Promoting cervical cancer screening in Georgia: A behavioral and cultural insights survey experiment using tailored health messages

In Georgia, cervical cancer remains a significant public health concern, with recent estimates indicating around 330 new cases and 210 deaths annually (age-standardized incidence 10.4 and mortality 5.8 per 100,000 women). Less than 25% of the target population of women aged 25-60 has been screened in the past 5 years. To inform an upcoming health campaign, this study aimed to identify effective communication messages to address barriers and drivers of cervical cancer screening. Using a randomized online survey experiment, the study tested the impact of three health communication messages, presented in poster format: (1) prevention-framed, (2) doctor endorsement (messenger-framed), and (3) pro-social motivation. The study included 2,443 women aged 25-60 years. Participants were randomly assigned to one of the three message conditions or a control group with no message. A survey captured self-reported primary outcomes (intention and self-efficacy to engage in screening) and several secondary outcomes (e.g. perceived information sufficiency and perceived screening importance), as well as self-reported barriers to cancer screening. Overall, the study sample was more highly educated and more positive towards screening than the general target population, with high baseline intention (M = 4.32 out of 5) and self-efficacy (M = 4.37 out of 5) in the control group, contributing to ceiling effects and limiting detectable changes in primary outcomes. Across the overall sample, the messages did not produce significant increases in intention or self-efficacy, but were associated with improved perceived information sufficiency (e.g. prevention-framed message: +0.21, p = 0.002); no negative impacts of any of the messages were found. Subgroup analyses suggested that, among women aged 50+, the prevention-framed message was associated with a modest increase in intention (+0.21, 95% CI [0.00, 0.42]), while prevention-framed (+0.17, p = 0.048) and messenger-framed (+0.24, p = 0.006) messages significantly raised self-efficacy in this group. However, subgroup sizes were small, and these findings should be interpreted cautiously. Concise, theory-informed messages can strengthen women's confidence in making informed screening decisions, though effects on intention and self-efficacy were limited in this highly educated, screening-engaged sample. The results informed the content of a subsequent national campaign, in which all three messages were used.