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J Health Commun. 2016 Jun;21(6):620-8. doi: 10.1080/10810730.2015.1114055. Epub 2016 May 4.

The Influence of Spiritual Framing on African American Women's Mammography Intentions: A Randomized Trial.

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a Department of Community and Family Health , College of Public Health, University of South Florida , Tampa , Florida , USA.
b Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.
c Behavior & Cancer Prevention and Control Program, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.
d Division of Cancer Prevention and Control , Centers for Disease Control and Prevention , Atlanta , Georgia , USA.
e South Carolina Contraceptive Access Campaign , Columbia , South Carolina , USA.


Spiritual framing of breast cancer communication may provide a useful strategy for addressing disparate rates of breast cancer mortality among African American women. The efficacy of a spiritually framed breast cancer screening (BCS) message was compared with that of a traditional BCS message. Specifically, 200 African American women were randomly assigned to review either a spiritually framed or traditional BCS message and complete a self-administered survey, including a thought-listing form. Message efficacy was measured by number of thoughts generated (elaboration), ratio of positive to negative thoughts (polarity), and intention to obtain and/or recommend a mammogram. Multiple linear regression and structural equation modeling were used to assess direct and indirect (mediated) associations among variables. Spiritual framing was positively associated with greater elaboration (β = .265, SE = .36, p < .001) and more positive polarity (β = .237, SE = .04, p < .001) . Spiritual framing also had a significant indirect effect on mammography intentions through polarity (standardized indirect effect = .057, 95% confidence interval [.024, .106], p < .001). These results indicate that spiritual framing may improve the efficacy of BCS messages among African American women by eliciting more positive thoughts about screening. Interventions targeting African American women might consider the role of spirituality when tailoring messages to encourage regular mammography use.

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