PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
Cancer Causes Control. Author manuscript; available in PMC 2017 August 1.
Published in final edited form as:
PMCID: PMC5116371
NIHMSID: NIHMS829629

Framing research for state policymakers who place a priority on cancer

Ross C. Brownson, PhD,[1][2] Elizabeth A. Dodson, PhD, MPH,[2] Jon F. Kerner, PhD,[3] and Sarah Moreland-Russell, PhD[2]

Abstract

Purpose

Despite the potential for reducing the cancer burden via state policy change, few data exist on how best to disseminate research information to influence state legislators' policy choices. We explored: 1) the relative importance of core framing issues (source, presentation, timeliness) among policymakers who prioritize cancer and those who do not prioritize cancer and 2) the predictors of use of research in policymaking.

Methods

Cross-sectional data were collected from US state policymakers (i.e., legislators elected to state Houses or Senates) from January through October 2012 (n=862). One-way analysis of variance was performed to investigate the association of the priority of cancer variable with outcome variables. Multivariate logistic regression models examined predictors of the influence of research information.

Results

Legislators who prioritized cancer tended to rate characteristics that make research information useful higher than those who did not prioritize cancer. Among differences that were statistically significant were three items in the “source” domain (relevance, delivered by someone respected, supports one's own position), one item in the “presentation” domain (telling a story related to constituents), and two items in the “timeliness” domain (high current state priority, feasible when information is received). Participants who prioritized cancer risk factors were 80% more likely to rate research information as one of their top reasons for choosing an issue on which to work.

Conclusions

Our results suggest the importance of narrative forms of communication and that research information needs to be relevant to the policymakers' constituents in a brief, concise format.

Keywords: cancer control, evidence, health policy, policy making, research

Introduction

Policy change is a powerful vehicle for reducing the burden of cancer [18], with a wide array of effective policy approaches available [913]. These strategies span the cancer control continuum [14] from primary prevention to improved quality of life and extended survival. In the United States, many of the opportunities for cancer control policy change exist at the state level. This state-level focus relates, in part, to the constitutional doctrine of reserved powers, where the 50 states retain enormous authority to protect the public's health [15].

The impact of policy related measures can be observed across numerous cancer-related risk factors [16]. There are many examples where progress in cancer control has been achieved due to state-level policy. State laws and regulations require the reporting of cancer cases, which are recorded in state cancer registries [1719]. For primary prevention of cancer, state-level policies (e.g., the California Tobacco Program which included a strong emphasis on smokefree environments) are effective and cost-effective [20]. In addition, state mandates requiring insurance coverage of colorectal cancer screening are associated with a higher rate of recent endoscopy [21].

Despite this potential for alleviating the cancer burden via state policies, few data exist on how best to disseminate research information to influence state legislators' policy choices (i.e., the “framing” of evidence-based policy) [2226]. State policy makers face a diverse set of issues and priorities [27]. And they can be on the receiving end of sometimes disconnected, random, and chaotic information [28,29]. While state policymakers generally report being receptive to shaping policy based on research evidence [30], it is likely that the ability to develop evidence-based cancer policy involves several characteristics including how the message being delivered is perceived (unbiased, credible), how to deliver the message (appropriately packaged, understandable), and timing (available when needed) [31,23,32,33].

To better understand these issues, the current study seeks to understand: 1) the relative importance of core framing issues (source, presentation, timeliness) among policymakers who prioritize cancer and those who do not prioritize cancer; and 2) predictors of use of research evidence in policymaking.

Methods

Design/setting

The study used cross-sectional survey methods and was conducted in the United States.

Sample and data collection

The study population included US state policymakers (i.e., legislators elected to state Houses or Senates). The team partnered with the National Conference of State Legislatures to identify a population of 7,525 state legislators from all 50 states and three US territories (Puerto Rico, Guam, and the US Virgin Islands). From the list of 7,525, a random sample of 1,880 legislators was selected. From this group, 862 individuals completed the full survey, 161 completed part of the survey, and 857 declined participation. This resulted in a 45.6% response rate (862/1880). Interviews were conducted by telephone from January through October 2012 (15–20 minutes in length). Each legislator was contacted up to 10 times. Interviews were confidential but not anonymous.

The Institutional Review Board at Washington University in St. Louis approved this study.

Measures

The core survey items were originally developed by Bogenschieder and Coorbett [31], with additional testing among state-level policymakers [34,35].

Covariates and stratifying variables

Sociodemographic and political variables

Data were collected on participants' gender, age, and educational attainment. Political variables included: legislative chamber (house or senate), political party membership, and whether participants self-identified as liberal, moderate, or conservative on social and fiscal issues [26,36].

Priority of cancer

Participants were asked two questions about their legislative priorities. An open-ended question asked “What issues are your legislative priorities?” A second question asked participants to choose their most important health issues from a list of 19 items (“mental health,” “prescription drug abuse,” “access to healthcare,” “aging,” “cancer,” “diabetes,” “diet/nutrition,” “heart disease,” “HIV/AIDS,” “infectious diseases,” “injury prevention,” “Medicare/Medicaid,” “obesity,” “physical activity,” “quality of healthcare,” “the environment,” “tobacco use/cessation,” “universal coverage,” “violence prevention”). If cancer or cancer risk factors (tobacco use, physical activity, diet/nutrition, obesity) was selected for either of these two questions, then a priority for cancer was recorded for that participant (column headings in Table 1). Based in part on a previous study of state legislators [36], the items on the priority of cancer were adapted by the authors for this study.

Table 1
Characteristics of participants in the study of research use and usefulness in state policymakers, United States, 2012

Dependent variables

Predictors of research usefulness

A 5-point scale was used to have participants prioritize 12 statements regarding what makes research information useful to them (with 1 meaning low priority and 5 meaning high priority). These statements addressed three domains (i.e., source, presentation, timeliness (row headings in Table 2)).

Table 2
Characteristics that make research information useful to state policymakers, United States, 2012

Influence of research information

From a list of 7 items (“legislation being proposed by your colleagues,” “personal interest,” “research information,” “constituents' needs and opinions,” “data on impact in my local area,” “interaction with lobbyists,” “economic issues”), participants selected their top 2 factors that influence the choice of issues on which they work. A dependent variable was developed for those who selected “research information” as one of the items.

Analyses

Descriptive statistics were computed for legislators' characteristics and patterns in dependent variables. One-way analysis of variance (ANOVA) was performed to investigate the association of the priority of cancer variable with outcome variables. Multivariate logistic regression models were used to estimate adjusted odds ratios (aORs) for variables that predict the influence of research information. Covariates were allowed to enter the multivariate model at p ≤ 0.10.

Results

Table 1 summarizes participant characteristics. While the majority of legislators (74%) were males, female participants were more likely to select cancer as a legislative priority (p=0.03). The characteristics that make research information useful to policymakers varied across the three groups of legislators (Table 2). Legislators who prioritized cancer or cancer risk factors rated characteristics that make research information useful higher than those who did not prioritize cancer or cancer risk factors. Statistically significant differences were noted for the following:

  • 3 of 4 items in the “source” domain (relevance, delivered by someone respected, supports one's own position);
  • 1 of 5 items in the “presentation” domain (telling a story related to constituents); and
  • 2 of 3 items in the “timeliness” domain (high current state priority, feasible when information is received).

After testing each covariate separately (all variables in Table 1), participants who prioritized cancer risk factors were more likely to rate the influence of research information as one of their top reasons for choosing an issue to work on (aOR=1.80; 95% confidence interval =1.17, 2.80) (final model was adjusted for chamber and political party).

Discussion

This study presents data comparing the characteristics affecting research use and usefulness among state-level policymakers for whom cancer or cancer risk factors is a policy priority. While previous data have shown the need for relevant and timely evidence for policy making [32,37], sparse data are available regarding what makes research information useful and how policymakers interested in cancer-related issues may differ from other legislators with respect to the extent they value research evidence. Based on our data, state policymakers who prioritize cancer control place a higher value on scientific evidence than legislators who prioritize other issues. These are hopeful findings for applied researchers and cancer control advocates who seek to increase the use and usefulness of research in the policy process [23].

Similar to findings from Oliver and colleagues [37], timely access to relevant research information appears to be a key facilitator for successfully translating scientific evidence into policy. As noted elsewhere [38], scientific studies are not always conducted at the right time to influence policy decisions. This need for timely research evidence was highlighted in the current study as one of the most important variables among 12 characteristics that predict usefulness of science in the policy process. Timeliness is likely to operate in two different ways—timely research information may pique the interest of a legislator or a legislator has already made a decision to act and may be quickly seeking evidence to support such action.

Related to the “presentation” domain among state legislators who prioritize cancer and cancer risk factors, our data suggest the importance of narrative forms of communication (e.g., telling a story of relevance to constituents) [3943]. Narrative is a basic mode of human interaction and a fundamental way of acquiring knowledge [39,40]. A narrative is “any representation of a sequence of connected events and characters that has an identifiable structure, is bounded in space and time, and contains implicit or explicit messages about the topic addressed” [44]. Narrative communication has long been recognized in political communication, where elected officials report that policy-oriented stories can trump statistical data in part because statistics can be seen as too complicated or boring [45,46,26].

Our data also reinforce that research information needs to be relevant to the policymakers' constituents in a brief, concise format [43]. This suggests the notion of “making data talk” [47] is well suited for cancer control policymaker audiences. This may involve knowing the characteristics of the target audience and expressing data in meaningful ways (so-called “social math”[48]) [49]. The use of infographics to present data in accessible and appealing formats can also be a useful tool for more effectively packaging policy-relevant information [50,35].

Tabak and colleagues published similar data on characteristics that make research information useful among 77 state-level advocates [51]. Data among advocates were largely congruent with the current findings. However, for a few items (e.g., the need to have research information delivered by a trusted individual) state policymakers rated the characteristic higher than advocates [51].

A few limitations should be noted. Given that the survey came from a university, there may have been social desirability bias (e.g., a general “up-rating” for items related to research evidence). In addition, the questionnaire response rate was lower than is typical of other population-based surveys [52], but higher than rates in numerous other policy-related studies, where response rates are as low as 10% [53,54,26]. Another potential limitation involves the lack of data on legislative staff members, who are often the gatekeepers and opinion shapers for many health-related issues [38].

The knowledge base for controlling cancer through policy approaches is now substantial [14]. To increase the use of research information in the cancer control policy process, our study provides promising leverage points.

Acknowledgments

The authors are grateful for the assistance from the National Conference of State Legislatures.

This research was funded in part by the National Cancer Institute at the National Institutes of Health (grant numbers 1R01CA124404-015, R25CA171994-02, and P30 CA09184); the National Institute of Diabetes and Digestive and Kidney Diseases (grant number 1P30DK092950); and Washington University Institute of Clinical and Translational Sciences (grant numbers UL1 TR000448 and KL2 TR000450) from the National Center for Advancing Translational Sciences.

REFERENCES

1. Colditz GA, Samplin-Salgado M, Ryan CT, Dart H, Fisher L, Tokuda A, Rockhill B. Harvard report on cancer prevention, volume 5: fulfilling the potential for cancer prevention: policy approaches. Cancer Causes Control. 2002;13(3):199–212. [PubMed]
2. Selig WK, Jenkins KL, Reynolds SL, Benson D, Daven M. Examining advocacy and comprehensive cancer control. Cancer Causes Control. 2005;16(Suppl 1):61–68. doi:10.1007/s10552-005-0485-1. [PubMed]
3. Steger C, Daniel K, Gurian GL, Petherick JT, Stockmyer C, David AM, Miller SE. Public policy action and CCC implementation: benefits and hurdles. Cancer Causes Control. 2010;21(12):2041–2048. doi:10.1007/s10552-010-9668-5. [PMC free article] [PubMed]
4. McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002;21(2):78–93. [PubMed]
5. Chriqui JF, O'Connor JC, Chaloupka FJ. What gets measured, gets changed: evaluating law and policy for maximum impact. J Law Med Ethics. 2011;39(Suppl 1):21–26. doi:10.1111/j.1748-720X.2011.00559.x. [PubMed]
6. Kerner JF, Guirguis-Blake J, Hennessy KD, Brounstein PJ, Vinson C, Schwartz RH, Myers BA, Briss P. Translating research into improved outcomes in comprehensive cancer control. Cancer Causes Control. 2005;16(Suppl 1):27–40. [PubMed]
7. Kerner J, Tajima K, Yip CH, Bhattacharyya O, Trapido E, Cazap E, Ullrich A, Fernandez M, Qiao YL, Kim P, Cho J, Sutcliffe C, Sutcliffe S. Knowledge exchange--translating research into practice and policy. Asian Pac J Cancer Prev. 2012;13(4 Suppl):37–48. [PubMed]
8. Nykiforuk CI, Wild TC, Raine KD. Cancer beliefs and prevention policies: comparing Canadian decision-maker and general population views. Cancer Causes Control. 2014;25(12):1683–1696. doi:10.1007/s10552-014-0474-3. [PubMed]
9. Colditz GA, Gortmaker SL. Cancer prevention strategies for the future: risk identification and preventive intervention. Milbank Q. 1995;73(4):621–651. [PubMed]
10. Grunfeld E, Zitzelsberger L, Evans WK, Cameron R, Hayter C, Berman N, Stern H. Better knowledge translation for effective cancer control: a priority for action. Cancer Causes Control. 2004;15(5):503–510. doi:10.1023/B:CACO.0000036448.40295.1d [doi] 5271932 [pii] [PubMed]
11. Brownson RC, Haire-Joshu D, Luke DA. Shaping the context of health: a review of environmental and policy approaches in the prevention of chronic diseases. Annu Rev Public Health. 2006;27:341–370. [PubMed]
12. Frieden TR, Myers JE, Krauskopf MS, Farley TA. A public health approach to winning the war against cancer. Oncologist. 2008;13(12):1306–1313. doi:theoncologist.2008-0157 [pii] 10.1634/theoncologist.2008-0157. [PubMed]
13. Task Force on Community Preventive Services [Accessed November 15, 2015];Guide to Community Preventive Services. Centers for Disease Control and Prevention. 2015 www.thecommunityguide.org.
14. National Cancer Institute [Accessed November 15, 2015];Cancer Control Continuum. National Cancer Institute, US National Institutes of Health. 2015 http://cancercontrol.cancer.gov/od/continuum.html.
15. McGowan A, Brownson R, Wilcox L, Mensah G. Prevention and control of chronic diseases. In: Goodman R, Rothstein M, Hoffman R, Lopez W, Matthews G, editors. Law in Public Health Practice. 2nd edn. Oxford University Press; New York: 2006.
16. Eyler A, Chriqui J, Moreland-Russell S, Brownson R, editors. Prevention, Policy, and Public Health. Oxford University Press; New York, NY: 2016.
17. CDC State cancer registries: status of authorizing legislation and enabling regulations--United States, October 1993. MMWR Morb Mortal Wkly Rep. 1994;43(4):71, 74–75. [PubMed]
18. Izquierdo JN, Schoenbach VJ. The potential and limitations of data from population-based state cancer registries. Am J Public Health. 2000;90(5):695–698. [PubMed]
19. Black BL, Cowens-Alvarado R, Gershman S, Weir HK. Using data to motivate action: the need for high quality, an effective presentation, and an action context for decision-making. Cancer Causes Control. 2005;16(Suppl 1):15–25. [PubMed]
20. Lightwood J, Glantz SA. The effect of the California tobacco control program on smoking prevalence, cigarette consumption, and healthcare costs: 1989-2008. PLoS One. 2013;8(2):e47145. doi:10.1371/journal.pone.0047145 PONE-D-12-17427 [pii] [PMC free article] [PubMed]
21. Cokkinides V, Bandi P, Shah M, Virgo K, Ward E. The association between state mandates of colorectal cancer screening coverage and colorectal cancer screening utilization among US adults aged 50 to 64 years with health insurance. BMC Health Serv Res. 2011;11:19. doi:1472-6963-11-19 [pii] 10.1186/1472-6963-11-19. [PMC free article] [PubMed]
22. Akl EA, Oxman AD, Herrin J, Vist GE, Terrenato I, Sperati F, Costiniuk C, Blank D, Schunemann H. Framing of health information messages. Cochrane Database Syst Rev. 2011;(12):CD006777. doi:10.1002/14651858.CD006777.pub2. [PubMed]
23. Brownson RC, Chriqui JF, Stamatakis KA. Understanding evidence-based public health policy. Am J Public Health. 2009;99(9):1576–1583. doi:AJPH.2008.156224 [pii] 10.2105/AJPH.2008.156224. [PubMed]
24. Jones E, Kreuter M, Pritchett S, Matulionis RM, Hann N. State health policy makers: what's the message and who's listening? Health Promot Pract. 2006;7(3):280–286. doi:7/3/280 [pii] 10.1177/1524839906289583. [PubMed]
25. Rothman AJ, Salovey P. Shaping perceptions to motivate healthy behavior: the role of message framing. Psychol Bull. 1997;121(1):3–19. [PubMed]
26. Brownson RC, Dodson EA, Stamatakis KA, Casey CM, Elliott MB, Luke DA, Wintrode CG, Kreuter MW. Communicating evidence-based information on cancer prevention to state-level policy makers. J Natl Cancer Inst. 2011;103(4):306–316. doi:djq529 [pii] 10.1093/jnci/djq529. [PMC free article] [PubMed]
27. Fox D. The Convergence of Science and Governance: Research, Health Policy, and American States. University of California Press; Berkeley, CA: 2010.
28. Kingdon JW. Agendas, alternatives, and public policies. Updated 2nd edn. Longman; Boston: 2010.
29. McDonough J. A Legislator's Stories of Government and Health Care. University of California Press; Berkeley, CA: 2000. Experiencing Politics.
30. Dodson EA, Stamatakis KA, Chalifour S, Haire-Joshu D, McBride T, Brownson RC. State legislators' work on public health-related issues: what influences priorities? J Public Health Manag Pract. 2012;19(1):25–29. doi:10.1097/PHH.0b013e318246475c 00124784-201301000-00005 [pii] [PMC free article] [PubMed]
31. Bogenschneider K, Coorbett T. Evidence-Based Policymaking: Insights from Policy-Minded Researchers and Research-Minded Policy Makers. Routledge; New York: 2010.
32. Lavis JN, Robertson D, Woodside JM, McLeod CB, Abelson J. How can research organizations more effectively transfer research knowledge to decision makers? Milbank Q. 2003;81(2):221–248. 171–222. [PubMed]
33. Choi BC, Li L, Lu Y, Zhang LR, Zhu Y, Pak AW, Chen Y, Little J. Bridging the gap between science and policy: an international survey of scientists and policy makers in China and Canada. Implement Sci. 2016;11(1):16. doi:10.1186/s13012-016-0377-7 10.1186/s13012-016-0377-7 [pii] [PMC free article] [PubMed]
34. Bogenschneider K, Little O, Johnson K. Policymakers' use of social science research: Looking within and across policy actors. Journal of Marriage and Family. 2013;75(2):263–275.
35. Moreland-Russell S, Barbero C, Andersen S, Geary N, Dodson EA, Brownson RC. “Hearing from all sides” How legislative testimony influences state level policy-makers in the United States. Int J Health Policy Manag. 2015;4(2):91–98. doi:10.15171/ijhpm.2015.13. [PMC free article] [PubMed]
36. Davis JR, Kern TG, Perry MC, Brownson RC, Harmon RG. Survey of cancer control attitudes among Missouri state legislators. Mo Med. 1989;86(2):95–98. [PubMed]
37. Oliver K, Innvar S, Lorenc T, Woodman J, Thomas J. A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res. 2014;14:2. doi:1472-6963-14-2 [pii] 10.1186/1472-6963-14-2. [PMC free article] [PubMed]
38. Brownson RC, Royer C, Ewing R, McBride TD. Researchers and policymakers: travelers in parallel universes. Am J Prev Med. 2006;30(2):164–172. [PubMed]
39. Green M. Narratives and cancer communication. Journal of Communication. 2006;56:S163–S183.
40. Hinyard LJ, Kreuter MW. Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. Health Educ Behav. 2007;34(5):777–792. doi:1090198106291963 [pii] 10.1177/1090198106291963. [PubMed]
41. Stamatakis K, McBride T, Brownson R. Communicating prevention messages to policy makers: The role of stories in promoting physical activity. J Phys Act Health. 2010;7(Suppl 1):S00–S107. [PMC free article] [PubMed]
42. Dahlstrom MF. Using narratives and storytelling to communicate science with nonexpert audiences. Proc Natl Acad Sci U S A. 2014;111(Suppl 4):13614–13620. doi:1320645111 [pii] 10.1073/pnas.1320645111. [PubMed]
43. Dodson EA, Geary NA, Brownson RC. State legislators' sources and use of information: bridging the gap between research and policy. Health Educ Res. 2015 doi:cyv044 [pii] 10.1093/her/cyv044. [PMC free article] [PubMed]
44. Kreuter MW, Green MC, Cappella JN, Slater MD, Wise ME, Storey D, Clark EM, O'Keefe DJ, Erwin DO, Holmes K, Hinyard LJ, Houston T, Woolley S. Narrative communication in cancer prevention and control: a framework to guide research and application. Ann Behav Med. 2007;33(3):221–235. [PubMed]
45. McDonough JE. Using and misusing anecdote in policy making. Health Aff (Millwood) 2001;20(1):207–212. [PubMed]
46. Jewell CJ, Bero LA. “Developing good taste in evidence”: facilitators of and hindrances to evidence-informed health policymaking in state government. Milbank Q. 2008;86(2):177–208. [PubMed]
47. Nelson D, Hesse B, Croyle R. Communicating Public Health Data to the Public, Policy Makers, and the Press. Oxford University Press; New York, NY: 2009. Making Data Talk.
48. Wallack L, Woodruff K, Dorfman L, Diaz I. News for a Change An Advocate's Guide to Working with the Media. Vol. 23. Sage Publications, Inc; Thousand Oaks, CA: 1999. vol 3.
49. Slater MD, Kelly KJ, Thackeray R. Segmentation on a shoestring: health audience segmentation in limited-budget and local social marketing interventions. Health Promot Pract. 2006;7(2):170–173. [PubMed]
50. Otten JJ, Cheng K, Drewnowski A. Infographics And Public Policy: Using Data Visualization To Convey Complex Information. Health Aff (Millwood) 2015;34(11):1901–1907. doi:34/11/1901 [pii] 10.1377/hlthaff.2015.0642. [PubMed]
51. Tabak RG, Eyler AA, Dodson EA, Brownson RC. Accessing evidence to inform public health policy: a study to enhance advocacy. Public Health. 2015;129(6):698–704. doi:S0033-3506(15)00065-7 [pii] 10.1016/j.puhe.2015.02.016. [PMC free article] [PubMed]
52. Mokdad AH. The Behavioral Risk Factors Surveillance System: past, present, and future. Annu Rev Public Health. 2009;30:43–54. [PubMed]
53. Jervis KJ. A review of state legislation and a state legislator survey related to not-for-profit hospital tax exemption and health care for the indigent. J Health Care Finance. 2005;32(2):36–71. [PubMed]
54. Sorian R, Baugh T. Power of information: closing the gap between research and policy. When it comes to conveying complex information to busy policy-makers, a picture is truly worth a thousand words. Health Aff (Millwood) 2002;21(2):264–273. [PubMed]