the second study (n = 1400), the analysis of online surveys from users after the VH-based intervention showed that to positively influence the user intentions to pursue the health topic further, the results recommend the use of an animated VH to deliver health information compared to other mediums of information delivery, such as text. The analysis also shows that very few user comments were related to the VH’s appearance after visual design iterations in the second study. The design guidelines from the two studies can be used by developers when using VH-based interventions to positively influence users’ intention to change behaviors.

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Cancer decision-making interventions commonly utilize narratives as a persuasive strategy to increase identification with the message source, promote involvement with the topic, and elicit greater willingness to adopt recommended behaviors. However, there is little empirical research examining the mechanisms underlying the effectiveness of this strategy in the context of cancer research participation. Data for the current manuscript were collected as part of a larger study conducted with cancer patients (N = 413) from the USA, UK, and the Republic of Ireland. Participants viewed and evaluated video-recorded vignettes, illustrating different strategies for discussing clinical trials participation with family members. Results showed nationality was a significant predictor of identification with the main character (i.e., patient) in the vignette. Unexpectedly, these cross-national differences in identification disappeared when patients currently undergoing treatment had higher perceived susceptibility of their cancer. Identification with the main character in the vignettes was a significant predictor of intentions to participate in cancer research, but only when the mediating role of narrative transportation was considered. The findings demonstrate the importance of considering how individual and social identities influence identification with characters in cancer narratives and yield practical guidance for developing arts-based interventions to increase cancer research participation.

Purpose The purpose of this paper is to explore the linkages between public relations efforts and policymaking activity during a non-election setting. Design/methodology/approach Using a time-lag design, this study used content analysis to examine public relations materials and policymaking activity during the first six months of US President Barack Obama’s second term. The public relations data were collected from the official White House website and social media. The policymaking data were collected from congressional calendars of business. Findings The data revealed varying degrees of support across the three levels of agenda-building for issues, attributes, and issue/attribute co-occurrence. Contrary to the expected relationship that public relations drives policymaking activity, the data suggest that policymaking activity was a stronger predictor of public relations material. Research limitations/implications This study provides modest support for time-lag agenda-building effects across three levels. However, future experimental research is needed to truly assess causal relationships. Future research should also explore alternative sources of data for policymaking activity. Practical implications This study demonstrates that the efficacy of information subsidy types is not uniform and should be chosen strategically. Traditional subsidy types were most effective for driving issues, while digital subsidy types provided more useful outlets for driving issue attributes. Originality/value This study contributes to political public relations scholarship by exploring the temporal relationships between public relations efforts and policymaking activity in a non-election setting. The time-lag design serves as an exploratory inquiry into the agenda-building process.