The saturation of the Internet into daily life in many parts of the world has characterised the early part of the 21^st century.  As a communication medium, the Internet has huge potential to increase health-related knowledge and behaviours among the general population to ultimately help prevent chronic diseases such as cancer.  However, the actual effectiveness of the Internet in improving cancer-preventive behaviours among older adults, who are among the most at risk for cancer, is unclear.  Importantly, there is unequal access to and use of the Internet in the population.  In the United Kingdom, women, older adults, and those with low income are less likely to use the Internet; this phenomenon is called the ‘digital divide’.  If using the Internet leads to participation in healthy behaviours and ultimately lower chances of cancer, then inequalities in access to online health information may increase inequalities in cancer outcomes.

Our study examined whether Internet use is associated with cancer-preventive behaviours and whether a ‘digital divide’ exists. To do this we used data from 5,943 participants in the English Longitudinal Study of Ageing: a nationally-representative study of English adults aged 50 years and older.  The study participants responded to questions about Internet and email use, self-reported colorectal and breast cancer screening, physical activity, eating habits, physical and cognitive abilities, and demographics every two years from 2002 to 2011.

We found that 41.4% of older English adults reported not using the Internet at all between 2002 and 2011, while 38.3% used the Internet intermittently and 20.3% used the Internet continuously during this time period.  Men and women who consistently used the Internet were two times more likely to participate in colorectal cancer screening than those who never used the Internet. They were also 50% more likely to take part in regular physical activity, 24% more likely to eat at least five daily servings of fruit and vegetables, and 44% less likely to be current smokers.

In short, we found that Internet plays a positive role in promoting healthy cancer-preventive behaviours.  Our research also confirmed that a ‘digital divide’ exists: Internet use in this study was higher in younger, male, white, wealthier, and more educated adults and lower in older, female, non-white, poorer, and less well-educated adults.  Age is a particularly important factor in the ‘digital divide’, as over 40% of all adults aged 50 and up reported never using the Internet.  Providing appropriate support and opportunities for Internet access among older adults may be a key first step to improving health among the ageing population. More generally, increasing Internet access among groups with low rates of Internet usage may have substantial public health benefits.  Policymakers must understand this potential for ‘digital divides’ to influence inequalities in cancer outcomes – whether for worse, or, for better if targeted efforts are made to increase Internet access and literacy among vulnerable groups.

References

Office for National Statistics. Internet access quarterly update, 2013 Q1. 2013 [cited 25 October 2013]. Available from: http://www.ons.gov.uk/ons/rel/rdit2/internet-access-quarterly-update/2013-q1/stb-ia-q1-2013.html

Viswanath K, Nagler R, Bigman-Galimore C, McCauley MP, Jung M, Ramanadhan S. The communications revolution and health inequities in the 21^st century: implications for cancer control. Cancer Epidemiol Biomarkers Prev 2012;21:1701-8.

Xavier AJ, d’Orsi E, Wardle J, Demakakos P, Smith SG, von Wagner C. Internet use and cancer-preventive behaviours in older adults: findings from a longitudinal cohort study. Cancer Epidemiol Biomarkers Prev 2013 (in press).

Type Jade Goody’s name into Google Images and you find an array of pictures from bouncy Big Brother star, through smiling but bald cancer patient, to pain-wracked dying woman.  Jade was diagnosed with cervical cancer in 2008 and died at the age of 27 just a few months later.  Her tragic story received unprecedented media attention and the general public were privy to the intimate details of the last months of her life.  In what has become known as the ‘Jade Effect’, her story had an extraordinary impact on women’s participation in cervical screening – we think about half a million extra women went for screening during the time of her illness.

As psychologists, we were interested in which women were influenced by Jade’s story and why.  To try to understand more about the Jade Effect, we did a survey of 890 women in England – all of them within the age range that are offered screening..  We collected information about women’s age and their social background and we asked them if they’d been affected by Jade’s story in their decisions about cervical screening.  The survey was done about 18 months after Jade’s death, so we asked women to think back over that time period.

The most interesting finding was that younger women were more influenced by Jade, and so were women who had children at a younger age, and who came from more deprived backgrounds.  So why do we think this is?  Well, Jade was 27 when she died, and it’s no secret that she had a hard childhood in Bermondsey – hers was a ‘rags to riches’ story.  She also had children young – in her early 20s.  So it seems possible that the women who were most influenced by her were those who could identify with her.  Perhaps there was a sense of ‘it could have been me’ – and this was the prompt they needed to go for screening.  Suddenly the stakes were raised and the barriers to having a smear test didn’t seem so important.  It’s also possible that some people are more affected by stories than facts.  The blanket media coverage and the emotional story of Jade’s illness probably affected people very differently compared with the kind of factual leaflets that are usually used in screening programmes.  It could be a case of heart vs. head, and perhaps as psychologists and health educators, we need to realise that stories, or ‘narratives’ as they’re sometimes known, can be a good way to get our message across.

Jo Waller (j.waller@ucl.ac.uk)

References

Lancucki L, Sasieni P, Patnick J, Day TJ, Vessey MP.  The impact of Jade Goody’s diagnosis and death on the NHS Cervical Screening Programme.   J Med Screen. 2012 Jun;19(2):89-93. doi: 10.1258/jms.2012.012028. Epub 2012 May 31.

Marlow LA, Sangha A, Patnick J, Waller J.  The Jade Goody Effect: whose cervical screening decisions were influenced by her story?   J Med Screen. 2012 Dec 27. [Epub ahead of print]

Plans to complete a Bowel Cancer Screening test reduce after exposure to the nitty gritty of the test

We all make plans to do things that are good for us, whether it is going for the Sunday morning jog, eating an extra spoonful of greens or saying no to that second (third or fourth!) drink in the pub. The problem is, when the time comes to actually doing whatever it is we’ve been promising ourselves and others to do, all those good intentions seem to disappear as quickly as they arrived.  For the runners among you that have woken only to be faced with a dark and drizzly January morning, you will know what it is that I’m talking about.

So why is it that some people are able to overcome hurdles like the miserable weather, the unappealing sight boiled cabbage and the luring temptation of that extra glass of bubbly? Here at the HBRC we are particularly interested in attempting to answer that question by researching how the perception of time influences people’s behaviour. Some people are always looking towards the future and always want to be prepared for what is to come. Others just want to live for the moment and prefer not to think about what could be round the corner. Interestingly, this appears to be a relatively stable personality characteristic and it is linked to how we feel about behaving in certain ways.

We have recently shown how plans to complete a bowel cancer screening test are affected by time perceptions. Completing a bowel cancer screening kit requires overcoming some pretty immediate obstacles (handling faeces being the most obvious to spring to mind). In addition, the benefits of doing the test won’t be experienced for at least one month (when you hopefully receive a reassuring all-clear letter), or worse, in several years’ time (when you have successfully lived for five years after your bowel cancer treatment). The question we wanted to answer was whether the same people that are able to get out of bed on a cold January morning ready for a 5 mile run, are better able to overcome the short term obstacles of a bowel cancer screening test. In other words, is the ability to look towards the future influencing decisions to complete a bowel cancer screening kit?

We presented some snippets of information to over 200 volunteer middle aged adults (i.e. the group approaching screening age) and asked them after each statement to report ‘how likely it is that you would take part in the screening programme’ (see box 1 for the statements we showed people). Our findings showed how certain parts of the screening programme (e.g. completing it at home) were appreciated, and after finding this out the volunteers increased the strength of their plans. However, once participants were gradually informed about the nitty gritty of the test, people started to waiver. Motivation rapidly declined once people realised they had to collect a sample of faeces and hit a second low when they were informed that the test requires this to be done three times.

Perhaps most interestingly is that people that prefer to live for the moment were more put off by completing it three times and by some photos explaining how to complete the test kit. This enables us to pinpoint the exact stage at which motivation is reduced the most, allowing us to intervene and help people overcome these obstacles.  While this is an exciting finding (even if we do say so ourselves!), it doesn’t explain why those who prefer to stay in the present reduce their motivation faster than others. Is it because they were more put off by the short term obstacles that might affect their short term plans? Or were they just less able to see how beneficial it might be for them in the future? Our analysis seems to suggest that as always, it might be a bit of both. So back to work it is for us, but not before that five mile run I told you about. Anyone?

Reference

Von Wagner, C., Good, A., Smith, S. G., Wardle, J. (in press) Responses to procedural information about colorectal screening using Faecal Occult Blood testing: the role of consideration of future consequences. Health Expectations. DOI: 10.1111/j.1369-7625.2011.00675.x

Sam (Samuel.smith@ucl.ac.uk)