Dr. Samanthika Ekanayake1 Dr. Diego Llovet1 Dr. Jorge Ginieniewicz1 Dr. Lawrence Paszat1, 2

1Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto 2 Institute for Clinical Evaluative Sciences

© Dr. Samanthika Ekanayake 2014

“I appreciate it was a human being giving me information”: Use of a testimonial to promote colorectal cancer screening with fecal occult blood test

Cancer Care Ontario. ColonCancerCheck 2010 Program Report. Toronto, Canada

2012.

Dal Cin S, Zanna MP, Fong GT. Narrative persuasion and overcoming resistance. In:

Knowles ES, Linn JA, editors. Resistance and persuasion. Mahwah, NJ: Lawrence

Erlbaum Associates; 2004. p. 175–91.

Dillard AJ1, Fagerlin A, Dal Cin S, Zikmund-Fisher BJ, Ubel PA. (2010) Narratives that

address affective forecasting errors reduce perceived barriers to colorectal cancer

screening. Soc Sci Med. 71(1):45-52.

Kreuter,M.W.,Green,M.C.,Cappella,J.N.,Slater,M.D.,Wise,M.E.,Storey,D.,etal

(2007).Narrative communication in cancer prevention and control: a frame-work to

guide research and application. Annals of Behavioral Medicine,33, 221-235.

Rabeneck L, Tinmouth JM, Paszat LF, Baxter NN, Marrett LD, Ruco A, Lewis N, Gao

J. (2014) Cancer Ontario's ColonCancerCheck: results from Canada’s first province-

wide colorectal cancer screening program. Epidemiol Biomarkers Prev. 23(3):508-15.

Tinmouth J, Ritvo P, McGregor SE, Claus D, Pasut G, Myers RE, et al. (2011) A

qualitative evaluation of strategies to increase colorectal cancer screening uptake.

Can Fam Physician. 57:7-15.

Contact Information: samanthika.ekanayake@sunnybrook.ca

• Testimonials from people who had a good

experience with FOBT may create a positive frame

of mind towards screening among some eligible

individuals.

• Peer testimonials can be used to persuasively

convey key facts and arguments about colorectal

cancer screening.

• Testimonials may be considered for inclusion in

communication campaigns promoting screening

with FOBT.

• Testimonials may be more effective if signed by

someone with a gender-neutral name; the

testimonial should appear clearly separated from

the main text of the letter.

• Peer testimonials are first-person narrative

messages that convey an experience to similar

others.

• Narratives influence readers’ emotions and

beliefs, and may be effective in promoting specific

health behaviour (Dal Cin et al., 2004).

• Narrative communication is more effective in

convincing or influencing people with limited

experience or knowledge of screening (Kreuter et

al., 2007).

• People find it difficult to counterargue or deny

narratives because they are associated with real-

life characters and experiences (Dal Cin et al.,

2004).

• Narratives from peers are an effective way to

promote CRC screening (Dillard et al., 2010).

• Colorectal cancer (CRC): second-leading cause of

cancer deaths and third most commonly

diagnosed cancer in Ontario (Cancer Care

Ontario, 2012).

• ColonCancerCheck, the provincial CRC screening

program, recommends bi-annual screening with

Fecal Occult Blood Test (FOBT) for average risk

individuals aged 50 to 74 (CCO, 2012).

• Mailed letters are used to invite eligible people to

do FOBT; however, FOBT participation rate in

Ontario remains low; only 30% of the eligible

population completed the test in 2010-2011

(Rabeneck et al., 2014).

• Previous studies have suggested that brief and

personalized letters with strong and powerful

messages would be helpful to increase screening

uptake (Tinmouth et al., 2011).

• Seven focus groups in Barrie, Scarborough,

Guelph and Hamilton in 2013 to test messages

for FOBT promotion.

• 52 participants were recruited through random

digit-dialling.

• Participants: aged 50-74, 40% female, 54%

Canadian-born, 30% high-school graduates or

lower, 30% never-screened for colorectal

cancer. Separate male and female groups were

conducted.

• Phase 1 (4 focus groups, Winter): Participants

were shown a testimonial of positive FOBT

experience from a peer living in the same area

and of the same gender as them.

• •

• Participants were asked whether testimonial

was clear, believable, acceptable and

compelling.

• Phase 2 (3 focus groups, Summer): Participants

were shown FOBT invitation letters that

included a peer testimonial; initial testimonial

was slightly changed based on the findings of

the initial focus groups.

• Focus groups were audio-recorded, transcribed

verbatim and analyzed using Nvivo10.

• Focus group findings from phases one and two

are presented below.

• The testimonial was well-received by most of

the participants. The “human feeling” and the

“personal tone” of the message made it credible

and reassuring to many.

• Several participants appreciated hearing

about the screening experience from “someone

like them.”

• Many participants liked the testimonial because

it gives a “positive” feeling or “sense of comfort.”

Having peace of mind after receiving normal

FOBT results was seen as important. The

message also reinforced how easy FOBT is.

• A few participants disliked the testimonial,

saying that it may not be personally relevant to

them. They felt the testimonial was “gimmicky”

and may not be real. Others preferred "factual"

over "anecdotal" messages.

• Based on the results of this study, the initial

testimonial was modified and the following

testimonial was used in new invitation letters:

“Doing the FOBT was easy and I knew within a few

weeks that my result was normal. I am thankful for

the peace of mind!”

(Terry K., Guelph)

• This study explores how individuals eligible for

FOBT screening react to a written testimonial of

someone sharing his/her positive FOBT

experience.

"I completed the FOBT

and I knew within a few

weeks that everything

was fine. I am thankful

for the peace of mind.”

(Margaret S, Barrie)

Background

Use of Testimonials in Screening

Promotional Materials

Objectives

Methodology

Results

Conclusions and Recommendations

“I appreciated that it was a human being who was

giving me information…. [the testimonial] is easy-

going. It’s less formal…So that would be okay. That

would probably put me at ease if, because this

circumstance is all a little bit, unnerving to begin with,

to think that you needed to be screened to begin

with.” (Paula, Guelph)

“…There’s a face to this Peter S. He is one of us, and

he of course is expressing his sincere kind of, you

know, thanks or what that he did it…I like [this

message].” (Phillip, Scarborough)

“...if someone else has done it and it was that easy and

it’s given them peace of mind, yeah, it’s probably a lot

easier than you think it’s going to be … it’s just

reinforcing the fact that you’re kind of in control so why

not just do it. Why not just do it.” (Bonnie, Hamilton)

“It’s a testimonial. It’s one person who’s done it. Word of

mouth…word of mouth usually helps people…to think.

Like, if you had a good experience and somebody else

had a good experience and this is why I think

encouraging people to talk about issues of prostate

cancer, colon cancer, other things… the initial

experience from somebody else, I think, has a positive.”

(Josie, Scarborough)

“I don't need it at all. Maybe I've read too many

commercial …junk mail… It’s not important to me. I

don't know whether it's (peer testimonial) true or you

added it, or whether you exaggerated it, or what.”

(Dominic, Scarborough)

References