Communication Campaigns: Social Marketing Practices and Dissemination of Breast Cancer Risk Information to the Lay Public
Chuck Atkin, Ph.D. Kami Silk, Ph.D. Department of Communication Michigan State University
Overview
fundamental campaign components ► Discuss social marketing practices ► Present options for risk representations ► Provide a dissemination plan for risk messages
► Identify
Communication Campaign Strategies
Basic model of communication:
SOURCE MESSAGE CHANNEL RECEIVER
Overview of components
►SOURCE: SPONSOR & MESSENGER ►MESSAGE: PERSUASIVE APPEALS &
.
INFORMATION CONTENT
►CHANNEL: MEDIA & INTERPERSONAL
►AUDIENCE:
Social Marketing concepts
Health Message Sources
SPONSOR
Creates and disseminates messages
MESSENGER
Models who are featured in messages
SPONSORING ORGANIZATION
► Government
agencies
► Associations
and foundations ► Medical and educational institutions ► Corporations
High vs. low visibility High vs. low credibility
Credibility of BC Sources
►10
(0-10 scale)
9 ►9 ►9 ►8 ►3
►
American Cancer Society Federal agencies Medical centers Komen Foundation Universities Pharmaceutical firms
Messenger = Personalization
► ► ►
Credibility: Expertise, Trust Relevance: Identification Attractiveness: Attention-getting
Health Messengers
►Expert
specialist
doctor… researcher
►Specially experienced person G victim… survivor… successful role model ►Public official gov leader… agency director
Source Messenger
►Celebrity G athlete… entertainer ►Average
person
G typical girl… mom
►Professional ►Unique
performer
G
character
Channels: Comprehensive Array
► ► ► ►
Television: News, PSA spots, Talk G Radio: PSAs, News coverage, Call-in Newspaper: News, Editorial comment Magazine: Feature stories, News
Channels
► Internet
Web pages G G G
► Billboards/Posters ► Pamphlets/Booklets ► Direct
mail/email materials
BC stories seen per year
►9
TV public service spots
►8
►8
Magazine stories
TV newscast stories
►7
►4
Newspaper news/feature items
TV content in talk shows/dramas
►
20% have searched internet for BC
Channels: Interpersonal
►Informal ►Internet
family… friends
chat room
doctor… teacher
TWO-STEP FLOW
►Professional
Direct vs. Indirect Impact
Message Target audience
Message Influentials Target audience Message Policymakers Target audience
Campaign message environment
MEDIA STORIES ABOUT…
Cancer ►Environmental risks ►Nutrition ►Exercise
►Breast
NEWS COVERAGE in National Media
Environmental risk factors:
12% ► 6% ► 3% ► 2% ► 2% ► 1% ► 1% ► 1%
►
Use of Hormones/Estrogen/Progesterone/HRT Use of other pharmaceuticals Obesity Exposure to chemical contaminants Eating certain unhealthy foods Exposure to pesticides Lack of exercise Exposure to second-hand smoke
Note: Heredity = 16%
KEY NEWS CATEGORIES
38% TREATMENT (surgical, chemo, radiation)
35% PREVENTION (mostly aspirin… 10% obesity, exercise, food)
30% PREVALENCE of BC (number, odds, trends) 23% DETECTION SCREENING (self, mammo) 2% PARENT ACTIONS to PROTECT DAUGHTERS
Environmental Factors Limited
► Lifestyle
practices & environmental contaminants infrequent; HRT dominates coverage at expense of other risk factors to limit perceptions of susceptibility to the neglected risks (although emphasis on prevalence should contribute to vulnerability) no information to educate parents about how to protect daughter or how to take collective action
► Likely
► Almost
Persuasive Appeals
►
Physical health incentives
-- general disease vs. breast cancer
►
Psychological (e.g., security)
►
Social (e.g., normative)
Persuasive appeals
Positive promise vs. Negative threat Expectancy vs. Value
Susceptibility vs. Severity Positive: Promise vs. Payoff
Negative:
Self Efficacy vs. Response Efficacy
Implications of Treatment Emphasis
► Based
on positive treatment news, 90% of women perceive that survival rate is high or rising… do they infer less severity? belief of lower fatality risk lead women to have a lower level of concern and consequently less focus on prevention behavior? mothers be less likely to take action to protect their young daughters?
► Does
► Are
Social Marketing
commercial marketing strategies to plan, develop, implement, & evaluate pro-social programs/campaigns. ► Emphasis is on selling an idea rather than a product ► Uses a traditional marketing mix that incorporates the “Four Ps”
► Adapting
Social Marketing and Breast Cancer
► Product ► Price
Prevention; engage in healthy behaviors as a protective function Uncertainty and fear; time and resources to engage in healthy behaviors Interpersonal channels, media vehicles, Integrate media campaigns, school-based programs, physician and family interactions, media advocacy efforts
► Place
► Promotion
Social Marketing and Breast Cancer
► Publics
Adolescent girls, mothers, policymakers, health educators
► Partnership
Schools, community-based organizations
► Policy
Need an environment that supports prevention; e.g., school lunch and physical education programs
► Purse
Strings
Where will $$$ come from for prevention and promotion?
Risk Communication
Risk Communication
The National Research Council (1989) defined risk communication as: ► “...an integrative process of exchange of information and opinions among individuals, groups, and institutions; often involves multiple messages about the nature of the risk or expressing concerns, opinions, or reactions to risk messages or to the legal and institutional arrangements for risk management.”
Risk Communication
Experts
► Similar
The Public
► Risk
to technical estimates of annual fatalities ► Logarithmic in character ► Concerned with probability ► Unrelated to many dimensions of risk
Perceptions strongly affected by several ideas Threat to future
generations How Catastrophic Controllability If Voluntary or Not Obtained Benefits
► More qualitative in nature
Risk Communication
“Risk perceptions” include [Weinstein]:
Beliefs about the nature of the potential consequences Beliefs about the probability of these consequences Beliefs about personal risk and the factors that modify one’s risks
Risk Communication
properties associated with risk impact lay public perceptions. ► Increased Perceived Risk
Infrequent Catastrophic Involuntary
► Decreased ► Different
Perceived Risk
Frequent Familiar Voluntary
Seven Cardinal Rules of Risk Communication (Covello & Allen, 1988) and involve the public as a partner. ► Plan carefully and evaluate your efforts. ► Listen to the public's specific concerns. ► Be honest, frank, and open. ► Work with other credible sources. ► Meet the needs of the media. ► Communicate clearly and with compassion.
► Accept
How do we communicate risks?
RISK FACTORS
Breast Cancer
Objective of Risk Message
detection ►Prevention behaviors
vs. Collective action ► Protecting Self vs. Other
► Individual
►Screening
Conveying BC Risk Factors
PRESENT RISK FACTOR IN ISOLATION: -- SIMPLY IDENTIFY FACTOR -- SPECIFY DEGREE (Verbal) -- SPECIFY DEGREE (Numerical) -- SPECIFY and EXPLAIN (Rationale)
Multiple Risk Factors
PRESENT RISK CLAIMS IN CONTEXT:
-- RANK ORDERING -- NUMBER OF OTHER RISK FACTORS -- COMPARISON WITH FAMILIAR RISK
Options for Representing Risk
► Risk
time frame: 5 Years vs. Lifetime (1 in 9) vs. Percent (11%) statement vs. evidence
► Odds
► Authority ► Self
vs. loved one
Other strategy considerations
► Provide
intuitive explanation / rationale to convince audience of risk claim? to overcome time lag between behavior and disease? if actual risk is less than expected
► How
► What
risk?
NCI Risk Assessment Tool
age ► Age first menstrual period ► Age first full pregnancy ► First-degree BC relatives ► Benign biopsies ► LCIS ► Race / ethnicity
CALCULATES 5-YEAR AND LIFETIME ODDS (%)
► Current
NCI Comprehensive List
1.
2.
3. 4.
5.
6. 7.
8.
Age Personal history of BC Family history LCIS Gene changes (BRCA1 BRCA2) Age of menarche Age of first child birth HRT (E+P)
NCI List (continued)
9. White race 10. Radiation therapy 11. Breast density 12. Took DES 13. Overweight (post-menopause) 14. Lack of physical activity 15. Drinking alcohol
Note at end of NCI list:
“Other possible risk factors are under study…” ► “effect of diet” ► “physical activity” ► “whether certain substances in the environment can increase the risk of breast cancer”
NCI caveats re risk factors
► Most
women who have known risk factors do not get breast cancer
REASSURANCE? COMPLACENCY?
► Most
women with breast cancer do not have a family history of the disease… they have no clear risk factors except for growing
older
UNCERTAINTY? VIGILANCE? FEAR? FATALISM?
BC Risk Factors
►9 ►9 ►7 ►7 ►6 ►6
(0-10 scale)
►4
Smoking cigarettes Genetics / Family history HRT Secondhand smoke High-fat foods in childhood Obesity in childhood Chemicals / Pesticides