October 13, 2017
Daniela Friedman, Ph.D., is a professor and chair for the University of South Carolina’s Department of Health Promotion, Education, and Behavior. Since receiving both her masters and doctoral degrees in health studies and gerontology from the University of Waterloo, Friedman has established an extensive research career investigating how diverse populations access and interpret information about health risks.
Focusing initially on prostate cancer in African-American men, Friedman has expanded her focus to investigate how individuals perceive their risk of disease. Her current NIEHS-funded study, Strategies for Communicating the Environmental Risks of Cancer (SCERC), part of the Breast Cancer and the Environment Research Program (BCERP), looks at how African-American women learn about, react to, and process information about breast cancer risk in their environment.
As part of the BCERP Dissemination and Outreach working group, Friedman and other communication specialists are using health communication principles to distribute technical research results to the public, making them more readable for the average person. The working group develops communication tools, such as brochures and fact sheets, for local organizations to customize and distribute.
Involving Communities in Formative Health Communication Research
Breast cancer is the second most commonly diagnosed cancer among American women. In South Carolina, African-American women who receive this diagnosis face a higher mortality rate than their European-American counterparts. For this reason, Friedman and her colleagues chose to focus their current study on African-American women. Since cultural influence often plays a large role in how individuals encounter and learn about environmental risk, Friedman’s work aims to understand factors influencing risk perception in order to develop culturally appropriate, evidence-based messages.
"Understanding community needs and cultural contexts is crucial to creating health messages for a specific group," Friedman said. "We can't accomplish anything in public health if we can’t figure out the best ways to reach people, and that means working closely with the communities from the start."
To better understand how their target audience learns, processes, and understands information about breast cancer risk, Friedman and her multidisciplinary team divided the SCERC project into three phases, each with a different objective in understanding risk perception.
Using a Multi-Step Study to Gather Information
In the first phase of SCERC, African-American women from central South Carolina were invited to participate in focus groups to share and discuss what they already know about breast cancer and environmental risk. This step assessed not only the women’s health literacy but also the readability and cultural sensitivity of information they use. Friedman and her team paid special attention to small details the women shared, including the specific language they use in internet searches and their preferences for how they like to receive information about breast cancer risk.
The team determined that although some participants found credible sources about health risks, they did not always understand or know how to navigate the information. "Health literacy is complex, especially given the vast amount of information available on the internet," Friedman said. "Having access to information doesn't mean you are necessarily going to know how to use it," she explained. Understanding not only what kind of information is available but also how it will realistically be used by the intended audience is a key component of SCERC's first and second phases.
Using information gathered from the first phase, the team will develop visual representations of environmental risks for breast cancer to share with focus group participants. These could include one-page infographics, story maps, posters, or educational campaign videos. The research team will then evaluate how women respond to the information and update the materials based on their information needs. Data collected from this second phase will help shape information outreach for future health education campaigns for breast cancer and other diseases.
For the third phase, the women will be asked to go out into their communities and take photographs of things that they feel are exposure risks, a qualitative research method called PhotoVoice. As part of the final product, the research team will put together a display of the photographs and hold a discussion where women can talk about risks they saw in their communities. Friedman has utilized the PhotoVoice method in other projects and is a proponent of the functional health literacy benefits it provides to research. "PhotoVoice is a great way to see the community and its risks through the eyes of people who know it best," Friedman said.
Moving forward, Friedman hopes that the messaging techniques her team learns from this study can be applied statewide or, possibly, on an even larger scale. Though SCERC is purely an informative project, meaning that there is no intervention aspect, Friedman hopes that the study will inform future projects aimed at improving health literacy for many different health issues, not just breast cancer. "It's just about figuring out the best ways we can get information back to people who need it the most."