Cancer Communication Behavior, Preferences, and Needs and Associations with Health Behaviors Among Clients of United Way 2-1-1

Theoretical Background and research questions/hypothesis:  Effective communication with and outreach to underserved populations can help reduce disparities in cancer. However, the heterogeneity of health communication in these populations has been understudied, resulting in limited guidance for channel-specific health communication with these groups. The United Way 2-1-1 system provides socioeconomically disadvantaged individuals with referrals to local social services (e.g., food, housing) and offers a unique opportunity to examine channel-specific health communication and behavior in a vulnerable population. This study sought to describe varying patterns of channel-specific cancer communication behavior, preferences, and needs in a sample of 2-1-1 clients and their associations with health behaviors. Findings can inform future health communication intervention and outreach efforts seeking to address disparities in cancer.

Methods:  Preliminary data (N=1301) from a larger ongoing survey of adult clients of 2-1-1 were analyzed. Self-reported measures included health communication characteristics (e.g., interpersonal health communication, health literacy, channel preferences for receiving health information), health behaviors (e.g., smoking, cancer screening), other health-related factors (e.g., health insurance status), and demographics. Bivariate analyses examined health communication characteristics by demographics. Multivariable binomial logistic regression examined associations between health communication characteristics and health behaviors while controlling for demographics and health-related factors.

Results:  The sample was 78% female, 89% nonwhite, 31% uninsured, and 75% had annual incomes of <$20,000. Bivariate analyses found health communication characteristics varied by demographics. For example, women had significantly higher health literacy than men (p<.0001). Additionally, the most preferred channel for receiving health communication varied by demographics, e.g., 51% of individuals with less than a high school education most preferred to receive health information from someone they could talk with over the phone compared to only 34% of those with more education (p<.001). In multivariable analyses, several health communication characteristics were associated with health behavior. For example, smoking-related analyses found individuals who reported not having anyone to remind them to protect their health had 97% higher odds of smoking than those who reported they often had people remind them (aOR=1.97; 95% CI=1.32, 2.94).

Conclusions:  This study builds upon the growing body of health research with 2-1-1 and provides the most detailed examination to date of health communication among 2-1-1 clients. Findings indicate broad variation in health communication behavior, preferences, and needs within this population. Results suggest a more comprehensive understanding of health communication within underserved groups can inform more targeted cancer prevention and control efforts.

Implications for research and/or practice:  More effective and targeted strategies are needed to connect 2-1-1 clients and other vulnerable populations to cancer information, programs, and services. Continued research identifying evidence-based, channel-specific health communication strategies is vital to these efforts. As 2-1-1 systems are reached by millions of socioeconomically disadvantaged individuals each year, these systems have exceptional potential for connecting individuals to resources such as the American Cancer Society and national cancer screening programs. Partnerships with 2-1-1 hold promise for helping to eliminate disparities in cancer and advancing health equity on a national scale.