Developing a Typology of African Americans With Limited Literacy Based on Preventive Health Practice Orientation: Implications for Colorectal Cancer Screening Strategies

Abstract

Preventive health messages are often tailored to reach broad sociodemographic groups. However, within groups, there may be considerable variation in perceptions of preventive health practices, such as colorectal cancer screening. Segmentation analysis provides a tool for crafting messages that are tailored more closely to the mental models of targeted individuals or subgroups. This study used cluster analysis, a psychosocial marketing segmentation technique, to develop a typology of colorectal cancer screening orientation among 102 African American clinic patients between the ages of 50 and 74 years with limited literacy. Patients were from a general internal medicine clinic in a large urban teaching hospital, a subpopulation known to have high rates of colorectal cancer and low rates of screening. Preventive screening orientation variables included the patients' responses to questions involving personal attitudes and preferences toward preventive screening and general prevention practices. A k-means cluster analysis yielded three clusters of patients on the basis of their screening orientation: ready screeners (50.0%), cautious screeners (30.4%), and fearful avoiders (19.6%). The resulting typology clearly defines important subgroups on the basis of their preventive health practice perceptions. The authors propose that the development of a validated typology of patients on the basis of their preventive health perceptions could be applicable to a variety of health concerns. Such a typology would serve to standardize how populations are characterized and would provide a more accurate view of their preventive health-related attitudes, values, concerns, preferences, and behaviors. Used with standardized assessment tools, it would provide an empirical basis for tailoring health messages and improving medical communication.

Medical Mistrust and Colorectal Cancer Screening Among African Americans

“…However, one study found that females were more likely to report colonoscopy receipt and less likely to report receiving an FOBT than men (27). Additional studies found that women were not significantly more likely to participate in CRC screening than men (24, 31, 32). …”

“…Bynum et al (2012) used the item “How much does lack of trust in medical people interfere with your taking part in a cancer screening exam?” Gordon et al (2014) asked respondents if they would get a colonoscopy if a trusted doctor recommended it (24). Three studies measured trust but did not specify which measures or items were used in the study (25–27).…”

How Do Low-Literacy Populations Perceive “Dirty Bombs”? Implications for Preparedness Messages

“…The instrument followed a format consistent with that used in other studies we have conducted with low-literacy populations. 56,57…”

Randomized Trial of a Computerized Touch Screen Decision Aid to Increase Acceptance of Colonoscopy Screening in an African American Population with Limited Literacy

“…Details of the process used to develop the CDA have been published previously (Bass et al, 2013), as has the analysis of perceptual mapping variables used in it (Gordon et al, 2014). Using a k -means cluster analysis, perceptual mapping, and vector message modeling analysis we developed the CDA in collaboration with the Patient Education Institute (PEI).…”

“…We worked with PEI to modify its “X-Plain” colonoscopy tutorial by reducing the reading/comprehension level from ninth to sixth grade, making the content specific to the clinic population by including graphics chosen to illustrate African American patients and health care providers. The most important change, however, was in selection of key messages based on findings from the vector modeling that emphasized that having a doctor’s recommendation, having peace of mind, and knowing that family would want them to have the test were most important to this population (Gordon et al, 2014). The modeling enabled us to simplify messages and reduce the length by eliminating elements found unimportant (e.g., technical information on colon cancer, development of polyps, and anatomy of the digestive system) and focusing on those that were (e.g., importance of testing for family, colonoscopy’s effectiveness at detecting cancer, why knowing results is important).…”