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Understanding the Health Screening Behaviors in Underserved African American Men
Nishal Shah
Health Message Design
Dr. Matsaganis
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Nishal Shah
Health Message Design
Dr. Matsaganis
Understanding the Health Behaviors in Underserved African American Men
Behavioral Analysis:
As noted in the Topic Selection Proposal, a primary issue must be addressed is the
growing concern of African American men residing in an underserved community who have
contracted oral cancer due to smoking tobacco. In addition, educating and promoting regular
health checkups within the low socio-economic African American community is also observed
and inversely related to the target audience being screened for cancer. Even though the proposed
targeted community holds negative beliefs about health screenings, providing them with a safe
and comfortable experience is of utmost necessity. While preventing tobacco use should be the
first step in curbing the onset of oral cancer, the fundamental behavior change that must be
altered is the frequency with which African American men in underserved neighborhoods visit
their physicians for regular health screenings. Through these screenings, not only will they be
aware of any surface-level health complications they may have, but it could also enable them to
find cancerous cells before it becomes malignant.
Considering the many minority groups infrequently visit their primary care doctors, a
study conducted by Fiscella and Holt notes that “the frequency of primary care visits seems to
contribute minimally to racial and ethnic disparities in preventive services. In general, African
American and Hispanic patients have fewer primary care visits, and fewer primary care visits are
associated with lower rates of preventive care” (2007). It can also be concluded that since a
majority of the target audience has similar negative beliefs toward health care and health
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screenings, that belief could be detrimentally passed down through generations. Therefore, two
models can be attributed to altering the target audience’s behavior: the health belief model and
social cognitive theory. The health belief model enables one to understand if a “person will take
a health-related action if that person: 1. feels that a negative health condition can be avoided; 2.
has a positive expectation that by taking a recommended action, he/she will avoid a negative
health condition; and 3. believes that he/she can successfully take a recommended health action”
(Resource Center for Adolescent Pregnancy Prevention, 2018). The model can aid in assessing if
there is potential for the target audience to begin scheduling regular health screenings if they
believe it will help detect cancer. The social cognitive theory, developed by Albert Bandura,
“explains how people acquire and maintain certain behavioral patterns while also providing the
basis for intervention strategies” (University of Twente, 2018). The theory heavily considers
environmental and social conditions that influence the target audience's decision. In this
situation, SCT could be used in order to determine how the target audience’s surroundings affect
their trust in doctors and the frequency of health screenings.
As previously mentioned, the distrust among the underserved African American
community has resulted in a low rate of individuals attending regular health screenings. A study
by Roberts, Colby, Lu, and Ferketich states that the target audience did not seek out physician
consultations because “participants often described how physicians focused on profit, rather than
their care. As one participant stated: "I really don’t trust the doctors that they really care about
me because you know if you don’t have insurance, if they don’t see where they can get paid, they
are really not interested in you” (2016). Furthermore, the same study mentions how many
participants continuously cited the infamous Tuskegee experiment for their negative perception
of health care. Aside from these perceptions, economic factors also play an essential part in why
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the target audience may avoid health screenings. In their study, Fiscella and Holt concurred that
“in general, minority participants had lower income, less education, poorer health and functional
status, fewer visits, and were less likely to receive preventative services than non-Hispanic
whites” (2007). Since the target population is unaware of the benefits of regular health
screenings, it is critical to communicate to them the importance of primary care visits. These
misconceptions, attitudes and beliefs regarding health care can be put to rest if the target
audience is provided with accurate information about its benefits. With such a firmly held belief,
the target audience’s salient cognitions range from their perceptions and attitudes to their beliefs
and feelings. However, as it would be both time-consuming and exhaustive trying to tackle each
cognition, the essential cognition that must be sought after to change is the target audience’s
deep-held beliefs toward health screenings.
From the various behavior change theories, the health belief model is the most applicable
model to this situation. Through this model, a campaign can be created wherein the audience can
understand how routine health screenings and primary care visitations would benefit them. In
addition, for those diagnosed with oral cancer, the model would assist in relaying information
about how health screenings can detect cancer in its early stages and how it can help mitigate any
complications that may arise.
The second behavior change theory that may be useful for enhancing the target
audience’s understanding of the necessity for health screenings is the social cognitive theory.
Through this theory, it would be beneficial to understand how social and environmental
constructs positively and negatively influence the target audience. For example, this theory
would allow for an observation about the target audience’s resources (i.e., how far the closest
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physician is) and the beliefs that everyone else around them has about health screenings (i.e., the
beliefs of their families, close friends and neighbors).
Target Audience:
Considering that the male African American population of low socio-economic status is
the most susceptible to contracting oral cancer after extensive tobacco use, they are also the most
logical primary target audience for intervention. However, one aspect to consider is that African
Americans are less likely to smoke at an early age yet are also less likely to quit smoking later.
As mentioned in a study by Roberts, Colby, and Ferkeitch, “By the time individuals are in their
late 20s and early 30s, greater onset among African Americans and greater cessation among
whites cause the prevalence of African Americans smoking to equal – and often exceed – that of
whites” (2016). In addition, the study also states that since African Americans are more likely to
begin tobacco use at a later age, they are also less likely to stop smoking. Furthermore, even if
African American men have the resources to attend a health screening, they are still “less likely
than white men to see a doctor when in poor health even after accounting for insurance status,
and availability, and access to, medical resources/services” (Thorpe et al., 2012). Since the target
audience must be properly educated about the positive effects of health screenings, the secondary
target audience would be physicians and healthcare professionals close to these underserved
communities. If this audience is engaged, they can convey critical information about the
importance of health screenings to the primary target audience.
Conclusion:
In order to change the behavior of African American men in an underserved community
who have negative beliefs about health screenings, implementing the health belief model and the
social cognitive theory will allow for communication messaging to arise that portrays positive
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and critical information. By providing a channel for communication between physicians and the
targeted audience, the rate of individuals who go for regular health screenings might increase.
There are also possibilities for clinics to be installed closer to the target audiences or to provide
them with resources to travel to clinics that may be farther.
Even though both the health belief model and the social cognitive theory have been
heavily used throughout health communication, there are still some weaknesses. The health
belief model enables us to understand the personal beliefs and attitudes of the target audience. At
the same time, the social cognitive theory allows us to understand the beliefs and attitudes of an
entire community. That being said, the weakness in both theories and models is that there is no
guarantee that the target audience will alter their behaviors.
Works Cited:
Fiscella, K., & Holt, K. (2007). Impact of primary care patient visits on racial and ethnic
disparities in preventive care in the United States. Journal of the American Board
ofFamily Medicine, 20(6), 587-597. doi: 10.3122/jabfm.2007.07.070053
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Theories & Approaches: Health Belief Model (HBM). (n.d.). Retrieved from
http://recapp.etr.org/recapp/index.cfm?fuseaction=pages.theoriesdetail&PageID=13
Health Communication | Social Cognitive Theory. (n.d.). Retrieved from
https://www.utwente.nl/en/bms/communication-theories/sorted-by-cluster/Health
Communication/Social_cognitive_theory/
Boscoe, F. P., Johnson, C. J., Sherman, R. L., Stinchcomb, D. G., Lin, G., & Henry, K. A.
(2014). The relationship between area poverty rate and site-specific cancer incidence in
the United States. Cancer, 120(14), 2191-8.
Thorpe, R. J., Bowie, J. V., Wilson-Frederick, S. M., Coa, K. I., & Laveist, T. A. (2012).
Association between race, place, and preventive health screenings among men: findings
from the exploring health disparities in integrated communities study. American journal
of men's health, 7(3), 220-7.
Jacobs, E. A., Rolle, I., Ferrans, C. E., Whitaker, E. E., & Warnecke, R. B. (2006).
Understanding African Americans' views of the trustworthiness of physicians. Journal of
general internal medicine, 21(6), 642-7.
Roberts, M. E., Colby, S. M., Lu, B., & Ferketich, A. K. (2016). Understanding Tobacco Use
Onset Among African Americans. Nicotine & tobacco research : official journal of the
Society for Research on Nicotine and Tobacco, 18 Suppl 1(Suppl 1), S49-56.
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