Encouraging communication within a social network may promote uptake of desired medical services or health behaviors. Little is known about the use of this approach to promote colorectal cancer (CRC) screening. We conducted in-person interviews with 438 insured adults ages 42-73 in Massachusetts, Hawaii, and Georgia.

Participants were shown a sample message in which the sender shares that he has completed a colonoscopy and urges the recipient to discuss CRC screening with a doctor. We asked participants to edit the message to create one they would be willing to send to friends and family via email or postcard. Changes to the message were recorded. Edited text was analyzed for content and concordance with original message.

The majority of participants (61.6%) modified the message; 14.2% added to or reframed the existing personalizing words (e.g. adding ‘because I love you’), 10.3% added urgency to the message (e.g. “please don’t delay”) and 8% added reassurance (e.g. “It’s really not that bad.”) Almost one in five (18.3%) deleted a negatively framed sentence on colon cancer risks. In 5.7% of cases, the meaning of at least one sentence was changed but only 2.7% created messages with factual inaccuracies.

Modifiable messages transmitted within a social network offer a way for screened individuals to promote CRC screening. Further study is needed to identify the optimal combination of user-generated content and pre-written text, allowing for creation of messages that are acceptable to senders, persuasive and factually accurate.