Messaging Strategies to Reduce Breast Cancer Over-screening in Older Women

This is an online survey experiment with data collection over 2 time points two weeks apart. This is Aim 2 of a three-aim R01 project; overall project goal is to better understand how messages from different sources interact to affect older women's breast cancer screening decisions. In this current project, the investigators propose to test the effect of combined exposure to a clinician message + a message from another source (i.e. family/friend or media) on older women's breast cancer screening beliefs, attitudes, and intentions.

In a two-wave national online survey experiment, the investigators will randomly assign 3,000 women 65 years or older without personal history of breast cancer to 6 groups, including two control groups and four experimental groups. The experimental groups will read a message at Time 1 (T1) that may be from either family/friend or the media followed by a second message from a clinician one to two weeks later at Time 2 (T2). The clinician message will be directed at reducing over-screening, mentioning the harms of over-screening and supporting screening cessation. The investigators will systematically vary the non-clinician message to be either consistent with the clinician message (also mentions harms of over-screening and supports screening cessation) or conflicting (mentions benefits of screening, supports continued screening and opposes screening cessation). The investigators include a no-exposure control group (Group 1) where the participants read no message at either time point and will only be asked the assessment questions. The investigators also include a single exposure group that reads only the clinician message (Group 2).

T1 - message from media source aimed at reducing over-screening. T2 - message from clinician aimed at reducing over-screening

T1 - message from a close family member aimed at reducing over-screening. T2 - message from clinician aimed at reducing over-screening

T1 - message from media source aimed at supporting continued screening. T2 - message from clinician aimed at reducing over-screening

T1 - message from a close family member aimed at supporting continued screening. T2 - message from clinician aimed at reducing over-screening

Different messages describing either the benefits of breast cancer screening aimed at supporting continued screening or messages describing the harms of over-screening and making recommendations to stop screening

Breast cancer screening intention for a hypothetical patient in survey vignette assessed by score on a scale

Screening intention for a hypothetical patient; assessed by score on a 7 point likert scale question developed by the investigators.

Screening intention assessed by score on a 7 point likert scale question developed by the investigators.

Attitude toward mammogram importance; assessed by score on a 5 point likert scale question developed by the investigators.

Attitude toward mammogram benefits; assessed by score on a 5 point likert scale question developed by the investigators.

Attitude toward mammogram being worthwhile; assessed by score on a 5 point likert scale question developed by the investigators.

Message effectiveness toward thinking carefully about getting a mammogram; assessed by a 5 point likert scale question developed by the investigators.

Message effectiveness toward finding out more about the benefits of a mammogram as assessed by score on a scale

Message effectiveness toward finding out more information about the potential benefits of getting a mammogram; assessed by a 5 point likert scale question developed by the investigators.

Message effectiveness toward finding out more about downsides of getting a mammogram as assessed by score on a scale

Message effectiveness toward finding out more information about the potential downsides of getting a mammogram; assessed by a 5 point likert scale question developed by the investigators.

Participants will rate the extent of feeling annoyed after reading the message; assessed by a 5 point likert scale question developed by the investigators.

Participants will rate the extent of feeling interested after reading the message; assessed by a 5 point likert scale question developed by the investigators.

Participants will rate the extent of feeling worried after reading the message; assessed by a 5 point likert scale question developed by the investigators.

Participants will rate the extent of feeling reassured after reading the message; assessed by 5 point likert scale question developed by the investigators.

Participants will rate how much the information discouraged wanting to get a mammogram; assessed by score on a 5 point likert scale question developed by the investigators.

Participants will rate how much the information makes getting a mammogram seem unpleasant; assessed by score on a 5 point likert scale question developed by the investigators.

Participants will rate concern about the health effects of getting a mammogram; assessed by score on a 5 point likert scale question developed by the investigators.

Participants will indicate awareness of medical guidelines concerning women over age 65 who have a lot of health problems, medical guidelines recommend against regular mammograms; assessed by yes/no question developed by the investigators.

Participants will indicate awareness of mammograms that find slow-growing breast cancers that might never cause problems but can lead to unnecessary, risky treatments such as surgery or radiation; assessed by yes/no question developed by the investigators.

Participants will indicate awareness of mammograms that can have false alarm results that may cause stress, anxiety, and require breast biopsies; assessed by yes/no question developed by the investigators.

Participants will rate how confusing mammogram screening recommendations to be; using a 5 point likert scale question developed by the investigators.

Participants will rate whether it is clear or not whether to continue or stop getting mammograms; assessed by 5 point likert scale question developed by the investigators.

Participants will rate whether medical guidelines provide good advice about mammogram screening; assessed by 5 point likert scale question developed by the investigators.

Participants will rate trust in doctors' advice about continuing or stopping getting mammograms; assessed by 5 point likert scale question developed by the investigators.

Participants will rate having mixed feelings about getting mammograms; assessed by 5 point likert scale question developed by the investigators.

Inclusion Criteria: Part of an online survey panel called KnowledgePanel able to complete survey in English Exclusion Criteria: Personal history of breast cancer