A multi-state research team from Arizona, Colorado, New Mexico, and Utah has published research on a rural health intervention in the Journal of Medical Internet Research. The study developed and pilot tested a theory-based intervention via the web to reduce six cancer risk factors among rural emerging adults through community-engaged research.

The rapid growth of user-generated web-based health information increases the complexity of cancer information seeking. One promising strategy for promoting high-quality cancer information consumption is through targeted interventions that are intentionally designed to reach individuals in the online spaces they occupy. However, there is a paucity of evidence-based information on the best strategies for designing and implementing web-based health behavior change interventions to improve individuals’ cancer-related knowledge and prevent cancer.

This mixed methods approach describes the development of an online cancer prevention intervention aimed at rural emerging adults aged 18-26 years in the United States and delivered in Facebook private groups. The intervention was guided by behavior change theory and co-created with young adults and Stakeholder Organization Advisory Boards to ensure relevance, accessibility, and appropriateness. The paper reported on three formative surveys, a pilot intervention, protocol development, and the community-engaged process for intervention development.

The authors developed 400 posts for a Facebook feed aimed at reducing six cancer risk behaviors (unhealthy diet, lack of physical activity, tobacco use, alcohol use, sun exposure, and human papillomavirus infection) with iterative input from the emerging adults and stakeholder advisory boards. Formative surveys with rural 297 emerging adults and a pilot study of the intervention with this 26 people from this population were conducted. In the pilot study, the intervention reached a sample of participants across several rural counties, with sustained engagement over a one-month period. Key modifications to the intervention content and design emerged from both advisory boards, the formative surveys, and the pilot intervention, focusing on using perceived reliable sources and direct links to source material.

The authors concluded that this web-based cancer prevention intervention is scalable and delivers engaging, evidence-informed health information to rural emerging adults. They offered key insights into the design and implementation of web-based cancer prevention interventions for emerging adults by describing the resources, timelines, and expertise needed to design and implement the intervention. Considerations for fully engaging young people and community stakeholder partners are presented, and how their involvement resulted in modifications that strengthened the intervention was discussed. Finally, the authors highlighted the importance of theory-based health-behavior messaging, digital messaging skillsets, and platform-tailored dissemination strategies for maximizing web-based intervention acceptability.

The research is supported by a grant from the National Cancer Institute (CA268037; Dr. David Buller and Dr. Andrew Sussman, Multiple Principal Investigators). Dr. Buller is the Director of Research at Klein Buendel. Dr. Sussman is from the University of New Mexico Comprehensive Cancer Center. Other collaborating investigators are from the University of Utah, the University of Arizona, the University of Colorado, and Colorado State University. The lead author of the Journal of Medical Internet Research paper is Dr. Echo Warner from the College of Nursing and the Huntsman Cancer Institute at the University of Utah.