Research
In this section, you can keep track of the project’s progress in achieving each of its goals. Click on the first goal to learn more about the phases already completed and those currently being implemented!
identify
The Relevant Factors in Defining Profiles of Adherence to Cancer Screening Programs
to develop
Developing Effective Communication Models through Tailored Messages for the Promotion of Cancer Screenings
to activate
Activate short motivational counselling training courses for doctors and operators
GOAL 1: IDENTIFYING THE FACTORS RELEVANT TO DEFINING PROFILES OF ADHERENCE TO CANCER SCREENINGS
GOAL 1: IDENTIFYING THE FACTORS RELEVANT TO DEFINING PROFILES OF ADHERENCE TO CANCER SCREENINGS
PHASE 1 – LITERATURE ANALYSIS
The first phase of the Miriade project focused on studying the existing scientific literature on the subject, specifically targeting two aspects:
Study of national and international literature aimed at understanding the theoretical models and psychosocial constructs that explain the processes underlying adherence to screening practices for colorectal cancer, breast cancer, and cervical cancer. Researchers have constructed a systematic review to highlight the models, based on studies conducted in the last five years, the theoretical models, and the constructs most commonly used to explain participation in screening practices.
Study of national and international literature aimed at understanding the factors that promote participation in screening practices for colorectal, cervical, and breast cancer. In this case, too, researchers have constructed a systematic review of international studies from the last 5 years that highlighted the main factors promoting and/or hindering participation in cancer screenings.
PHASE 2 – CONSTRUCTION OF THE CLIENTELE AND EMPIRICAL EXPLORATION OF THE LOCAL CULTURE
The second phase of the Miriade project focused on exploring the local culture within which screening practices are constructed, conceived, and organized.
Primarily, in order to construct the commissioning of the question posed by the Campania region, a narrative interview grid was administered aimed at listening to the subjective experience and viewpoints of healthcare workers, such as key experts (screening references, midwives, gynecologists, radiologists, etc.) who enliven and carry forward screening practices within the healthcare relationship with citizens every day. This phase, which resulted in a pubblicazione, allowed for an in-depth exploration of the constraints and resources that the operators themselves highlight in their practices and, above all, the actions and development trajectories that, according to their privileged perspective, can support active citizen participation and focus on the healthcare relationship. Regarding the findings, you can consult the summary videos we have created. You can find them here on the side!
Simultaneously, narrative interviews were conducted with citizens who regularly undergo screening at the local health authorities (ASL) of the Campania region. From a research perspective, this allowed, on one hand, to explore the subjective experiences, factors, and psychological and psychosocial processes that underlie their active participation (engagement) in screening practices. The research work resulting from this is currently in the submission phase, but it is already possible to consult the videos that summarize its main results. You can find them here on the side!
Furthermore, during this phase, we also had the opportunity to highlight the emotions, often negative, that shape the relationship between the individual and screening practices both before undergoing the diagnostic examination, during the examination, and while waiting for the results. This work, with a privileged focus on women undergoing breast cancer screening, is in submission, but it is possible to consult the videos containing useful TIPS on how women manage the fear of screening. You can find them here on the side!
PHASE 3 – MODELLING INDIVIDUAL PROCESSES OF ADHERENCE TO CANCER SCREENINGS: CONSTRUCTION OF TEST BATTERIES AND PILOT STUDY
The analysis of the reference literature conducted in the previous phases and throughout the project informed a preliminary hypothesis for modelling the processes that, at an individual level, could lead to adherence – or otherwise – to screening programmes for colorectal, breast, and cervical cancer. With these guidelines in mind, initial data collections were initiated using digital questionnaires aimed at constructing a preliminary dataset through which to verify the statistical effectiveness of these hypothesised models in the target population of the three screenings.
The first pilot study, based on the Theory of Planned Behaviour (TPB; Ajzen, 1991), aimed to test the effectiveness of an integrated psychosocial model in predicting adherence to colorectal screening. In particular, the theoretical model included socio-cognitive variables such as attitudes towards screening, social norms, planning, personal identity, and perceived risk. The results confirmed the effectiveness of the model and are summarised in an international article.
In light of the results obtained from the first pilot study, this same model, already validated for colorectal screening, was extended to include mammographic and cervical screenings, aiming to capture possible peculiarities specific to these adherence processes (second pilot study). The results confirmed the predictive capability of the hypothesised model in the context of female screenings as well. An international article was produced in this case too.
In parallel, to deepen the understanding of the psycho-social variables that may play a key role in shaping the intention to undergo cancer screenings, the research team aimed to construct and validate a measurement scale for motivations specifically suited to this behaviour, an area lacking in the existing literature. This work had three main objectives: i) to capture the multiple dimensions of motivation to undergo screenings, not covered by the previously hypothesised model (and existing literature); ii) to integrate these new motivational dimensions into the theoretical reference model; iii) to inform the creation of adherence profiles to cancer screenings that consider both the TPB model variables and the new motivational dimensions. Currently, the work is completed and submitted to an international journal.
Finally, a third pilot study is underway to test an integration of the model that includes the evaluation of the role of psychological-clinical variables (e.g., health anxiety, body image, emotional regulation) in explaining the phenomenon of adherence to colorectal screening. The work is currently in the submission phase to an international journal.
OBJECTIVE 2: CREATE EFFECTIVE COMMUNICATION MODELS THROUGH TAILORED MESSAGES FOR THE PROMOTION OF ONCOLOGY SCREENING
OBJECTIVE 2: CREATE EFFECTIVE COMMUNICATION MODELS THROUGH TAILORED MESSAGES FOR THE PROMOTION OF ONCOLOGY SCREENING
PHASE 1 – BIBLIOGRAPHIC RESEARCH ON TAILORED MESSAGES APPLIED TO SCREENING
Before the design and implementation of the experimental study, an in-depth analysis of the psychosocial literature regarding the effectiveness of communication interventions for the promotion of cancer screenings based on tailored approaches was conducted. This work led to the development of a systematic review on the topic (the scientific article is currently under submission to an international journal). The main objective of the review was to assess the effectiveness of tailored communication interventions compared to non-tailored ones in promoting the intention and behaviour of adherence to cancer screenings. Although the results were heterogeneous, the review highlights that interventions based on behavioural change theories, which utilise multiple channels (e.g., digital ones and telephone counselling), that aim both to modify any erroneous beliefs (e.g., the belief that the screening test is painful) and to leverage some key individual characteristics (e.g., individual motivations), prove to be the most promising.
PHASE 2 – IDENTIFICATION OF THE TEST BATTERY TO BE ADMINISTERED – REDUCTION OF ITEMS (STATISTICAL PHASE) STARTING FROM PILOT TESTS
Having defined the theoretical foundations for the design of the experimental study, the process of adapting the test battery was initiated based on the results obtained from pilot studies. To optimise the effectiveness and usability of the final questionnaire, the Item Response Theory (IRT) technique was applied, with the aim of selecting the most representative items of each psychological scale. This approach allowed for a reduced and optimised version of the scales to be included in the final questionnaire, ensuring both the robustness of the measures and the reduction of cognitive load for the participants.
PHASE 3 – FORMULATION OF THE EXPERIMENTAL STUDY, DESCRIPTION OF THE TAILORED MESSAGES ADMINISTERED – INVOLVEMENT OF THE ASTRA RICERCHE COMPANY FOR THE REALISATION OF THE SAMPLING
Once the test battery to be administered was defined, the design and implementation of the experimental study was divided into five main sub-phases:
Administration of the test battery (T0): Three distinct questionnaires were developed, each specifically aimed at one of the three target populations of cancer screenings. Sampling was carried out according to a reasoned choice quota procedure, stratified based on demographic characteristics such as gender, age, and reference Local Health Authority (ASL). The data collection, conducted by the Astra Ricerche company between April and June 2024, involved a total of 4,346 participants.
Identification of subgroups in the eligible population: The data collected at T0 were analysed using the Reduced k-means clustering technique, in order to identify homogeneous subgroups in each of the three target populations, based on psychological characteristics. This process allowed for the definition of specific adherence profiles.
Formulation of persuasive messages: Based on the psychological profiles identified from the analysis, specific persuasive messages were constructed for each profile and for each of the three screenings. In particular, the profiles were used to construct targeted messages, aimed at leveraging the most relevant psychosocial variables of the group of belonging. In addition to these, tailored messages were also constructed, which, besides considering the psychological profile, integrated the most relevant motivational lever for each individual. Overall, 64 distinct persuasive messages were created.
Pre-testing of the messages: Before the final administration, the messages were pre-tested on a subgroup of 100 participants, selected from the initial sample. This process, managed by the Astra Ricerche company, allowed for the assessment of comprehensibility, communicative effectiveness, and perceived relevance of the messages. The results required only minor modifications.
Implementation of the final study (T1): The experimental phase involved the administration of three distinct questionnaires, one for each type of cancer screening. Astra Ricerche was tasked with engaging, from the subjects recruited at T0, at least 300 participants for each of the three screenings. Participants were randomly assigned to one of the following experimental conditions:
- Targeted condition: message based on the characteristics of the belonging profile, determined from the data collected at T0.
- Tailored condition: integrated message, combining the characteristics of the profile with the most relevant motivational lever for each individual.
- Control condition: no persuasive message administered.
In this phase, a total of 1,385 participants were involved. Currently, statistical analyses are underway to evaluate the effectiveness of the intervention. It is also planned to recontact these participants after 6 months to verify actual adherence to the screening (T2), which will allow us to verify the effectiveness of the proposed psychosocial model.
FASE 1 – LITERATURE ANALYSIS
The first phase of the Miriade project focused on studying the existing scientific literature on the subject, specifically targeting two aspects:
Study of national and international literature aimed at understanding the theoretical models and psychosocial constructs that explain the processes underlying adherence to screening practices for colorectal cancer, breast cancer, and cervical cancer. The researchers constructed a systematic review designed to highlight the models, based on studies conducted in the last five years, the theoretical models and constructs most commonly used to explain participation in screening practices.
Study of national and international literature aimed at understanding the factors that promote participation in screening practices for colorectal, cervical, and breast cancer. In this case, too, the researchers constructed a systematic review of international studies from the last 5 years that highlighted the main factors promoting and/or hindering participation in cancer screenings.
FASE 2 – CONSTRUCTION OF THE CLIENTELE AND EMPIRICAL EXPLORATION OF THE LOCAL CULTURE
The second phase of the Miriade project focused on exploring the local culture within which screening practices are constructed, conceived, and organized.
Firstly, in order to construct the commissioning of the question posed by the Campania region, a narrative interview grid was administered aimed at listening to the subjective experience and viewpoints of healthcare workers, such as key experts (screening references, midwives, gynecologists, radiologists, etc.) who enliven and carry forward screening practices within the healthcare relationship with citizens every day. This phase, which resulted in a pubblicazione, allowed for an in-depth exploration of the constraints and resources that the operators themselves highlight in their practices and, above all, the actions and development trajectories that, according to their privileged perspective, can support active citizen participation and focus on the healthcare relationship. Regarding the findings, you can consult the summary video we have created. You can find it here on the side!
Parallel to this, narrative interviews were conducted with citizens who regularly undergo screening at the local health authorities (ASL) of the Campania region. From a research perspective, this allowed, on one hand, to explore the subjective experiences, factors, and psychological and psychosocial processes that underlie their active participation (engagement) in screening practices. The resulting research work is currently in the submission phase, but it is already possible to consult the video that summarizes its main findings. You can find it here on the side!
Additionally, during this phase, we also had the opportunity to highlight the emotions, often negative, that organize the relationship between the individual and screening practices both before undergoing the diagnostic examination, during the examination, and while waiting for the results. This work, with a privileged focus on women undergoing breast cancer screening, is in submission, but it is possible to consult videos containing useful TIPS on how women manage the fear of screening. You can find it here on the side!
FASE 3 – MODELING OF INDIVIDUAL PROCESSES OF ADHERENCE TO CANCER SCREENINGS: CONSTRUCTION OF TEST BATTERIES AND PILOT STUDY
The analysis of the reference literature conducted in the previous phases and throughout the project informed a preliminary hypothesis for modeling the processes that, at an individual level, could lead to adherence – or lack thereof – to screening programs for colorectal, breast, and cervical cancer. With these guidelines in mind, initial data collections were initiated using digital questionnaires aimed at constructing a preliminary dataset through which to verify the statistical effectiveness of these hypothesized models in the target population of the three screenings.
The results of the first pilot study, focused on the evaluation of an integrated psychosocial model of adherence to colorectal screening, confirmed the majority of the hypotheses proposed and are condensed in a work currently in submission.
At the same time, an extension of this same model, already validated for colorectal screening, is being applied to mammographic and cervical screenings as well, with the aim of identifying possible peculiarities specific to these adherence processes.
Additionally, a further pilot study is underway to test an integration of the model that opens up to the evaluation of the role of psychological-clinical variables (e.g., health anxiety, body image, emotional regulation) in explaining the phenomenon of adherence to colorectal screening.