Use of the Persuasive Health Message framework in the development of a community-based mammography promotion campaign.

PURPOSE: We describe how the Persuasive Health Message (PHM) framework was used to guide the formative evaluation informing development of messages and materials used in a community-based multi-media campaign intended to motivate low-income African American women to obtain low- or no-cost mammograms through the CDC's National Breast and Cervical Cancer Early Detection Program. METHODS: Seventy-eight African American women were recruited for eight focus groups that discussed breast cancer screening. The moderator guide was developed in accordance with the PHM framework and solicited information on perceived threat and efficacy, cues, salient beliefs and referents, and barriers to self-efficacy. RESULTS: We created persuasive messages to emphasize that African American women are susceptible to the threat of breast cancer, but that their personal action in obtaining regular mammograms may lead to early detection, subsequent treatment, and reduced cancer mortality. The messages addressed concerns of self-efficacy by emphasizing that uninsured women can also obtain high-quality low- or no-cost mammograms. In an attempt to combat the sentiment that breast cancer is a death sentence, the messages indicated that breast cancer can be successfully treated, especially when detected early. CONCLUSIONS: The PHM framework consists of three steps: (1) determine information about threat and efficacy; (2) develop an audience profile; and (3) construct a persuasive message. It offered our team easy-to-follow, flexible steps to create a persuasive and effective campaign promoting awareness and use of mammogram screening among low-income African American women.

The African American Women and Mass Media (AAMM) campaign in Georgia: quantifying community response to a CDC pilot campaign.

PURPOSE: To evaluate whether a culturally appropriate campaign using "Black radio" and print media increased awareness and utilization of local mammography screening services provided by the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program among African American women. METHODS: The evaluation used a quasi-experimental design involving data collection during and after campaign implementation in two intervention sites in GA (Savannah with radio and print media and Macon with radio only) and one comparison site (Columbus, GA). We used descriptive statistics to compare mammography uptake for African American women during the initial months of the campaign (8/08-1/09) with the latter months (2/09-8/09) and a post-campaign (9/09-12/09) period in each of the study sites. Comparisons of monthly mammogram uptake between cities were performed with multinomial logistic regression. We assumed a p value <0.05 to be significant. RESULTS: We observed an increase of 46 and 20 % in Savannah and Macon, respectively, from the initial period of the campaign to the later period. However, the increase did not persist in the post-campaign period. Analysis comparing monthly mammogram uptake in Savannah and Macon with Columbus showed a significant increase in uptake from the first to the second period in Savannah only (OR 1.269, 95 % CI (1.005-1.602), p = 0.0449). CONCLUSIONS: Dissemination of health promotion messages via a culturally appropriate, multicomponent campaign using Black radio and print media was effective in increasing mammogram uptake in Savannah among low-income, African American women. Additional research is needed to quantify the relative contribution of campaign radio, print media, and community components to sustain increased mammography uptake.

Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men Who Have Sex With Men (Black MSM Initiative): Protocol for Program Evaluation.

BACKGROUND: The HIV epidemic in the United States disproportionately affects Black communities. Nearly half of Black men who have sex with men (MSM) will be diagnosed with HIV in their lifetime. There is a significant unmet need for behavioral health care services among Black MSM, and untreated behavioral health needs make it less likely the person is retained in HIV care. OBJECTIVE: This paper offers a description of the Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men (Black MSM) Initiative, a program to integrate clinical care and behavioral health/supportive services for Black MSM with HIV. The Black MSM Initiative is funded through the Health Resources & Services Administration HIV/AIDS Bureau Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance. METHODS: The components of the Black MSM Initiative include providing technical assistance to 8 Initiative demonstration sites; conducting a comprehensive and culturally responsive, mixed method, multisite evaluation; and disseminating evaluation findings and lessons learned to the RWHAP community. RESULTS: As of December 31, 2020, demonstration sites enrolled 809 clients in the multisite evaluation. The research team will continue evaluation data collection through December 2021 for analysis and dissemination starting in 2022. The Black MSM Initiative fully supports the US Department of Health and Human Services' Ending the HIV Epidemic in the United States Initiative. CONCLUSIONS: In order to succeed, providers and programs will need to engage populations traditionally considered "hard to reach," like many people receiving RWHAP services. Findings and lessons learned from the Black MSM Initiative will expand the tool kit of solutions to support and retain Black MSM in HIV care, furthering the goals of the Ending the HIV Epidemic Initiative and the RWHAP. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/36025.

Multiple health risk perception and information processing among African Americans and whites living in poverty.

We investigated the risk-information-processing behaviors of people living at or near the poverty line. Because significant gaps in health and communication exist among high- and low-income groups, increasing the information seeking and knowledge of poor individuals may help them better understand risks to their health and increase their engagement in health-protective behaviors. Most earlier studies assessed only a single health risk selected by the researcher, whereas we listed 10 health risks and allowed the respondents to identify the one that they worried about most but took little action to prevent. Using this risk, we tested one pathway inspired by the risk information seeking and processing model to examine predictors of information insufficiency and of systematic processing and extended this pathway to include health-protective action. A phone survey was conducted of African Americans and whites living in the southern United States with an annual income of ≤$35,000 (N= 431). The results supported the model pathway: worry partially mediated the relationship between perceived risk and information insufficiency, which, in turn, increased systematic processing. In addition, systematic processing increased health-protective action. Compared with whites and better educated respondents, African Americans and respondents with little education had significantly higher levels of information insufficiency but higher levels of systematic processing and health-protective action. That systematic processing and knowledge influenced health behavior suggests a potential strategy for reducing health disparities.

How Right Now? Supporting Mental Health and Resilience Amid COVID-19.

The How Right Now communication initiative (HRN) was developed to facilitate resilience amid the COVID-19 pandemic in the United States. HRN was designed as a conduit for promoting mental health and addressing feelings of grief, worry, and stress experienced during this time. This article provides an overview of the rapid, mixed-method, culturally responsive formative research process undertaken to inform the development of HRN. Specifically, it describes how HRN's disproportionately affected audiences (adults aged 65 and older and their caregivers, adults with preexisting physical and mental health conditions, adults experiencing violence, and adults experiencing economic distress) describe and discuss emotional resilience, what they need to be resilient, and what factors contribute to the perceptions of their ability to "bounce back" from the conditions caused by the COVID-19 pandemic. Data collection methods included an environmental scan (n ≥ 700 publications), social listening (n ≥ 1 million social media posts), partner needs-assessment calls (n = 16), partner-convened listening sessions with community members (n = 29), online focus groups (n = 58), and a national probability survey (n = 731), all in English and Spanish. Results revealed that HRN's audiences have diverse perceptions of what constitutes resilience. However, common factors were identified across populations to support resilience amid the COVID-19 pandemic, including informal and formal social support and access to services to meet basic needs, including food and housing resources. Stress, anxiety, depression, and experience with stigma and discrimination were also linked to resilience. Understanding the perspectives and experiences of disproportionately affected populations is vital to identifying supports and services, including the engagement of community stakeholders.

Evaluation of a Web-Based Program for African American Young Breast Cancer Survivors.

INTRODUCTION: Among women aged <45 years, African Americans have the highest breast cancer incidence rates of any ethnic/racial group and disproportionately higher rates of mortality. Young breast cancer survivors (YBCSs) may require psychosocial and reproductive health support when navigating diagnosis, treatment, and follow-up care. To address these needs, the Young Sisters Initiative: A Guide to a Better You! Program (YSI) was developed, implemented, and evaluated. The purpose of this study was to assess implementation and fidelity; identify barriers and facilitators to implementation; and explore audience access, use, and perceived value of the YSI. METHODS: A mixed-method, process evaluation of the YSI using interviews, an online screener, and post-use survey was conducted with data collected and analyzed from February through August 2013. Thematic analysis of qualitative data was conducted without qualitative data analysis software. Survey data were analyzed using PASW Statistics, version 18. RESULTS: YSI core elements were implemented as intended. A total of 1,442 people visited the YSI website; 93% of breast cancer survivors who visited the site (and consented to be in the study) were African American; 75% of post-use survey YBCS respondents were very or somewhat satisfied with the YSI; and 70% of YBCS respondents said the YSI content was somewhat or very useful. CONCLUSIONS: Findings suggest the value of using the Internet, including social media, to provide African-American YBCSs who are newly diagnosed, in treatment, and post-treatment with reproductive and psychosocial information and support. Further implementation and evaluation of programs addressing the needs of YBCSs are needed.

Promoting brain health for African Americans: evaluating the healthy brain initiative, a community-level demonstration project.

INTRODUCTION: African Americans are at significantly greater risk than non-Hispanic Whites or Hispanics for cognitive impairment. This study presents an evaluation of the Alzheimer's Association's Healthy Brain Initiative, a culturally tailored community-level intervention to increase knowledge and awareness of brain health among African American baby boomers. METHODS: The evaluation used a mixed-method design with data collection before, during, and after intervention implementation. RESULTS: The intervention was implemented with fidelity to model design by Alzheimer's Association chapters. Partnerships between chapters and community organizations to increase awareness of brain health among African American baby boomers were facilitated. Community members who participated in intervention workshops demonstrated increased knowledge, awareness, and intentions to engage in recommended health-protective behaviors. CONCLUSION: A community-level intervention can increase knowledge and awareness of brain health among African American baby boomers. In addition, such interventions can motivate participants' intentions to engage in health-protective behaviors to maintain overall health and brain health.

Adolescents' perceptions of smoking and stress reduction.

The present study examined how adolescents perceive the relationship between smoking and stress and where they learn that smoking cigarettes may be an effective stress-reduction mechanism. Eight focus groups were conducted with low-income African American and European American 14- to 16-year-olds in urban and rural locations, in which they suggested that the primary reasons why they smoked-namely, as a coping mechanism (to calm nerves), for social acceptance, and because of environmental influences. Family issues, boyfriend/girlfriend problems, and school were common stressors. Although participants overwhelmingly believed that people smoke to reduce their stress, a few believed that cigarettes do not actually reduce stress. When asked for examples of smoking in popular media, teens predominantly generated examples of individuals smoking to reduce stress. Ethnic and gender differences were found among the types of media in which they had seen smoking, their opinions of anti-smoking messages, and the media's perceived influence.