Informing breast and colon cancer screening narratives: Focus group findings from Project REEL

Background. African American women over 50 are screened for breast and colorectal cancer later in the progression of disease and die from these cancers at higher rates than women from other groups. Project REEL (Refining Entertainment Education for cancer screening Literacy) is testing several versions of an original, culturally tailored prevention soap opera embedded with screening promotion messages. The soap opera content was informed by focus groups. Method. Eight focus groups were held (N = 61). Separate groups discussed breast and colorectal cancer. Participants were “doers,” women who had been screened as per recommendations, and “non-doers,” women who were behind schedule. The facilitator's guide included questions relevant to: (1) Social Cognitive Theory and the Theory of Planned Behavior, (2) character and scenario authenticity and appeal, (3) health information-seeking and service access, and (4) recruitment for the subsequent experiment. Groups were audio-taped, and the tapes were transcribed. After two coders achieved inter-coder reliability of > 80%, the transcriptions were theme-coded using NVivo version 2009. A hierarchical (tree node) coding scheme reflected guide items and other themes that emerged from the discussion. Results. There were many areas of agreement between doer and non-doer women, e.g., the opinion that using humor would relieve anxiety about screening. Examples of areas of divergence were: (a) doer women used memory aids for staying on schedule (“I make my mammogram appointment on my birthday”), (b) non-doer women could list few admirable role models, and (c) non-doer women were less likely to call free health information telephone lines.