AttL - Sample Topline Summary

TECHNICAL MONITOR
Ingrid Hall, PhD
REPORT PREPARED BY
C. Ashani Turbes, PhD
Ngozi Kamalu, MPH
Danielle Beauchesne, MPH
COVER AND LAYOUT DESIGN
Betty Trechitta
FOR MORE INFORMATION
Ingrid Hall, PhD
Phone: 770.488.3035
SUGGESTED CITATION
Centers for Disease Control and Prevention. (2007). African American women and mass media: Perception
of concepts and messages for breast cancer screening. Atlanta, GA: Author.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
i

C O N T E N T S

I.

INTRODUCTION .................................................................................... 1

II.

METHODOLOGY ................................................................................... 2

III.

AUDIENCE .......................................................................................... 3

IV.

FINDINGS ........................................................................................... 4

A.
B.
C.

Conceptual Message Testing ......................................................................................... 4
Message Testing (Audio) .............................................................................................12
Participant Messages and Placement .........................................................................16

V.

SUMMARY OF MAJOR FINDINGS ACROSS GROUPS ................................... 18

VI.

REFERENCES..................................................................................... 21

APPENDICES

A.
B.
C.
D.

Screener
Moderator Guide
Pre-Discussion Information Sheet (PDIS)
PDIS Results

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
ii

I.

INTRODUCTION

In the United States, breast cancer is a serious national problem. The chance of a woman having
invasive breast cancer at some time in her life is about 1 in 8, and the chance of death from breast
cancer is about 1 in 33. With the exception of skin cancer, breast cancer is the most commonly
diagnosed cancer among women and the second leading cause of cancer death in women after lung
cancer. In 2007, the American Cancer Society (ACS) estimates that 178,480 people will have invasive
breast cancer. About 40,460 women will die from the disease this year. Currently, there are slightly
more than 2 million women living in the United States who have been treated for breast cancer
(ACS, 2007a). While data indicates that the rates of death from breast cancer are declining (likely due
to early detection via mammograms and improved treatment), evidence suggests that African
American women suffer disproportionately from breast cancer mortality.
African American women with breast cancer are 67% more likely to die from the disease than their
white counterparts (ACS, 2007b). In order to address this disparity in breast cancer morbidity and
mortality, the overarching purpose of this study is find ways to improve low-income African
American women’s knowledge and awareness of no-cost breast cancer screening and ultimately
increase mammograms and early detection in this population. This topline report presents the
findings from Phase II of this study to investigate radio messages and concept boards designed,
based on Phase I findings, to increase knowledge, awareness, and breast cancer screening among
African American women.
Audio message and concept testing was done to determine if the concepts and messages developed
in radio and poster board format are clear and understandable to the target audience, personally
relevant to the target audience, have sensitive or controversial elements, capture audience attention,
match audience preferences for wording and format, and feature appropriate settings and activities.
Specifically, this phase investigates through eight focus groups:
►
►
►
►
►

What are the audience’s general thoughts about the concepts presented?
What are the audience’s general thoughts about the radio ads?
Are the radio ads understandable?
Does the audience relate to the radio ads?
How do the radio ads affect the audience?

The target audience for this research is low-income African American women aged 40–64, residing
in Savannah and Macon, Georgia. As such, this study seeks to inform future development of a
theory-driven pilot intervention/campaign using mass media to raise awareness about breast cancer,
no-cost mammograms, and the benefits of early detection via mammography specifically among
African American women.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
1

II.

METHODOLOGY

Due to the exploratory and formative nature of this research, we chose focus groups as the most
appropriate investigative technique, because of their “information-rich” nature. Focus group
discussions, or “intensive group interviews,” are a flexible tool for exploring respondent awareness,
behavior, concerns, beliefs, experiences, motivation, operating practices, and plans related to a
particular topic and subissues (Krueger, 1994).
Focus group methodology is particularly useful for investigating emergent or poorly understood
topics, such as how to address disparities in breast cancer by reaching a low-income African
American audience with information about no-cost mammograms. A moderator can amplify
individual responses through group comments and feedback or through a process of “sharing and
comparing.” In addition, a skilled moderator can follow up or probe certain themes or views that
were unanticipated in the design of the moderator guide, often yielding new information or
additional nuances to existing information (Greenbaum, 1998; Morgan, 1998).
Note that despite its advantages, focus group methodology is not without limitations. Findings from
focus group discussions are neither quantitative nor generalizable to the population as a whole.
Focus group methodology emphasizes depth and insight; therefore, it does not utilize a rigorous
sampling methodology that would be necessary in drawing wide-ranging conclusions (Krueger, 1994;
Greenbaum, 1998). For example, the experiences of African American women participating in the
focus groups in Savannah and Macon may or may not be reflective of and cannot be extrapolated to
women who have different ethnic backgrounds and/or who live in other locations.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
2

III. AUDIENCE
In August 2007, eight focus groups were conducted with low-income African American women in
Savannah and Macon, Georgia. The focus groups were segmented by women’s ages (40–49 years
and 50–64 years) and screening status (screened or unscreened). Half of the participants were
women who had received a mammogram in the past 2 years (screened), and the other half were
women who met the eligibility criteria for enrollment but had not had a mammogram in the past 3
years (unscreened). Sixty-eight women participated in the groups. The table below presents the focus
group segmentation. In each cell, the number in parentheses represents the number of women who
participated in that focus group.
SEGMENTATION TABLE

City

Screened
(Women Screened in the Past 24
Months)
40–49 years
50–64 years

Unscreened
(Women Not Screened in the Past 3
Years)
40–49 years
50–64 years

Macon

1 group (10)

1 group (10)

1 group (9)

1 group (9)

Savannah

1 group (5)

1 group (9)

1 group (7)

1 group (9)

The focus groups were held in two southern cities: Savannah and Macon. In both cities, local site
recruiters (LSRs) conducted the recruitment and distributed recruitment screeners (Appendix A). To
ensure the participation of between six and ten individuals per group, LSRs attempted to recruit at
least 12 eligible individuals to attend each session. A skilled African American female moderator
guided the focus group discussions. Staff members from Macro International Inc., Images USA, and
the Centers for Disease Control and Prevention observed the groups.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
3

IV. FINDINGS
The findings below represent key responses to various questions posed to respondents in each topic
area on the moderator guide (Appendix B). The topic areas are below.
► Conceptual message testing
► Message testing
► Message posttest

If there are any observed differences in the segments, they are discussed within the topic areas
presented below. The prediscussion information sheet and results are in Appendices C and D.
Please note that the text in quotes is gathered from field notes and is not directly quoted from
transcripts.

A. Conceptual Message Testing
Concept boards 1, 2, and 3 were tested with participants aged 50 to 64 years. The findings from
concept testing are presented in table format below.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
4

RESPONSE TO CONCEPT BOARDS 1, 2, AND 3

What do you
think about
this phrase?

1. Think About What You’re Not Doing

2. You Can’t Put a Price On Life

3. The Price of Life is Free With a
Mammogram

Positive Impressions
Overall participants liked the phrase and
images on the concept board. Many
participants commented that the phrase made
them “think about taking better care of myself.”
Related to the images, in most groups,
participants reported that they liked the images.
They appreciated seeing beautiful happy people
and family showing an elderly woman, a middleage woman, and a young woman. They also
said the image made them think that the older
women had their mammograms and received
good results.

Positive Impressions
Across groups, most women liked this
phrase and image on the board. Many
stated that the concept board was perfect.
Overall, the participants thought the phrase
made sense and was a true statement. They
said the phrase and image “makes you think
about the chances you’re taking.”

Positive Impressions
In some groups, participants liked the
phrase and said it made them think that it
“does not cost anything to get it done, so
go on ahead and do it.” They liked that the
phrase stressed early detection and the
importance of attending to every aspect of
one’s body.

Related to the images, many respondents
said that the image portrayed love,
dreams, and beauty. They appeared to
connect with the image of a grandmother
with gray hair and said that it reminded them
of their grandchildren. Respondents said that
this picture meant, “if you had waited a
second longer you may not be able to hug
your grandchild.”

Negative Impressions
Although some women liked the phrase,
many thought the phrase was unclear.
Most said that “Even if you get a
mammogram, doesn’t mean it will save your
life.” Also “life isn’t free,” and “there is no
price on life.” They said the phrase is
“contradicting itself because now you’re
putting a price on life.” Some women said
that mammograms are not free and life the
price of life is not free so the phrase was
incorrect and confusing. Others
misinterpreted the phrase and thought it
means, If you get a mammogram, they can
find the cancer” or “If you do not get a
mammogram, you would get cancer”.

Negative Impressions
Although participants liked the phrase, almost all
women said the phrase did not suggest the
need to get a mammogram. Some women said
that it instead made them think about having
safe sex. Many participants said they rarely read
all of the information in an ad so the “picture and
the heading should prompt us to read the
bottom.”
Related to the images, in some groups a few
participants reported that the woman on the far
right of the picture looked like a man.

Negative Impressions
When asked what they disliked, only one
respondent reported not liking the closed
eyes. She recommended having models
with open eyes and smiling.

Related to the images, most women did not
like that the picture was in black and white
instead of color and that they could not see
the models’ eyes. Some women said that
they did not like that they could not tell the
model’s race/ethnicity. They said that the
black and white made it look somber. One
participant remarked, “It looks like she may
have waited too long because of the way
she’s hugging the child.”
Note that participant discussion and the
responses in the unscreened group tended
to be heavily centered on being cancer free.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
5

RESPONSE TO CONCEPT BOARDS 1, 2, AND 3

What do you
think the
phrase
means?

1. Think About What You’re Not Doing

2. You Can’t Put a Price On Life

3. The Price of Life is Free With a
Mammogram

In most groups, respondents said that the main
idea of the phrase was to get a mammogram
and take advantage of things that are free.
Others reported that the phrase stressed the
need to pass along information to younger
generations and those you love.

In Savannah, respondents said that the
phrase meant to enjoy life as long as you
can. They said the main message was “no
matter the cost of a mammogram, you
should get it done” and that “since there is
low cost or no cost, women should have no
excuse.”

Respondents said that meaning of the
phrase is that “you can get a mammogram
free and a mammogram can save your life if
you get it early/before it’s too late.”

Is there
anything
confusing
about the
phrase?

Most participants said the phrase was unclear
and not explicit enough. They commented that if
they walked by a billboard with this image and
phrase they would not think about breast
cancer.

Do you
believe what
the phrase is
telling you?
Why or why
not?

All of the women stated that they believed what
the phrase was telling them, especially if they
read the bottom of the poster and learned that
what they were not doing was getting a
mammogram.
Participants reported that this ad was meant for
all ages because it included a young woman in
the middle.

When asked this question, respondents in
Macon did not offer a response, but instead
engaged in discussion about access to free
or low-cost services. In the unscreened
groups, they said that they were unaware of
free mammography services.
Across groups, participants did not note
anything confusing about this phrase.

All of the women commented that they
believed the phrase.
Participants said that the ad was for all
women. However, one woman in Macon
stated that the older model in the poster
looked “pretty well off” suggesting that the ad
was for middle to upper class women.

In contrast, some women reported that the
meaning of phrase was “life is free, but a
mammogram is not.” Some respondents said
that the phrase and image targeted middle
and upper class women and the elderly.

When asked this question, participants did
not report anything confusing about this
phrase. However, as noted earlier some
women said that they could not understand
how life was supposed to be free with a
mammogram. In some groups, participants
said that the phrase was vague and
misleading because in the real world you
have to pay something if you want good
healthcare.
In the screened groups, participants said that
they did not believe what this phrase was
telling them. They said, “mammograms are
not free” and “life is not free.”
Conversely, all of the women in the
unscreened segment believed the phrase.
They said that it meant a mammogram could
save your life.
Across groups, most participants said that
the ad was geared toward older Black
people, as well as everybody.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
6

RESPONSE TO CONCEPT BOARDS 1, 2, AND 3

What would
be a better
way to say
what is
meant by
this phrase?

1. Think About What You’re Not Doing

2. You Can’t Put a Price On Life

3. The Price of Life is Free With a
Mammogram

Place the words breast cancer or the word
mammogram in the phrase or somewhere
noticeable on the board.
Putting the words breast cancer in a new
phrase, bolded at the top of the concept board,
while keeping the language of the current
phrase.

Across groups, participants did not have any
suggestions for better way to say what was
meant by the phrase.

Across groups, respondents had many ideas
for revisions to the phrase. These included:
► “The life of a mammogram is free.”
► “Life is free with a mammogram.”
► “A free mammogram can save your life”
► “Get a mammogram/Live longer.”
► “Price of a mammogram is free (leave the
word life out).”
► “Protecting life with a mammogram.”

Include men in the picture because men get
breast cancer too.
Use the phrase the price of life is free with a
mammogram on this board.

Would this
phrase
appeal to
women like
you?

Change the phrase to:
► “Breast cancer…think about what you’re not
doing.” or
► “What you’re not doing about your
mammogram…”
In almost all groups, participants said that the ad
appealed to them. They also said that the ad
was meant for the whole family, young girls,
men, middle-aged women, African Americans,
and all nationalities.

In the screened groups, women stressed
keeping the message about how
mammograms can save one’s life. In the
older screened groups, women said to clarify
how a mammogram is important to have.

Across groups, all women agreed that the
phrase appealed to them. In addition, many
women liked the image of a grandmother
and grandchild.

In screened groups, women said the phrase
did not appeal to women like them because
the concept targeted middle-class women. In
contrast, unscreened participants commonly
reported that the phrase was appealing
because they liked seeing the word “free”.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
7

Concept Boards 1–3 Comparisons
Which of these phrases appeals to you the most? Why?
Across groups, participants said that the “Think about what you’re not doing” concept board appealed to
them the most. Respondents called the phrase a “true” statement and said it offers a powerful
message to women. Women commonly reported that the message and pictures convey the idea that
it is not just your own life, but instead the lives of your family members that you should be
concerned about. For example, one participant stated, “If I don’t take care of myself, I can’t take care of
others.” In Macon, however, most unscreened respondents did not like the phrase “think about what
you’re not doing” to promote mammography. They said that there are several things that they do not
do that they should think about doing, many of which do not include breast cancer screening.
In Savannah, participants also liked the “You can’t’ put a price on life” board. In the older groups,
women said that the board reminded them of their grandchildren. In addition, in Savannah,
although women commented that “the price of life is free with a mammogram” phrase was confusing, they
liked what they perceived to be a clear directive telling them exactly what to do (i.e., get a
mammogram).
Which appeals to you the least? Why?
Across all groups, respondents reported that the least appealing phrase was “The price of life is free with
a mammogram.” Participants commonly said that the phrase was confusing. They also questioned if
mammograms are free.
Concept boards 4, 5, and 6 were tested with participants aged 40 to 49 years. The findings from
testing these concepts boards are presented in table format below.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
8

RESPONSE TO CONCEPT BOARDS 4, 5, AND 6
What do
you think
about this
phrase?

4. Long Live Life

5. Strength Comes From Within…

6. Side Effects Include Knowledge

Positive Impressions
Across groups, women had a positive
impression of this phrase. Although some
respondents commented that the phrase
sounded backwards. Some respondents said
the phrase made them think of early detection.
They suggested changing to “get your breasts
checked and you will live a long life” or “if you
take care of yourself, you’ll live longer.”

Positive Impressions
Participants said that the overall poster
was appealing. Many respondents said that
the phrase made them think of being tested,
having courage, and not being afraid. They
said that that phrase made them think about
their health and what they are not doing. One
woman said, the phrase “makes you think that
you need to do something about this…right
now.” They also agreed “the wording…the
word strength is powerful.”

Positive Impressions
In almost all groups, the overall impression
of this poster was positive. Related to the
phrase, participants were not sure what side
effects referred to. The women said that the
phrase made them want to find out more about
what it meant. Some participants, especially
in the unscreened group, liked the phrase
because they wanted to know more about the
side effects. The phrase prompted many
women to think they should get checked out,
noting that the model in the poster looked like
she may have received her mammogram
results and they were positive.

Related to the images, women across
groups said that the picture was beautiful
and the colors were excellent. Most
respondents in the unscreened groups said
the model in the image looked peaceful, like
“she’s saying thank you Lord.” One woman
said that she “looks like she had that
mammogram and is at peace with herself.”
Negative Impressions
When asked what they disliked, some
women in the screened groups said the
model looked like she was dead or might
be dying. Others felt that she was praying.
One person mentioned that the model’s face
seemed to show sadness, to which another
person commented that she might be
meditating. A few respondents said that the
poster needed more pink.

Related to the images in the board,
respondents liked the colors and the
woman’s open eyes. However, some women
in the unscreened group reported that the
model looked sad and had a lot on her mind.
Negative Impressions
Although participants did not report having
anything they disliked, they did remark that
there was too much writing on the poster.

Related to the images, women said that the
model looks like she received mammogram
results and they were positive. In addition,
in all groups, women liked that the model was
Black, with a nice smile and big breasts. They
said she looked “real”. However, they did not
think that the concept board provided them
with enough information, especially since it did
not explicitly mention breast cancer.
Negative Impressions
Participants commented that the idea of “side
effects” was somewhat frightening (see
discussion below).

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
9

RESPONSE TO CONCEPT BOARDS 4, 5, AND 6
What do
you think
the phrase
means?

4. Long Live Life

5. Strength Comes From Within…

6. Side Effects Include Knowledge

Overall, women said the main idea of the
phrase was to get a mammogram; live a long
life; and take care of your health.

Across groups, participants said that the
phrase meant to go get tested yearly. The
phrase also meant to get more focused on
your health, try to get a mammogram, and
promote early detection.

Participants said that the phrase meant that
people could avoid negative side effects, if
they have knowledge. Some women said it
meant that it is important to be educated about
mammograms and the side effects of
screening. Overall, there was not consistency
in women’s understanding of the phrase.

In terms of the image, a few women asked
why the breast logo was so small. Others
followed up by commenting that the inset
looked like a belly or a testicle, and not a
breast.

Women in the screened groups said that the
main message was to find out about your
health. One woman said, “what you don’t
know, you need to find out.” In the unscreened
groups, respondents said that phrase meant
that it is important to get a mammogram. They
also said that, “God gives you the strength to
get a mammogram because of what the
results could be.” These women focused on
the strength to deal with cancer versus the
strength to get a mammogram for early
detection.
In most groups, participants said the phrase
was clear; however, they reported that the
overall ad included too many messages.
Participants focused on the first part of the
phrase and did not pay much attention to the
language about how “a mammogram is
something we can’t do without.”

Is there
anything
confusing
about the
phrase?

In Savannah, some women said that wording
of the phrase was confusing. In Macon,
however, participants did not note anything
confusing about this phrase.

Do you
believe
what the
phrase is
telling
you? Why
or why
not?

Almost all participants said that they believed
what the phrase was telling them.

Participants said that they believed the phrase
and really valued the use of the word strength.

In the screened groups, women commonly
reported that ad was for African Americans,
middle-aged people, and everywoman. Some
women in the unscreened group said that the
image/phrase was meant for younger people;
others disagreed and commented that
because the face looked neither young nor
old, it was meant for everyone.

Most of the women agreed that the phrase
was meant for all women.

Women did not explicitly state that the phrase
was unclear; however, they said the idea of
“side effects” was scary. Participants did not
understand that “knowledge” is the side effect
in the message.

Across groups, respondents said that they did
not believe the phrase mainly because they
did not understand what was meant by “side
effects”.
Most participants said that the phrase and
board were targeting all women—especially
African American women.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
10

RESPONSE TO CONCEPT BOARDS 4, 5, AND 6
What
would be a
better way
to say what
is meant
by this
phrase?

Would this
phrase
appeal to
women like
you?

4. Long Live Life

5. Strength Comes From Within…

6. Side Effects Include Knowledge

Have the phrase read:
► “Live life” or “Live a long life”.
► “Life lives” or “live life longer.”

Across groups, participants did not have any
suggestions for better way to say what was
meant by the phrase.

Drop the words side effects from the phrase
and say.
► “Knowledge is wisdom.”
► “You need to have understanding.”
► “Knowing the knowledge about the side
effects.”
► Educate yourself about breast cancer.”

Also, enlarge the words on the bottom of the
poster so they are not glossed over and
difficult to read.
In terms of the image, the women commented
that the picture in the corner is not a good
picture of a breast. They also suggested
changing the color of the advertisement,
making the letters pink, and including the
breast cancer ribbon.
In Savannah, women said that this phrase
would not appeal to them as written. They did
not understand the message that the phrase
was trying to convey. In Macon, participants
reported that this phrase would appeal to them
as written.

Put the information about breast cancer on the
top of the ad.

Across all groups, all women said that the
phrase appealed to them.

Most women reported that although the picture
was appealing, the phrase was not appealing
to women like them. They said the phrase was
unclear. Some asked why women should wait
until the are 40 to get screened. They said that
younger women should be screened also.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
11

Concept Boards 4-6 Comparisons
Which of these phrases appeals to you the most? Why?
Across groups, most women said “Strength comes from within” was the most appealing phrase.
Participants liked seeing the words strength and mammogram together in the concept board.
Which appeals to you the least? Why?
Participants said that the phrase “Side effects include knowledge” was the least appealing. In most groups,
women reported that they did not understand what was meant by “side effects” in this context. They
said the overall concept was confusing. In addition, many commented that the pictures did not
match the message. Some women said it looked like an advertisement for physical activity, bras for
plus-size women, or a hair advertisement—not for breast cancer screening.

B. Message Testing (Audio)
Audio messages 1, 2, and 3 were tested with all respondents. The findings from audio message
testing are presented in table format below.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
12

RESPONSE TO THE THREE AUDIO MESSAGES
What do you
think about
this ad?

Oh Harold

Maya Angelou

Phase II

Positive Impressions
Participants said that the ad is colorful,
comical, and informative. Women liked
“Harold’s” sharing important information
with his wife about her health and the
sound of his voice.

Positive Impressions
Across groups, most participants said that
they would stop and listen to this audio
message because they recognized Maya’s
voice and because it is a short ad. In
Savannah, most participants said that ad was
convincing. Across groups, most respondents
said they really liked her “strong and appealing”
voice. Women also said they liked the how the ad
was direct in telling them to “get a mammogram
once a year”.

Positive Impressions
In almost all of the groups, respondents
really liked this ad. Most participants
valued the fact that the message provided
the most information. Women said the ad
was “real…not phony.” They reported that it
was convincing because it included
testimony from a 17-year cancer survivor.
Some common participant comments about
the ad were:
“Wonderful.”
“I enjoyed it”.
“Very informative.”
“It made you pay attention.”

Across groups, most respondents said
that they would stop and listen to this ad if
they heard it on the radio because it is
dramatic, funny, and engaging, and
because they valued hearing a man
showing interest in his wife’s health.
Negative Impressions
Given the gravity of breast cancer,
many respondents said that they did
not like that the ad was comical. A few
participants said the woman in the ad was
“playing like it was a joke” when this is a
serious matter. A few women said that ad
perpetuated stereotypes of Black people
as comical. They said the ad should be
more serious and professional.

What do you
think is the
main
message of
the ad?

In some groups, participants commented
that the music was too loud. Others said
that the ad lacked information about what
is a mammogram or where to get one.
Women reported that the main message
of the ad is to get a mammogram, be
concerned about your health, and get
checked.
Across groups, most respondents said the
ad was clear and not confusing. They said
that “Harold” made it clear that his wife is
supposed to get a mammogram.

Negative Impressions
In Macon, impressions of the Maya ad differed
across age groups and screening status. Half
of the women in the 50–64 year age group
said that the Maya audio message was “too
jazzy.” They said that when they heard her voice
they were “expecting a poem”. Older women
were so enraptured with Maya’s voice that it
appeared hard for them to retain information in
the ad. In contrast, some women in the younger
groups did not even recognize Maya’s voice.
In some groups, women said that the ad was not
informative and failed to provide a phone number
to call. Others said they preferred to hear from
someone who was not famous, and did not like
the “loud,” “distracting” music.
Participants said that the main message of the
message is that every woman should get
checked, get a mammogram, and be tested.
Participants said the ad was clear, particularly the
part stating that women should be checked once
a year.

Across groups, participants commonly said
that they liked the clarity of voices, the
conversational tone, the mention of religion,
screening, the music, length, and hearing the
toll-free number
Negative Impressions
In some groups, particularly in the 40- to
49-year-old groups, women said that the
ad was too long and wordy. In these
groups, some participants also did not like
the music. In the younger groups, a few
participants did not like what they said
sounded like a white announcer.
Across groups, women commonly reported
that the main message is get a mammogram
for early detection.
Other key messages reported included: (1)
[Mammograms are] not as scary as people
say. (2) Call the toll-free number. You can
have a mammogram at no cost; you can
survive. (3) Get tested… recognize that
spirituality and strength can be a motivating
source; have faith; religion can give you
strength. (4) Early detection can save your

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
13

RESPONSE TO THE THREE AUDIO MESSAGES

Do you
believe what
this ad is
saying? Why
or why not?

What is the
most striking
thing about
this ad?

How could
the ad be
improved?

Oh Harold

Maya Angelou

In most groups, with the exception of the
screened 40- to49-year-old groups,
respondents said that they believed the
ad. The women commonly reported that
they related to the woman in the ad and
her interaction/relationship with “Harold.”
Those that did not believe the ad said that
the comical nature of the ad made it less
believable.

Participants said they believed the ad because of
Maya’s voice and focus on raising awareness
about breast cancer. Respondents especially
liked use of the phrase “Every woman counts—
every year” in the ad.

Participants said that the ad was meant
for a variety of people. Some respondents
said that it was meant for everyone:
couples, husbands, wives, and middleage women. Others reported that it was
geared to older people and black people
because the actors “sounded black.”
The man’s strong and distinct voice was
the most striking part of this ad.

Make the actors voices less stereotypical
and more professional sounding.
Use a less comical and more serious tone
for the ad. For example, “when the
actress in the audio message says, ‘do
you love me?” Harold should say ‘yes I
love you, so go get a mammogram.’

Across groups, respondents said that the ad was
geared toward Black women, but also low-income
women, middle-class women, and women of all
ages.

The most striking thing about this ad is Maya’s
voice.

Use another less famous voice.
Add a toll-free telephone number to call about
screening

Phase II
life; you can recover from breast cancer.
Across groups, women reported that they
believed the ad. Many said that they could
relate to the survivor’s experience with
screening.
Some groups said the ad was for all
women—especially Black women—because
of the reference to faith and religion.
Conversely, in the Savannah unscreened 40to 49-year-old group, participants reported
that the message was geared toward middleclass white women due to the “infomerciallike” music and voices that they said
“sounded white.”

The mention of faith is striking. One woman
said” it is something you don’t hear much” on
the radio or TV.
The survivor’s story is very powerful. The
voices, music, and detail in the ad are
important and stand out.
Participants in the screened groups did not
have suggestions to improve the ad. Women
often advised the moderator not to change
anything. One woman said, “if you changed
anything you would mess it up”.

Indicate that mammograms are low or no cost.
Cut the music and just allow Maya (or another
actor) to speak.

Share information about getting a yearly
mammogram first in the ad.

In the unscreened groups, participants
suggested shortening the conversation,
choosing a more aggressive voice for the
host, and using contemporary music

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
14

RESPONSE TO THE THREE AUDIO MESSAGES
After
listening to
this ad,
would you be
motivated to
do anything?

Oh Harold

Maya Angelou

Phase II

Across groups, most participants said that
this ad would motivate them to take
action. They said the overall message
was very clear—”Get a mammogram.”

Almost all respondents reported that this would
motivate them to do something. However, they
did not always say what the “something” was.

Most participants said that they would be
motivated to do something after listening to
this ad. They said Ms. Caldwell’s description
of mammograms and personal experience as
a breast cancer survivor was motivating.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
15

Audio Message Comparison
Out of the last three radio messages we just listened to, which do you like the most?
During comparison of the three ads, most participants said that they liked the “Oh Harold” audio message
the best. Participants commonly reported that the “Oh Harold” ad was funny and that they liked hearing a
husband taking an interest in his wife’s health. Across most groups, women also said that they liked the Phase
II message. They called Phase II the most informative of the three ads because it provided the most
information about breast cancer and the number to call about screening. These respondents also said the
Phase II ad was motivating because it was informative and provided details about cancer, screening, and the
toll-free number.

C. Participant Messages and Placement

If you could develop a message to communicate to women like you about breast cancer and
breast cancer screening, what would it say?
Participants often responded to this question with messages shown below.
PARTICIPANT MESSAGES
Savannah
►
►
►
►
►
►
►

Macon

Go get tested
Life is short
Go get tested for a long life
Get some help
Love your body
Go for regular check up
You’re so important to yourself and
others

►
►
►
►
►
►
►
►
►
►

All women should get tested…no matter race or creed
Get healthy/Get tested
Get tested for your life and loved ones
It’s all good
Call 1800 for cancer
Get a mammogram
Get a mammogram early
Get it every year…every women should have it
Get a mammogram/Your life is yours take charge of it
Be aware of your breasts every year

What are community events that you attend?
See below the types of places or community events where participants commonly reported going.
COMMUNITY EVENTS ATTENDED
Savannah
►
►
►
►
►
►

Gullah festival
NAACP and black business meetings
Martin Luther King parade
Churches
Savannah State Gala in May
Museums

Macon
►
►
►
►
►
►
►
►

Residents Association
Museums
Harriet Tubman Museum
Cherry Blossoms (Jazz club)
Church
Douglasville Theater
First Fridays
Gospel singing events

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
16

Where would you like to see posters placed?
See below the types of places where women want to see posters placed.
POSTER PLACEMENT
Savannah
►
►
►
►
►
►
►
►
►
►
►
►
►
►
►

Macon

Hospitals
Billboards
Community centers
Parks
Schools
Doctors’ offices/clinics
Nursing homes
Churches
Grocery stores
Restaurants
Bus stops
Rest rooms
Restaurants
The mall
Pharmacy

►
►
►
►
►
►
►
►
►

Billboards
Schools
Doctors’ offices
Health Department
City buses
Beauty salons
Family and children services
Child support services
Banks

Across groups, respondents said that they would most notice the posters on buses, in physician
waiting rooms, at clinic or health department reception desks, in church, or in their workplaces.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
17

V.

SUMMARY OF MAJOR FINDINGS ACROSS GROUPS

Attention to Images
► In most groups, participants naturally focused their comments on the concept board images

versus the concept/phrase on the concept board. They frequently had many comments about
pictures, colors, and what they thought was the story behind the image on the board. While the
moderator was able to effectively illicit and guide discussion about phrases, it is important to
note that respondents commonly focused on images and subsequently recommended that
phrases be concise and directive, such as “Go get a mammogram!”

“Women Like Us”
► Across groups, women said that they want to hear information about breast cancer and

screening from other African American women, particularly breast cancer survivors, versus
cultural icons (such as Maya Angelou). According to participants, hearing from “women like us”
offers additional motivation to engage in health protective behaviors.

Messages for “All of us”
► Focus group participants reported that they valued the images of happy, healthy African

American women and families in the concept boards and hearing African American voices in the
radio messages. Across groups, however, they stressed that the overall message in the concept
boards and radio ads is for everyone. They said that these messages are relevant for all women
and should ideally appeal to African American and Caucasian women.

Taboo Topic
► Although it was not a question asked during the groups, women in several groups said that

African American women do not talk about personal health concerns or needs with each other
or medical professionals. Many participants said that personal health, particularly related to
breasts or other private parts of the body, were taboo topics for discussion in their community.
Related to this, participants suggested that since African American women do not talk about
their breasts with medical professionals, doctors and nurses fail to inform them about low- or
no-cost services, such as mammograms, for which they may be eligible. One respondent stated,
“We aren’t taught these things; we don’t’ talk about this; we don’t go to the doctor.”

Contradictions
► Across groups, participant responses were sometimes contradictory.

For example, women
commented that “The Price of Life is Free” phrase was confusing, however some liked what
they perceived as a clear early detection messages in the phrase. In addition, participants
expressed ambivalence about the “Oh Harold” audio message indicating that it was too
“comical.” However, they also remarked that the message was the best of the three audio
messages. The inconsistencies may be due to participant’s initial responses influenced by group
discussion leading to their rethinking and modifying a response. Whatever, the reason for the
sometimes inconsistent or contradictory responses, this finding suggests the importance of
having a diversity of messages to reach a diversity of people with varied (and sometimes
capricious) ideas about cancer, early detection, and breast cancer screening messages.
Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
18

In conclusion, please see below a bulleted summary of responses to the audio messages and concept
boards in table format.
SUMMARY OF RESPONSES TO AUDIO TESTING
Audio*

Strengths/Likes

Oh Harold

►
►

Maya
Angelou

►

Phase II
Audio

►

►

Male interest in partner
health
Brevity of the message
Maya’s voice
Brevity of the message

Weaknesses/Dislikes
►

Too comical

Recommended Changes
►
►

►
►
►

Maya’s iconic voice
The music
Lack of information
Too long
The music was not
contemporary

Survivor’s testimonial
►
► Presence of medical
►
personnel
► Mention of faith
► Very detailed
*Audio was tested with all 40- to 64-year-old groups.

►
►
►
►

Make the tone more
serious
Change actor/actress
Use an everyday woman
Include more information
(e.g., a toll-free number)
Change the music
Break the message up
into parts

SUMMARY OF RESPONSES TO CONCEPT TESTING
Concepts*

Strengths/Likes

Think about
what you’re
not doing

►

►
►

You can’t put
a price on life

►
►
►

The price of
life is free
with a
mammogram

►

Weaknesses/Dislikes

Presentation of
multiple generations of
women
Showing family
Women smiling

►

Participants really liked
the phrase
The models are
beautiful
The colors are vibrant
Participants really liked
the depiction of family
closeness

►
►

►
►

►

Recommended Changes

The phrase is unclear;
it should be more
explicit about what
women are not doing
and what they should
be doing
Models’ eyes are
closed
Models are smiling,
but not showing teeth

►

Enhancing the phrase by
adding the words breast
cancer or mammogram

►

Use models with smiles
and open eyes

The model is too old
The phrase is
misleading and
unclear
The colors are bland

►

Change the phrase to
read: “The price of a
mammogram is free”
Enhance the colors in the
poster; make them more
vibrant

►

* These concept boards tested with groups of 50- to 64-year-old women.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
19

SUMMARY OF RESPONSES TO CONCEPT TESTING
Concepts*

Strengths/Likes

Long live life

►
►

The model is beautiful
There is good word
placement on the
board; it is “captivating”

Weaknesses/Dislikes
The model looks dead
or like she’s dying
The colors are muted
and uninteresting
The phrase is unclear

►

►

There is too much text
on the board

►

►

A young model
The main message is
unclear in the ad
“Side effects…is
negative and unclear”

►

►
►
►

Strength
comes from
within…

►

►

Side effects
include
knowledge

►
►

The models’ eyes are
open and she is
smiling
Participants liked
seeing the words
strength and
mammogram
The model is full
figured and beautiful
The colors are vibrant

Recommended Changes

►
►

►
►

►

Change the phrase to
read: “Live a long life”
Enhance the colors;
make them more vibrant
Use a model with open
eyes and a smile
Shorten the phrase

Do not use a body shot;
participants prefer
pictures of women’s
faces
Change the phrase to
read: “Knowledge is a
side effect…”

* These concept boards tested with groups of 40- to 49-year old women.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
20

VI. REFERENCES
American Cancer Society (a). How many women get breast cancer? (2007). Atlanta, GA: Author. Retrieved
September 12, 2007, from
http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_How_many_people_get_breast_
cancer_5.asp?sitearea=
American Cancer Society (b). (2007). African Americans more likely to die from breast cancer. Atlanta, GA:
Author. Retrieved September 12, 2007, from
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_African_Americans_More_Likely
_to_Die_from_Breast_Cancer.asp
Greenbaum, T. L. (1998). The handbook for focus group research (2nd ed.). Thousand Oaks, CA: Sage
Publications, Inc.
Krueger, R. A. (1994). Focus groups: A practical guide for applied research (2nd ed.). Thousand Oaks, CA:
Sage Publications, Inc.
Morgan, D. L. (1998). The focus group guidebook. Thousand Oaks, CA: Sage Publications, Inc.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
21

A. SCREENER

PHASE II
RECRUITMENT SCREENER
SCREENED

AND

UNSCREENED

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta,
Georgia 30333; ATTN: PRA (0920-XXXX)

Hello. My name is ____________ and I am working with ORC Macro, a consulting firm in
Atlanta, Georgia and the Centers for Disease Control and Prevention (CDC) to test some ideas
and messages for a health promotion campaign for African American women who may qualify
for free breast cancer screening.
We are asking 6 to 10 ladies to get together and talk about these ideas and messages. The
discussion will last about 2 hours and happen only once. We will not ask you any questions
about your own health status or personal health issues in the discussion groups.
If you participate in the group, you will receive $65.00 cash in appreciation of your time. We will
also serve a light meal prior to the discussion. Do you think that you might be interested in
participating in this type of discussion?
‰
‰

Yes (Continue with screener.)
No (Thank person for his/her time and end conversation.)

Would you mind if I ask you a few questions in order to determine whether or not you can
participate in the discussion group?
‰
‰

Yes (Continue with screener.)
No (Thank person for his/her time and end conversation.)

NOTE TO RECRUITER: Please continue through all questions before letting individuals know
that they cannot be invited to participate at this time based on at least one of the responses they
provided.
Record and Keep all Screened Data
1. Record gender
‰ Male (Terminate at end.)
‰ Female

2. Are you Hispanic/Latina?
‰ Yes
‰ No

Recruitment Screener

Page 1 of 4

3. How do you describe your race? Select one or more race.
‰ Black or African American
‰ White (Terminate at end.)
‰ American Indian or Alaska Native (Terminate at end.)
‰ Asian (Terminate at end.)
‰ Native Hawaiian or Other Pacific Islander (Terminate at end.)

RECRUITER: If an individual self-identifies as Black or African American and any other race
they remain eligible for the groups.
RECRUITER: We must determine your eligibility in the Breast and Cervical Cancer Program
(BCCP). To be eligible for enrollment in the BCCP and receive federally-funded breast
screening:
‰ The woman is within the age requirements recommended breast cancer screening.
‰ The woman is at or below 200% of the Federal poverty guidelines.
‰ The woman is uninsured.

4. Record age: _________________________
‰ What is your date of birth? (Month/Year)

RECRUITER: Record which age group they belong to:
‰ 39 and under (Terminate at end.)
‰ 40–49 (Recruit to 40–49 groups.)
‰ 50–64 (Recruit to 50–64 groups.)
‰ 65 and older (Terminate at end.)

5. How many immediate family members including you live in your house? ___________
[Record # of people]

6. What is your household income per month before taxes? ________________________
RECRUITER: If the woman hesitates, ask her if she thinks it is more than or less than the
amount you read next to the family size she just told you.
Read the dollar figure next to the correct Family Size the person just told you.
For family of 1, read $1,497 per month
For family of 2, read $2,020 per month
For family of 3, read $2,543 per month
For family of 4, read $3,067 per month
For family of 5, read $3,590 per month
For family of 6, read $4,113 per month
For family of 7, read $4,637 per month
For family of 8, read $5,160 per month

Recruitment Screener

More [Terminate at end]
More [Terminate at end]
More [Terminate at end]
More [Terminate at end]
More [Terminate at end]
More [Terminate at end]
More [Terminate at end]
More [Terminate at end]

Less [Continue]
Less [Continue]
Less [Continue]
Less [Continue]
Less [Continue]
Less [Continue]
Less [Continue]
Less [Continue]

Page 2 of 4

7. Do you have health insurance coverage (includes Medicaid)?
‰ Yes (Terminate at end.)
‰ No

8. Have you had a mammogram in the last 3 years?
‰ Yes (Go to question 9.)
‰ No (Recruit to UNSCREENED Focus Groups – Go to question 10.)

9. Have you had a mammogram in the last 24 months (or 2 years)?
‰ Yes (Recruit to SCREENED Focus Groups – Go to question 10.)
‰ No (Terminate at end.)

10. Have you ever been diagnosed with breast cancer or ANY form of cancer?
‰ Yes (Terminate at end.)
‰ No

11. What is your home zip code? ________________________
‰ Is on the list of zip codes from which to recruit
‰ Is not on the list of zip codes from which to recruit (Terminate at end.)

12. Do you have any family members who have been recruited for this study?
‰ Yes (Terminate at end.)
‰ No

13. Are you willing to participate in a discussion to offer your thoughts about materials
and messages to increase breast cancer screening in your community?
‰ Yes
‰ No (Terminate at end.)

TERMINATION SCRIPT: “We appreciate your willingness to answer each of the questions.
Unfortunately, one of your answers does not meet our requirements for participation in the focus
group. Thank you for your time.”
14. You are eligible to participate in the group. Are you still interested in participating?
‰ Yes
‰ No (Thank person for her time, terminate and end the conversation.)

Recruitment Screener

Page 3 of 4

I’m glad that you will be able to join us! The discussion group will last about an hour and a half.
It will be held at [INSERT LOCATION]. The group in which we would like you to participate is
scheduled for:

Place (Age Group)
TBD (40–49)
TBD (50–64)
TBD (40–49)
TBD (50–64)

Date
TBD
TBD
TBD
TBD

TBD (40–49)
TBD (50–64)
TBD (40–49)
TBD (50–64)

TBD
TBD
TBD
TBD

SCREENED
Group Number
Group 1
Group 2
Group 3
Group 4
UNSCREENED
Group 5
Group 6
Group 7
Group 8

Time
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD

15. Does this date and time work for you?
‰ Yes
‰ No (Thank person for her time, terminate and end the conversation.)
[GET OTHER AVAILABLE TIMES THAT MIGHT WORK.]
You will receive $65.00 for participating in the group. Do not forget that we will serve you a light
meal prior to the discussion.
We would also like to be able to send you a reminder before the group. Can you please confirm
your name, address, phone number, and e-mail?
Name:
Mailing Address:
Home Telephone:

Pager:

Work Telephone:

Cell Phone:

E-Mail:
Also, please contact [NAME] at [PHONE NUMBER] if your plans change so that we may
invite someone from the waiting list to attend instead. Otherwise, we’ll look forward to
seeing you on [Month/Day/Year] at [Time].
RECRUITER: (Please record the location where you screened this woman: ___________ )
Give the woman a focus group card with her group number (1–8), the focus group
location, phone number, and directions.

Recruitment Screener

Page 4 of 4

B. MODERATOR GUIDE

Form Approved
OMB No.: 0920-0738
Exp. Date: 12-31-2007

FOCUS GROUP MODERATOR GUIDE
TABLE

OF

CONTENTS

Public reporting burden of this collection of information is estimated to average 1 ½ hours per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta,
Georgia 30333; ATTN: PRA (0920-0738)

Introduction to Group Processes and Procedures (10 minutes)............................................ 2
Participant Introductions and Warm-up Exercise (5 minutes) ............................................... 3
Message Pre-Test (PDIS) (15 minutes) ..................................................................................... 3
Discussion Questions (40 minutes) ......................................................................................... 3
 Conceptual Message Testing (20 minutes) ......................................................................... 3
 Message Testing (20 minutes) ............................................................................................. 4
Message Post-Test (PDIS) (15 minutes) ................................................................................... 5
Closing (5 minutes) ..................................................................................................................... 5

Focus Group Moderator Guide

Page 1 of 5

[Moderator: Before participants enter room, write on flip chart visible to all participants: ]
● “Topic of Discussion: Thoughts about concepts and messages to educate women about
breast cancer and increase breast cancer screening (mammography) among African
American women.”
●

Focus group ground rules.

INTRODUCTION TO GROUP PROCESSES AND PROCEDURES (10 minutes)
Thank you for taking the time to be here. My name is ___________ and I work for Macro
International Inc., a research and consulting firm in Atlanta, Georgia. As you may remember
when you were recruited, we are conducting this focus group on behalf of the Centers for
Disease Control and Prevention (CDC) to learn about your thoughts about concepts and
messages designed to educate women about breast cancer and increase breast cancer
screening among African American women. First, I want to take a few minutes to tell you about
my role and what to expect from our discussion and then I’ll give everyone the chance to
introduce herself.
My role is simply to facilitate the discussion, make sure we stay on topic, and keep us within our
2-hour time limit. I am not here to push any particular agenda or point of view, but rather to hear
your frank and honest opinions. There are no right or wrong answers. We all have our own likes
and dislikes, our own thoughts and feelings.
I want to remind everyone that the discussion here will be maintained in a secure manner.
Please use only your first name. We will not report your comments by name, and we ask that
you respect each other’s privacy in the same way. We do not expect you to tell us anything that
you would be uncomfortable sharing with the group. But we do hope that you will be honest
with your responses to the questions I ask.
Before we begin, I need to give you the informed consent form. Let’s read it together and then
I’ll ask you to sign it. Most importantly, I want to make sure that you understand your
participation in this study is completely voluntary. That means you can leave at any time.
[Moderator: Review, collect informed consent form, and answer any questions.]
I’m going to ask a series of questions, but mainly I want to hear from you. As I mentioned, my
role is simply to guide the discussion. Sometimes we may really get going on one question, and
I’ll have to move you onto the next question so that we may cover everything. Please do not
take it personally! We just need to hear from everyone about several topics.
There are also a few ground rules that I would like us to adopt for our discussion:
●

You have been asked here to offer your views and opinions.

●

Everyone’s input is important. I may call on you if you are being quiet.

●

Avoid side conversations.

●

Let one person speak at a time.

●

I may need to cut a discussion short to get through the whole discussion.

●

Please turn off all cell phones!

●

There are no right or wrong answers.

Focus Group Moderator Guide

Page 2 of 5

●

All answers will be maintained in a secure manner, so feel free to speak your mind.

●

Respect one another at all times.

●

It’s okay to disagree.

Most importantly, please try to speak up, speak clearly, and one at a time. We are audiotaping
the discussion so that we can have an accurate record of the discussion. Do you have any
questions before we get started?
PARTICIPANT INTRODUCTIONS AND WARM-UP EXERCISE (5 minutes)
So we can get to know each other a little, let’s go around the room and introduce ourselves.
Please say your first name only and your favorite type of music.
MESSAGE PRE-TEST (15 minutes)
[Moderator: Refer to the PDIS and administer Part 1 (General Questions) and Part 2
(Pretest of Messages)]
DISCUSSION QUESTIONS (40 minutes)
Conceptual Message Testing (20 minutes)
Moderator: “Now I’d like us to focus on a few conceptual messages. I have a few
examples that I would like to show you and we will discuss each. We are interested in
your thoughts about these concepts. Remember that you are the experts and your
opinions are important to us. We’re interested in providing information that is as useful
as possible, so I really want your honest and frank responses to what we present you.”
Show one conceptual message at a time and ask the following questions for each.
1. What do you think about this phrase?
‰ Probe: What does it make you think about?
‰ Probe: What do you like about this phrase? Why?
‰ Probe: What do you dislike about the phrase? Why?

2. What do you think the phrase means?
‰ Probe: What is the main idea it is trying to communicate?

3. Is there anything confusing about the phrase? Please explain.

4. Do you believe what the phrase is telling you? Why/Why not?
‰ Probe: Who do you think this phrase is meant for?

Focus Group Moderator Guide

Page 3 of 5

[Moderator: We are trying to gather information about what group of people they think
the phrase is meant for, e.g. African Americans, young people, etc]
5. What would be a better way to say what is meant by this phrase?
‰ Probe: What else (or other types of information) would you want to hear in this phrase?
6. Would this phrase appeal to women like you?
[Moderator: After asking the questions above for each of the three phrases, say “Now
let’s take a look at all 3 phrases together…”]
7. Which of these phrases appeals to you the most? Why?

8. Which of these phrases appeals to you the least? Why?
MESSAGE TESTING (20 minutes)
Moderator: “Okay. Now I’m going to play three radio spots for you that CDC has
developed to educate African American women like you about breast cancer and breast
cancer screening.
I want to hear what you think about each of these radio
advertisements.”
Play one radio spot at a time and ask the following questions for each.
1. What do you think about this ad?
‰ Probe: Would you stop and listen to it if you heard it? Why or why not?
‰ Probe: What do you like about this ad? (e.g., voices, music, tone, etc.)
‰ Probe: What do you dislike about the ad? (e.g., voices, music, tone, etc.)

2. What do you think is the main message of the ad?
‰ Probe: What is confusing about the message?
‰ Probe: What is most clear about the message?

3. Do you believe what this ad is saying? Why or why not?
‰ Probe: Who do you think this ad is meant for?
‰ Probe: What about this ad can you relate to?

[Moderator: We are trying to gather information about what group of people they think
the ad is meant for, e.g. African Americans, young people, etc.]
4. What is the most striking thing about this ad?
‰ Probe: What do you think about the: (a) tone, (b) voices (c) music (d) length

5. How could the ad be improved?
‰ Probe: What might be a better way to say what this ad is trying to say?
‰ Probe: What would you change in this? Please explain why.
‰ Probe: What else would you want to hear in this ad? Why?

Focus Group Moderator Guide

Page 4 of 5

6. After listening to this ad would you be motivated to do anything? Please explain.
MESSAGE POST-TEST (15 minutes)
[Moderator: After playing each radio ad and asking the above questions, refer to the PDIS
and administer Part 3 (Posttest of Messages). Complete the PDIS post-test exercise
before you play the following ad. Conduct the Posttest for each ad.]
CLOSING (5 minutes)
Moderator: “As a closing activity, I just want to briefly go around the room and ask each
one of you…”
1. Out of the last three radio messages we just listened to, which do you like the most?
Explain why.
‰ Probe: Which was most informative? Why?
‰ Probe: Which was most motivating? Why?

2. Well, that’s the last of my questions. Do you have any questions?

[Moderator: “On the table behind me, you’ll see that we have brought some educational
materials about breast cancer, mammography and clinical breast exams. Please feel free
to help yourselves to any of this information.]
For women in unscreened groups only:
We also have a health educator here who can answer any immediate questions you may have.
Thank you again for taking the time to participate in this discussion. We sincerely
appreciate and value your input!”

Focus Group Moderator Guide

Page 5 of 5

C. PRE-DISCUSSION
INFORMATION SHEET (PDIS)

Form Approved
OMB No.: 0920-0738
Exp. Date: 12-31-2007

PHASE II
PRE-DISCUSSION INFORMATION SHEET—MODERATOR VERSION
Public reporting burden of this collection of information is estimated to average one-half hour per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta,
Georgia 30333; ATTN: PRA (0920-0738)

Moderator: “To get started today we would like you to take a moment and give us some
background information about you for the group and respond to a series of questions about three
demo radio messages that I will play for you shortly.
Let’s begin. I’m first going to ask you some questions about yourself. Please listen carefully as I
read aloud each of the questions and answers on the paper in front of you. You will record your
own responses to each question right on your paper. Remember that our discussion and what
you record on this paper will be maintained in a secure manner and that there are no right or
wrong answers.”

PART 1: GENERAL QUESTIONS (10 minutes)
Please do not write your full name on this form.
1. What is your date of birth? (Month/Day/Year)
2. What is your highest education level completed?
‰ 6th Grade or less
‰ 7th – 8th Grade
‰ 9th – 11th Grade
‰ 12th Grade without a High School diploma
‰ 12th Grade with a High School diploma
‰ GED
‰ Some college
‰ Associate degree
‰ Completed college (4 year degree)
3. What is your employment status? (Check all that apply)
‰ Full-time
‰ Part-time
‰ Presently not employed outside the home, looking for work
‰ Presently not employed outside the home, not looking for
work

‰
‰
‰
‰

Student
Laid Off
On Strike
Disabled

4. What do you do for a living? What is your occupation/profession? ________________

Pre-discussion Information Sheet—Moderator Version

Page 1 of 6

5. How often do you listen to the radio?
‰ Never or rarely
‰ 1-2 days a week
‰ 3-4 days a week
‰ 5-6 days a week
‰ Every day
6. During what time of the day do you most often listen to the radio?
‰ In the mornings (5am-12pm)
‰ In the afternoons (12pm-6pm)
‰ In the evenings (7pm-12am)
7. On which days of the week are you most likely to listen to the radio? (Check all that
apply)
‰ Monday
‰ Friday
‰ Tuesday
‰ Saturday
‰ Wednesday
‰ Sunday
‰ Thursday
8. Which of the following types of radio stations do you usually listen to? (Check all that
apply)
‰ Talk Stations
‰ Music Stations
‰ AM
‰ FM
9. When you listen to the radio, which station or stations do you listen to most often?
Write in station dial location and name: __________________________________________
PART 2: PRETEST OF MESSAGES (15 minutes)
Moderator: “I am going to play for you 3 radio messages. After I play each message, please listen
carefully as I read aloud each of the questions and answers on the paper in front of you. You will
record your own responses on the paper. Remember that our discussion and what you record on
this paper will be maintained in a secure manner and that there are no right or wrong answers.
We will conduct this exercise again near the end of our discussion.”

PART 2a: MESSAGE ONE PRETEST
[Moderator: Play the first radio message and ask the following questions.]

1. Did you like the voices that were used in the radio advertisement?
‰ Yes
‰ No

Pre-discussion Information Sheet—Moderator Version

Page 2 of 6

2. Did you like the music that was used in the radio advertisement?
‰ Yes
‰ No
3. Did you learn anything new from this radio advertisement?
‰ Yes
‰ No
If yes, what did you learn? __________________________________________________
4. After hearing this radio advertisement would you call your doctor or health
department about getting screened for breast cancer (or getting a mammogram)?
‰ Yes
‰ No
5. After hearing this radio advertisement would you contact a family member or friend
about getting screened for breast cancer (or getting a mammogram)?
‰ Yes
‰ No
PART 2b: MESSAGE TWO PRETEST
[Moderator: Play the second radio message and ask the following questions.]

1. Did you like the voices that were used in the radio advertisement?
‰ Yes
‰ No
2. Did you like the music that was used in the radio advertisement?
‰ Yes
‰ No
3. Did you learn anything new from this radio advertisement?
‰ Yes
‰ No
If yes, what did you learn? __________________________________________________
4. After hearing this radio advertisement would you call your doctor or health department about
getting screened for breast cancer (or getting a mammogram)?

‰
‰

Yes
No

5. After hearing this radio advertisement would you contact a family member or friend
about getting screened for breast cancer (or getting a mammogram)?
‰ Yes
‰ No

Pre-discussion Information Sheet—Moderator Version

Page 3 of 6

PART 2c: MESSAGE THREE PRETEST
[Moderator: Play the last radio message and ask the following questions.]

1. Did you like the voices that were used in the radio advertisement?
‰ Yes
‰ No
2. Did you like the music that was used in the radio advertisement?
‰ Yes
‰ No

3. Did you learn anything new from this radio advertisement?
‰ Yes
‰ No
If yes, what did you learn? __________________________________________________
4. After hearing this radio advertisement would you call your doctor or health
department about getting screened for breast cancer (or getting a mammogram)?
‰ Yes
‰ No
5. After hearing this radio advertisement would you contact a family member or friend
about getting screened for breast cancer (or getting a mammogram)?
‰ Yes
‰ No
[Moderator: Move back to the moderator guide and begin with concept testing questions 1 – 7.]

PART 3: POSTTEST OF MESSAGES (15 minutes)
Moderator: “I am going to play the same 3 radio messages for you again. After I play each
message, please listen carefully as I read aloud each of the questions and answers on the paper
in front of you. You will record your own responses on the paper. Remember that our discussion
and what you record on this paper will be maintained in a secure manner and that there are no
right or wrong answers.”

PART 3a: MESSAGE ONE POSTTEST
[Moderator: After playing the first radio message and asking questions 8 – 13 in the moderator
guide, ask the following questions.]

1. Did you like the voices that were used in the radio advertisement?
‰ Yes
‰ No

Pre-discussion Information Sheet—Moderator Version

Page 4 of 6

2. Did you like the music that was used in the radio advertisement?
‰ Yes
‰ No
3. Did you learn anything new from this radio advertisement?
‰ Yes
‰ No
If yes, what did you learn? __________________________________________________
4. After hearing this radio advertisement would you call your doctor or health
department about getting screened for breast cancer (or getting a mammogram)?
‰ Yes
‰ No
5. After hearing this radio advertisement would you contact a family member or friend
about getting screened for breast cancer (or getting a mammogram)?
‰ Yes
‰ No
[Moderator: Play the second radio message, move back to the moderator guide, and ask
questions 8 – 13 for the second radio message.]

PART 3b: MESSAGE TWO POSTTEST
[Moderator: After playing the second radio message and asking questions 8 – 13 in the moderator
guide, ask the following questions.]

1. Did you like the voices that were used in the radio advertisement?
‰ Yes
‰ No
2. Did you like the music that was used in the radio advertisement?
‰ Yes
‰ No
3. Did you learn anything new from this radio advertisement?
‰ Yes
‰ No
If yes, what did you learn? __________________________________________________
4. After hearing this radio advertisement would you call your doctor or health
department about getting screened for breast cancer (or getting a mammogram)?
‰ Yes
‰ No

Pre-discussion Information Sheet—Moderator Version

Page 5 of 6

5. After hearing this radio advertisement would you contact a family member or friend
about getting screened for breast cancer (or getting a mammogram)?
‰ Yes
‰ No
[Moderator: Play the third radio message, move back to the moderator guide, and ask questions
8 – 13 for the third radio message.]

PART 3c: MESSAGE THREE POSTTEST
[Moderator: After playing the third radio message and asking questions 8 – 13 in the moderator
guide, ask the following questions.]

1. Did you like the voices that were used in the radio advertisement?
‰ Yes
‰ No
2. Did you like the music that was used in the radio advertisement?
‰ Yes
‰ No
3. Did you learn anything new from this radio advertisement?
‰ Yes
‰ No
If yes, what did you learn? __________________________________________________
4. After hearing this radio advertisement would you call your doctor or health
department about getting screened for breast cancer (or getting a mammogram)?
‰ Yes
‰ No

5. After hearing this radio advertisement would you contact a family member or friend
about getting screened for breast cancer (or getting a mammogram)?
‰ Yes
‰ No
[Moderator: Move back to the moderator guide and ask questions 14 – 15.]

Pre-discussion Information Sheet—Moderator Version

Page 6 of 6

D. PDIS RESULTS

IV. PHASE II
PRE-DISCUSSION INFORMATION SHEET – RESULTS *

PDIS RESULTS ON THE MAYA ANGELOU AUDIO MESSAGE
Questions

1. Did you like the voices that were used in
the radio ad?
2. Do you like the music that was used in the
radio ad?
3. Did you learn anything new from this radio
ad?
4. After hearing this radio ad would you call
your doctor or health department about
getting screened for breast cancer?
5. After hearing this radio ad would you
contact a family member or friend about
getting screened for breast cancer?

Pretest
N
(%)
Yes
No
57
9
(86.4%)
(13.6%)
56
9
(86.2%)
(13.8%)
37
25
(59.7%)
(40.3%)
59
7
(89.4%)
(10.6%)

Posttest
N
(%)
Yes
No
60
6
(90.9%)
(9.1%)
57
8
(87.7%)
(12.3%)
35
28
(55.6%)
(44.4%)
59
5
(92.2%)
(7.8%)

61
(92.4%)

58
(89.2%)

5
(7.6%)

7
(10.8%)

% Change

Yes
4.5%

No
4.5%

1.5%

1.5%

4.1%

4.1%

2.8%

2.8%

3.2%

3.2%

PDIS RESULTS ON THE OH HAROLD AUDIO MESSAGE
Questions

1. Did you like the voices that were used in
the radio ad?
2. Do you like the music that was used in the
radio ad?
3. Did you learn anything new from this radio
ad?
4. After hearing this radio ad would you call
your doctor or health department about
getting screened for breast cancer?
5. After hearing this radio ad would you
contact a family member or friend about
getting screened for breast cancer?

Pretest
N
(%)
Yes
No

Posttest
N
(%)
Yes
No

% Change

Yes

No

51
(77.3%)
50
(76.9%)
35
(53.0%)
53
(81.5%)

15
(22.7%)
15
(23.1%)
31
(47.0%)
12
(18.5%)

36
(57.1%)
37
(58.7%)
24
(40.0%)
43
(69.4%)

27
(42.9%)
26
(41.3%)
36
(60.0%)
19
(30.6%)

20.2%

20.2%

18.2%

18.2%

13.0%

13.0%

12.1%

12.1%

54
(81.8%)

12
(18.2%)

44
(72.1%)

17
(27.9%)

9.7%

9.7%

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
Appendix D–1

PDIS RESULTS ON THE PHASE II AUDIO MESSAGE
Questions

1. Did you like the voices that were used in
the radio ad?
2. Do you like the music that was used in the
radio ad?
3. Did you learn anything new from this radio
ad?
4. After hearing this radio ad would you call
your doctor or health department about
getting screened for breast cancer?
5. After hearing this radio ad would you
contact a family member or friend about
getting screened for breast cancer?

Pretest
N
(%)
Yes
No
65
1
(98.5%)
(1.5%)
57
9
(86.4%)
(13.6%)
44
20
(68.8%)
(31.3%)
62
4
(93.9%)
(6.1%)

Posttest
N
(%)
Yes
No
62
1
(98.4%)
(1.6%)
51
10
(83.6%)
(16.4%)
39
23
(62.9%)
(37.1%)
59
3
(95.2%)
(4.8%)

65
(98.5%)

58
(93.5%)

1
(1.5%)

4
(6.5%)

% Change

Yes
0.1%

No
0.1%

2.8%

2.8%

5.9%

5.8%

1.3%

1.3%

5.0%

5.0%

* Note: We received a total of 66 PDIS from focus group participants. However, some participants did not complete all items on
the PDIS. Therefore, some cells do not sum to 66, which indicates missing items.

Perception of Concepts and Messages for Breast Cancer Screening—Topline Summary
Appendix D–2