The DRIVE Framework for Theory-Integrated Health Communication Development: An Application to Rural Colorectal Cancer Screening

Health communication campaigns increase awareness but do not consistently produce behavior change, in part because theory is not systematically integrated across communication development. This article introduces the DRIVE Framework (Discover, Refine, Investigate, Validate, Execute), a staged approach designed to intentionally link formative research, message development, testing, and real-world implementation through structured theory integration. Colorectal cancer screening (CRCS) messaging for newly eligible rural adults aged 45 to 49 in West Virginia served as an application example using data collected from 2024 to 2026. During Discover (N = 345), a cross-sectional survey guided by the Health Belief Model identified low perceived threat, lower self-efficacy, and elevated barriers. These findings informed theory-aligned message development in Refine using the Extended Parallel Process Model to increase urgency while reinforcing efficacy. In Investigate (N = 104), theory-informed messages significantly increased CRCS intention and motivation (p < .001) compared with predominant messaging in an experimental survey. In Validate (N = 600), patients from a partner health system were randomized to receive either a theory-informed postcard or a postcard reflecting the predominant communication approach. Theory-informed postcards significantly increased CRCS referral rates (p < .001). Completion rates were also higher (p = .050). Finally, Execute integrated validated strategies into an existing statewide initiative. Across stages, the theory functioned diagnostically, generatively, evaluatively, and operationally, demonstrating how staged integration can enhance transparency, strengthen message effectiveness, and support real-world implementation. For practice and policy, DRIVE offers a structured pathway to strengthen communication effectiveness and improve return on investment across population-based health promotion programs.