Experts at Philadelphia-based Temple Health have developed an approach to boost rates of lung cancer screenings in a low-socioeconomic area of the city leaning on specific marketing and messaging tactics.
Lung cancer is one of the most deadly cancers in the U.S., but patients in low-socioeconomic areas tend to also have higher lung cancer mortality rates and less access to care and screenings that could proactively address issues. That was the impetus behind the creation of the Temple Healthy Chest Initiative, designed to encourage early detection and better access to screening for eligible adults in a northern neighborhood of the city, where residents are more likely to be part of a low-socioeconomic demographic.
"We learned that language like 'lung cancer screening saves lives' may be perceived as threatening for some populations, and that ultimately results in a lack of engagement in either the advertising content or in the community outreach," Stefanie Murphy, associate vice president of corporate marketing at Temple Health and one of the lead authors of the study told Becker's. "So if we have a table setup with a drape that says 'lung cancer screening saves lives,' people might just walk right by and not even walk over to hear what you're talking about. This really called for a dramatic shift in the messaging strategy to promote and use positive framing for chest screenings like 'know your lung health.'"
Ms. Murphy along with a handful of Temple University students and Lauren Kogen, PhD, a professor in Temple University’s Klein College of Media and Communications, began to conduct focus groups with individuals from the neighborhood and identified three key barriers to proactively getting lung screenings:
- Lack of knowledge about lung cancer screenings
- Concerns about cost, time and transportation
- Lack of trust toward medical systems
"Fear messaging can be really effective, right? Sometimes if you're told you have to do this thing or this other really terrible thing is going to happen that lights a fire under our butts and can get us to do things," Dr. Kogen told Becker's. "But if you scare people and they don't feel like they have agency, they don't really feel they have a good way to address the problem. … In this case, we were working with a community that doesn't have a lot of agency and feels really marginalized by the system. They also feel very distrustful of the system. So our recommendation was to kind of move away from that scary messaging."
So instead of 'lung cancer screening saves lives,' the Temple Healthy Chest Initiative prioritized messaging about how accessible and easy getting a chest screening was, that it only takes around 10 minutes and is usually covered by insurance.
Once a patient does get an initial screening, conversations about any diagnosis or next steps can be taken from there since there is buy-in after that point, but it takes a careful approach to get them to take the initial step before getting into something that might spark fear, she explained.
"There is such a long history of providing patients with an overwhelming amount of information. And no one at any point is checking in to say, 'Does all of this make sense to you?' And I think that's really overlooked in marginalized communities," Ms. Murphy said. "I do think that clinicians taking a more thoughtful and proactive approach to this communication style with patients, would have immediate benefits because it demonstrates your commitment to this population. You're creating content and messaging that's meeting them where they are at versus asking the patient to engage in this content at a level that they may not be comfortable with."
After a full year of taking this approach, research showed that it did make a difference. The Temple Healthy Chest Initiative showed higher lung cancer screening rates for Black, Hispanic and female patients collectively.
For clinicians who may be seeking to engage low-socioeconomic populations in healthcare initiatives in other regions of the country, Dr. Kogen said the two most important things to do are to "talk to people and try to understand what their barriers are instead of assuming you know them," and "emphasize the positives and the convenience of the initiative as much as possible."