Development of Breast Cancer Campaign

Explain the rationale for the poster and evaluate approaches to communicating a health message.

• Kartsonaki Christini-Olga

Communication in the Helath Care Context

INTRODUCTION

The main goal of many campaigns is to give priority on increasing early detection and probable prevention of a disease (Jacobsen & Jacobsen, 2011). Patient postponement of asking for medical help after discovering symptoms is an important factor that leads to late stage diagnosis. Low cancer awareness (including knowledge about cancer symptoms, fear of cancer development, risk factors, treatment effectiveness or early detection results) is cultivating risk for patient delay (MacDonald et al, 2004). Campaigns that focus on public cancer awareness had been associated with progress in raising awareness and establishing early diagnosis of cancer, but the long-term benefits were dubious. Absence of evidence regarding the effectiveness of interventions in an effort to promote cancer awareness is hindering development of policy and local action (Austoker et al., 2009). Knowledge of screening, screening uptake and self-checking behavior – for example breast checking (including breast self -examination) or testicular checking – may be considered to be important elements of cancer awareness.

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Breast cancer is the most frequently occurring type of cancer that imperils women in the Western world. It is estimated that today one out of nine women are affected by the disease. When it comes to age, the disease affects all age groups from 20 to 90 years. Chances a woman gets infected significantly increase with age, while the risk of developing the disease quadruples after menopause. Unfortunately, 25% of cases involve young women younger than 45 years (www.bcactionfund.org).

One conjecture of the research findings in this paper is that well-established health campaigns may lead to positive results if they point to outcomes other than increased diagnoses. For example, intensifying fundraising options or enabling support groups for patients. Promoting early detection of chronic diseases that results in more effective, is associated with higher survival rates (Eyre, 2004) and inexpensive treatment at an early stage (Cohen, 2008), should be a significant public health field.

CAMPAIGNS FOR BREAST CANCER

Although efforts to increase awareness of breast cancer can be started about 1913, no ongoing organized efforts to increase breast cancer awareness existed until the mid-1970s, when a number of small advocacy groups began to publish information about treatment options and services (Lerner, 2002). The National Breast Cancer Awareness Month (NBCAM), as event were established in October 1985 and is a high –profile nationwide campaign (Catalano, 2003). Its’s primary goal is to encourage regular breast examination so that disease can be diagnosed at an early stage. Moreover breast cancer funding continues to be a priority area for the federal government (Jacobsen & Jacobsen, 2011). An increasing number of voluntary organizations, governmental agencies, and private corporations have sponsored various events like “wear pink” bracelet that show encouragement and support for those affected by breast cancer. Media coverage of breast cancer has increased markedly in recent years, and October months have received substantially more coverage than other months. Free or reduced cost mammograms have been offered to low-income and uninsured women (MMWR, 2005).

Other campaigns include interventions as public education programmes to increase cancer awareness (Blumenthal et al, 2005; Skinner, Arfken & Waterman, 2000). Educational programmes delivered in small groups increase breast cancer knowledge and screening uptake and promoting message dissemination to others in the social network . Multimedia programmes have been created to promote cancer knowledge and self-checking using posters, leaflets and shower gel in workplaces, health clubs and leisure centers (McCullagh, Lewis, Warlow 2005).

Although mass media health communication strategies can effectively promote health education, and influence health awareness, decisions and practices (Haider & Kreps, 2004), interpersonal communication channels are regarded as highly influential to persuade people to change health related behaviors (Yanovitzky & Blitz, 2000).All the above trials were heterogeneous in terms of nature of intervention, populations and outcomes measured and therefore there are limited evidence of effectiveness of interventions to promote cancer awareness. There are good evidence that Breast Cancer Awareness Month in the United States promotes diagnosis of breast cancer at an early stage (Catalano et al, 2003; Gabram et al, 2008).

POSTER- METHODS

The poster communication channel consists of the main message that is summed up in the phrase “why should your life be hanging by a thread”, which is being projected and filtered through a mixed cognitive and affective message strategy.

A cognitive message strategy is using reason to present arguments or facts to an audience that require cognitive processing. The main purpose of a cognitive message strategy is to create an advertisement that will have an impact on people’s beliefs or knowledge and suggest potential benefits. In the specific case of the breast cancer poster, the product is the examination and the benefit is prevention and reduction of the risk of cancer manifestation. The intention of this strategy is to present the audience with rational pieces of information about a product or service and then to motivate them to develop a positive feeling about that product (Clow & Baack, 2007, p.201). In the poster the cognitive message strategy can be located within the risk information that is being presented with a ratio in relation to the number of women who develop cancer during their lifetime in Greece.

We found some evidence that tailored print information was more effective than general information; tailored information increased average cancer knowledge scores by about 11% compared with no information and 4% compared with general information (De Nooijer, Lechner, Candel & de Vries, 2004). Tailored print information modified attitudes towards paying attention to and seeking help for symptoms only very modestly compared with no information (de Nooijer et al, 2004).

The second part of the poster method is the affective message strategy. This kind of approach attempts to evoke feelings or emotions and identify them with the product. Affective strategies are causing emotions that lead the audience to act favorably towards the presented good or service and subsequently affect their reasoning process (Clow & Baack, 2007 p.203). The breast cancer poster is making an attempt to elicit powerful emotions and generate positive attitudes and decisions. People subjected to the message become more prone to choose examination and reduce that way the risk of being affected by cancer. The word “life” in the message is very powerful and demonstrates the positive side of affective message strategy.

Emotional advertising is used here in combination with framing of risk strategy (negative frame). Switching from positive to negative feelings leads to the establishment of a more substantial emotional framework in which the audience feels compelled to make a decision. The emotion that is usually associated with risk is anxiety (Joffe, 2003). Anxiety, worry and fear are generally perceived as the intermediate goal of many risk communication efforts and in particular, public health communications (Lynch & de Chernatony, 2004). Although the primary target is preventative behaviour, the feelings of anxiety, worry and fear are considered to be an essential part of the motivation initiation process. In the poster this is being presented with help of the visuals. A woman that has lost her breast makes people think about what they have to lose and re-evaluate their health priorities. The poster uses moderate fear to induce a certain amount of stress to the audience, because an existing anxiety level can influence the effect of the message. High fear has been proven to be the least effective leading to blocking of information and inhibition of action. Moderate fear is the most effective (Mc Guire, 1968).

In order to develop an effective communication framework, the poster features an unknown woman. A celebrity may be likeable or attractive, but he or she may not be viewed as trustworthy. Trustworthiness is the degree of confidence or the level of acceptance the audience places in the spokesperson’s message. A trustworthy spokesperson helps people believe the message. Likeability and trustworthiness are highly related and in that sense, anonymity eliminates the risk of failing to deliver the message due to a bad selection of a celebrity. At this point, use of the principle of similarity is being made. An ordinary every-day woman is someone people can relate to. The audience is more inclined to be influenced by a message delivered by a person who is somehow familiar. To take this even further, the appearance of an average person, helps overcoming the obstacle of optimistic bias. The optimism bias (also known as unrealistic or comparative optimism) is a cognitive bias that causes a person to believe that they are less at risk of experiencing a negative event compared to others. Taylor and Brown (Joffe, 2003) assert that 95% of the population exhibit unrealistic optimism in relation to a range of risks (Weinstein & Klein 1996).

A certain amount of flexibility in accommodating the needs of participating community is important for ensuring intervention integrity and can ultimately influence the effectiveness of the intervention. It is important to design and implement an advertising process that will help both researchers and communities understand each other’s perspectives, minimize the barriers of access to the specific service (examination) and ensure that the goals and priorities of both parties are met. In the poster this criteria is met in the informational piece about free examinations in Aretaiio Hospital (Westmaas, Gil-Rivas & Silver, 2006).

The poster is based on the Health Belief Model (HBM), which was developed in the 1950’s to predict individual response to, and utilization of, screening and other preventive health services. Accordingly, the response and utilization of disease prevention programs will be predicated on an individual’s perceived seriousness of the disease, severity of the disease, perceived benefit of services and barriers to accessing such service (Airhihenbuwa & Obregon, 2000). In general the HBM is a rational-cognitive model and assumes a rational decision-maker. Most adolescents, and many adults, do not seem to approach the breast-cancer issue from such a logical perspective, but seem quite capable of discounting risks and optimistically perceiving themselves as invulnerable to harm. (Freimuth, 1992, p.101).The HBM which has been widely used to frame research studies related to the prediction of health-related behaviours in relation to health belief patterns, was selected as the frame of reference for the current study of Greek women’s breast cancer screening behaviours (Becker, 1974). Women’s self-reported breast cancer knowledge, attitudes, behaviors, and perceptions of support, and the components of the HBM (perceived susceptibility, perceived benefits, cues to action, self-efficacy) were explored in this campaign (Sadler et al., 2007).

The poster will be located on apartment billboards, n clinic waiting rooms, on pharmacy walls to maintain visual consistency (Clow & Baack, 2007). Repeatedly seeing a specific image or visual display helps embed it in long-term memory. The final principle is to create an effective flow

Except for the above poster, leaflets will be distributed at street events and the direct communication will be used due direct mailing to promote breast cancer screening, street promotion, outbound calls to women who signed application forms at the street promotions, small group educational sessions (Park et al., 2011).Therefore the interpersonal communication will be boosted with street promotions, direct mail-outs, and promotion of specialists’recommendations (Slater et al., 2005). Direct mail interventions may represent a more promising population-based strategy for promoting cancer screening including mammography. It is also a relatively efficient and inexpensive way to reach individuals in their homes, including people not typically exposed to mass media (Park et al., 2011).

CONCLUSION

More research is needed to evaluate the extent to which campaigns lead to cumulative increases in public awareness and year-round behavioral changes, to identify which types of awareness campaigns are most successful in achieving various well-defined outcomes, and to examine which segments of the population are most responsive to different types of awareness campaigns.

REFERENCES

Austoker, J., Bankhead, C., Forbes, LJL., Atkins, L., Martin, F., Robb, K., Wardle, J., Ramirez, AJ. (2009). Interventions to promote cancer awareness and early presentation: systematic review. British Journal of Cancer, 101, S31–S39

Becker, G. S. (1974). A Theory of Social Interactions. Journal of Political Economy, 82 (6), 1063-1093.

Blumenthal, D.S., Fort, J.G., Ahmed, N.U., Semenya, K.A., Schreiber, G.B., Perry, S., Guillory, J. (2005). Impact of a two-city community cancer prevention intervention on African Americans. J Natl Med Assoc, 97, 1479–1488.

Catalano, R., Winett, L., Wallack, L., Satariano, W. (2003). Evaluating a campaign to detect early stage breast tumors in the United States. European Journal of Epidemiology, 18, 545-550.

Clow, KC. & Baack, D. (2007). Executional Framework. Integrated Advertising, Promotion, and Marketing Communications. Third Edition. Pearson Education. 196-221

Cohen, J.T., Neumann, P.J., Weinstein, M.C. (2008). Does preventive care save money? Health economics and the presidential candidates. New England Journal of Medicine, 358, 661-663.

De Nooijer, J., Lechner, L., Candel, M., de Vries, H. (2004). Short- and long-term effects of tailored information versus general information on determinants and intentions related to early detection of cancer. Prev, Med 38, 694–703

Eyre, H., Kahn, R., Robertson, RM., ACS/ADA/AHA Collaborative Working Committee. (2004). Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Stroke, 35 1999-2010.

Freimuth, V.S. (1992). Theoretical Foundations of AIDS Media Campaigns. In: Edgar, T., Fitzpatrick, M.A. and Freimuth, V.S., Eds., AIDS: A Communication Perspective, Lawrence Erlbaum Associates, Hillsdale, 91-110

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Park, K., Hyun Hong, W., Yeon Kye, S., Jung, J., Kim, G., Park, HG. (2011) Community-based intervention to promote breast cancer awareness and screening: The Korean experience. BMC, 11, 468

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Yanovitzky, I. & Blitz, C.L. (2000). Effect of media coverage and physician advice on utilization of breast cancer screening by women 40 years and older. Journal of health communication, 5 117-134

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Westmaas, JL., Gil-Rivas, V., Cohen Silver, R. (2006) Designing and Implementing Interventions to Promote Health and Prevent Illness. Foundations of Health Psychology.

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