Can Prevention-Oriented Communication Via Health Organization Websites Affect Adherence to Breast and Cervical Cancer Screening? An Exploratory Study in Italy
1
Department of Political and Communication Sciences, University of Salerno, Fisciano, Italy
2
Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
Abstract
Background Public organizations in healthcare are progressively adopting digital tools to disseminate information regarding the benefits of screening. Nevertheless, no research has hitherto been conducted to investigate the link between the website-based health communications and cancer screening uptake. This study addresses this gap by assessing whether health communications conveyed via the websites of local health organizations improve adherence to breast and cervical cancer screening.
Methods We performed thematic content analysis of 97 websites belonging to Italian health organizations based on the OSEC-p model. This latter was developed to measure the compliance of prevention-oriented health communication with the effectiveness requirements indicated in the model. Next, correlation and regression analyses were performed to examine the relationship between the average regional OSEC-p scores and the regional breast and cervical cancer screening adherence rates reported by the National Centre for Screening Monitoring in 2022.
Results The findings show that the prevention-oriented health communication via health organizations’ websites can explain the 45% of the variance in female cancer (breast and cervical) screening uptake. Patient engagement tools and information on preventive cancer initiatives are key web-based communication elements that enhance cancer screening adherence.
Conclusion This exploratory study is one of the first to highlight the importance of digital health communications for improving cancer screening and public health. It offers insights both for national health policy-makers to optimize health economics through screening campaigns and health organizations managers to enhance the compliance of health communication on websites with the effectiveness requirements defined in the OSEC-p model.
Best AL, Vamos C, Choi SK, Thompson EL, Daley E, Friedman DB. Increasing routine cancer screening among underserved populations through effective communication strategies: application of a health literacy framework. J Cancer Educ. 2017;32(1):213-217. doi:1007/s13187-017-1194-7
Ford JS, Coups EJ, Hay JL. Knowledge of colon cancer screening in a national probability sample in the United States. J Health Commun. 2006;11(suppl 1):19-35. doi:1080/10810730600637533
Shneyderman Y, Rutten LJF, Arheart KL, Byrne MM, Kornfeld J, Schwartz SJ. Health information seeking and cancer screening adherence rates. J Cancer Educ. 2016;31(1):75-83. doi:1007/s13187-015-0791-6
Jun J. Cancer/health communication and breast/cervical cancer screening among Asian Americans and five Asian ethnic groups. Ethn Health. 2020;25(7):960-981. doi:1080/13557858.2018.1478952
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:3322/caac.21660
Guthmuller S, Carrieri V, Wübker A. Effects of organized screening programs on breast cancer screening, incidence, and mortality in Europe. J Health Econ. 2023;92:102803. doi:1016/j.jhealeco.2023.102803
Hakama M, Auvinen A, Day NE, Miller AB. Sensitivity in cancer screening. J Med Screen. 2007;14(4):174-177. doi:1258/096914107782912077
Lönnberg S, Šekerija M, Malila N, et al. Cancer screening: policy recommendations on governance, organization and evaluation of cancer screening. In: Albreht T, Kiasuwa R, Van den Bulcke M, eds. European Guide on Quality Improvement in Comprehensive Cancer Control. National Institute of Public Health; 2017:39-76.
Segnan N, Ronco G, Ciatto S. Cervical cancer screening in Italy. Eur J Cancer. 2000;36(17):2235-2239. doi:1016/s0959-8049(00)00316-6
Pelullo CP, Cantore F, Lisciotto A, Di Giuseppe G, Pavia M. Organized breast and cervical cancer screening: attendance and determinants in Southern Italy. Cancers (Basel). 2021;13(7):1578. doi:3390/cancers13071578
Paul C, Nicholls R, Priest P, McGee R. Making policy decisions about population screening for breast cancer: the role of citizens’ deliberation. Health Policy. 2008;85(3):314-320. doi:1016/j.healthpol.2007.08.007
Vega ES, Zepeda MFP, Gutierrez EL, Martinez MDCC, Gomez SJG, Caldera SD. Internet health information on patient’s decision-making: implications, opportunities and challenges. Med Res Arch. 2023;11(7.2). doi:18103/mra.v11i7.2.4066
Kampmeijer R, Pavlova M, Tambor M, Golinowska S, Groot W. The use of e-health and m-health tools in health promotion and primary prevention among older adults: a systematic literature review. BMC Health Serv Res. 2016;16(Suppl 5):290. doi:1186/s12913-016-1522-3
Siliquini R, Ceruti M, Lovato E, et al. Surfing the internet for health information: an Italian survey on use and population choices. BMC Med Inform Decis Mak. 2011;11:21. doi:1186/1472-6947-11-21
Petracca F, Ciani O, Cucciniello M, Tarricone R. Harnessing digital health technologies during and after the COVID-19 pandemic: context matters. J Med Internet Res. 2020;22(12):e21815. doi:2196/21815
D’Andrea A, Grifoni P, Ferri F. Online health information seeking: an Italian case study for analyzing citizens’ behavior and perception. Int J Environ Res Public Health. 2023;20(2):1076. doi:3390/ijerph20021076
Odone A, Buttigieg S, Ricciardi W, Azzopardi-Muscat N, Staines A. Public health digitalization in Europe: EUPHA vision, action and role in digital public health. Eur J Public Health. 2019;29(suppl 3):28-35. doi:1093/eurpub/ckz161
Whynes DK, Philips Z, Avis M. Why do women participate in the English cervical cancer screening programme? J Health Econ. 2007;26(2):306-325. doi:1016/j.jhealeco.2006.08.007
Selman TJ, Prakash T, Khan KS. Quality of health information for cervical cancer treatment on the internet. BMC Womens Health. 2006;6:9. doi:1186/1472-6874-6-9
Link E, Baumann E, Linn A, Fahr A, Schulz PJ, Abuzahra ME. Influencing factors of online health information seeking in selected European countries: analysis of country specifics. Eur J Health Commun. 2021;2(1):29-55. doi:47368/ejhc.2021.002
Maibach EW, Abroms LC, Marosits M. Communication and marketing as tools to cultivate the public’s health: a proposed “people and places” framework. BMC Public Health. 2007;7:88. doi:1186/1471-2458-7-88
Murukutla N, Cotter T, Kotov A. The instrumental role of strategic communication to counter industry marketing responses to sugary drink taxes: comment on "Understanding marketing responses to a tax on sugary drinks: a qualitative interview study in the United Kingdom, 2019.” Int J Health Policy Manag. 2023;12:7685. doi:34172/ijhpm.2023.7685
Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259-267. doi:1093/heapro/15.3.259
Rogers RW. A protection motivation theory of fear appeals and attitude change. J Psychol. 1975;91(1):93-114. doi:1080/00223980.1975.9915803
Giordano L, Webster P, Anthony C, et al. Improving the quality of communication in organised cervical cancer screening programmes. Patient Educ Couns. 2008;72(1):130-136. doi:1016/j.pec.2008.02.010
Whitten P, Nazione S, Lauckner C. Tools for assessing the quality and accessibility of online health information: initial testing among breast cancer websites. Inform Health Soc Care. 2013;38(4):366-381. doi:3109/17538157.2013.812644
Conte F, Oro R, Siano D. A framework for evaluating health communication aimed at breast and cervical cancer screening adherence: a pilot study on websites of Italian local health organizations. Int J Healthc Manag. 2024;17(3):441-452. doi:1080/20479700.2023.2194605
Cvijović J, Kostić-Stanković M, Krstić G, Stojanović L. Marketing communication in the area of breast and cervical cancer prevention. Vojnosanit Pregl. 2016;73(6):544-552. doi:2298/vsp141020132c
Wallington SF, Oppong B, Iddirisu M, Adams-Campbell LL. Developing a mass media campaign to promote mammography awareness in African American women in the nation’s capital. J Community Health. 2018;43(4):633-638. doi:1007/s10900-017-0461-1
Schliemann D, Htay MNN, Dahlui M, et al. Impact of a mass media campaign on breast cancer symptoms awareness and screening uptake in Malaysia: findings from a quasi-experimental study. BMJ Open. 2020;10(8):e036503. doi:1136/bmjopen-2019-036503
Lau J, Ng A, Wong GJ, et al. How effective are digital technology-based interventions at promoting colorectal cancer screening uptake in average-risk populations? A systematic review and meta-analysis of randomized controlled trials. Prev Med. 2022;164:107343. doi:1016/j.ypmed.2022.107343
Costantini L, Del Riccio M, Piccoli E, et al. Use of digital technologies to support cancer screening in community health promotion interventions: scoping review. Health Promot Int. 2023;38(1):daac189. doi:1093/heapro/daac189
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:1191/1478088706qp063oa
Bolin K, Lindgren A, Lindgren B, Lundborg P. Utilisation of physician services in the 50+ population: the relative importance of individual versus institutional factors in 10 European countries. Int J Health Care Finance Econ. 2009;9(1):83-112. doi:1007/s10754-008-9048-9
Cassell MM, Jackson C, Cheuvront B. Health communication on the Internet: an effective channel for health behavior change? J Health Commun. 1998;3(1):71-79. doi:1080/108107398127517
Neuhauser L, Kreps GL. Rethinking communication in the e-health era. J Health Psychol. 2003;8(1):7-23. doi:1177/1359105303008001426
Huang GJ, Penson DF. Internet health resources and the cancer patient. Cancer Invest. 2008;26(2):202-207. doi:1080/07357900701566197
Glynn RW, Kelly JC, Coffey N, Sweeney KJ, Kerin MJ. The effect of breast cancer awareness month on internet search activity—a comparison with awareness campaigns for lung and prostate cancer. BMC Cancer. 2011;11:442. doi:1186/1471-2407-11-442
Pollock A, Campbell P, Struthers C, et al. Stakeholder involvement in systematic reviews: a scoping review. Syst Rev. 2018;7(1):208. doi:1186/s13643-018-0852-0
Pellegrini G, Lovati C. Stakeholders’ engagement for improved health outcomes: a research brief to design a tool for better communication and participation. Front Public Health. 2025;13:1536753. doi:3389/fpubh.2025.1536753
Amicizia D, Piazza MF, Grammatico F, et al. Organizational determinants, outcomes related to participation and adherence to cancer public health screening: a systematic review. Cancers (Basel). 2025;17(11):1775. doi:3390/cancers17111775
Adami HO, Bretthauer M, Kalager M. Assessment of cancer screening effectiveness in the era of screening programs. Eur J Epidemiol. 2020;35(10):891-897. doi:1007/s10654-020-00684-7
Hersch JK, Nickel BL, Ghanouni A, Jansen J, McCaffery KJ. Improving communication about cancer screening: moving towards informed decision making. Public Health Res Pract. 2017;27(3):e2731728. doi:17061/phrp2731728
Lange F. The role of education in complex health decisions: evidence from cancer screening. J Health Econ. 2011;30(1):43-54. doi:1016/j.jhealeco.2010.08.008
Palme M, Simeonova E. Does women's education affect breast cancer risk and survival? Evidence from a population based social experiment in education. J Health Econ. 2015;42:115-124. doi:1016/j.jhealeco.2014.11.001
Hackl F, Halla M, Hummer M, Pruckner GJ. The effectiveness of health screening. Health Econ. 2015;24(8):913-935. doi:1002/hec.3072
Haining K, Lone N, Lemmon E, Hall P. Comparison of predictors for long-term survival and healthcare costs of cancer patients in Scotland. Eur J Public Health. 2023;33(suppl 2):ckad160.415. doi:1093/eurpub/ckad160.415
Schiller-Fruehwirth I, Jahn B, Einzinger P, Zauner G, Urach C, Siebert U. The long-term effectiveness and cost effectiveness of organized versus opportunistic screening for breast cancer in Austria. Value Health. 2017;20(8):1048-1057. doi:1016/j.jval.2017.04.009
Sieck CJ, Hefner JL, Walker DM, Kurien N, Phelps L, McAlearney AS. The role of health care organizations in patient engagement: mechanisms to support a strong relationship between patients and clinicians. Health Care Manage Rev. 2023;48(1):23-31. doi:1097/HMR.0000000000000346
Articles in Press, Corrected Proof Available Online from 10 March 2026
Conte, F. , Siano, D. and Oro, R. (2026). Can Prevention-Oriented Communication Via Health Organization Websites Affect Adherence to Breast and Cervical Cancer Screening? An Exploratory Study in Italy. International Journal of Health Policy and Management, (), -.
MLA
Conte, F. , , Siano, D. , and Oro, R. . "Can Prevention-Oriented Communication Via Health Organization Websites Affect Adherence to Breast and Cervical Cancer Screening? An Exploratory Study in Italy", International Journal of Health Policy and Management, , , 2026, -.
HARVARD
Conte, F., Siano, D., Oro, R. (2026). 'Can Prevention-Oriented Communication Via Health Organization Websites Affect Adherence to Breast and Cervical Cancer Screening? An Exploratory Study in Italy', International Journal of Health Policy and Management, (), pp. -.
CHICAGO
F. Conte , D. Siano and R. Oro, "Can Prevention-Oriented Communication Via Health Organization Websites Affect Adherence to Breast and Cervical Cancer Screening? An Exploratory Study in Italy," International Journal of Health Policy and Management, (2026): -,
VANCOUVER
Conte, F., Siano, D., Oro, R. Can Prevention-Oriented Communication Via Health Organization Websites Affect Adherence to Breast and Cervical Cancer Screening? An Exploratory Study in Italy. International Journal of Health Policy and Management, 2026; (): -.