Building Public Will and Social Norms for Colorectal Cancer Screening

Background: The Oregon Health Authority, Health Promotion and Chronic Disease Prevention Section, is working to increase colorectal cancer screening among Oregonians aged 50 to 75. Currently 60% of the target population is screened regularly; the goal is to increase that number to 80% by 2014.

Program background: One component of its approach is a social marketing intervention. To inform this work, OHA conducted qualitative research to determine barriers and motivators to screening. We then applied social marketing and public will building theories to the findings, which laid a clear path to a behavior change campaign that frames the issue, raises awareness, creates specific opportunities for change, motivates conviction and action, and evaluates and adjusts. These are the five phases of public will building, and can lead to adoption of screening as a social norm over time.  The core strategy of the campaign is to mobilize people who have already been screened to encourage their friends and family to be screened. Research and message pre-testing indicated this is one of the most powerful motivators for people to be screened, and a pathway to normalizing the behavior.

Evaluation Methods and Results: Message pre-testing resulted in an increase in screened individuals’ intention to talk to their friends about screening, the main call to action. The pilot campaign is in the field now and will be completed and evaluated (using a telephone poll compared with a pre-intervention poll, evaluation by participating providers, and process measures) in April.

Conclusions: The statewide rollout of the campaign is anticipated in the summer. By the time of the conference, we will have results and implications to share.

Implications for research and/or practice: To create measurable behavior change and ultimately shift public will and change social norms, public health campaigns must be based on research and a clear understanding of audience barriers, motivators and pathways. This case study outlines a research-based social marketing and public will building campaign that uses diffusion of innovation as a core strategy. This model of research and campaign design has implications for other health issues.