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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
► Identify
fundamental campaign components
► Discuss social marketing practices
► Present options for risk representations
► Provide a dissemination plan for risk
messages
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
9
►9
►9
►8
►3
►
(0-10 scale)
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
►Professional
►Unique
G typical girl… mom
performer
character
G
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
► Billboards/Posters
► Pamphlets/Booklets
► Direct
G
G
mail/email materials
BC stories seen per year
►9
TV public service spots
►8
Magazine stories
►8
TV newscast stories
►7
Newspaper news/feature items
►4
TV content in talk shows/dramas
►
20% have searched internet for BC
Channels: Interpersonal
►Informal
►Internet
family… friends
chat room
►Professional
doctor… teacher
TWO-STEP FLOW
Direct vs. Indirect Impact
Message  Target audience
Message  Influentials  Target audience
Message  Policymakers  Target audience
Campaign message environment
MEDIA STORIES ABOUT…
►Breast
Cancer
►Environmental risks
►Nutrition
►Exercise
NEWS COVERAGE in National Media
Environmental risk factors:
►
►
►
►
►
►
►
►
12% Use of Hormones/Estrogen/Progesterone/HRT
6% Use of other pharmaceuticals
3% Obesity
2%
2%
1%
1%
1%
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
► Likely
to limit perceptions of susceptibility to the
neglected risks (although emphasis on prevalence
should contribute to vulnerability)
► Almost
no information to educate parents about
how to protect daughter or how to take collective
action
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?
► Does
belief of lower fatality risk lead women to
have a lower level of concern and consequently
less focus on prevention behavior?
► Are
mothers be less likely to take action to protect
their young daughters?
Social Marketing
► Adapting
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”
Social Marketing and Breast Cancer
► Product
 Prevention; engage in healthy behaviors as a protective
function
► Price
 Uncertainty and fear; time and resources to engage in
healthy behaviors
► Place
 Interpersonal channels, media vehicles,
► Promotion
 Integrate media campaigns, school-based programs,
physician and family interactions, media advocacy
efforts
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
to technical
estimates of annual
fatalities
► Logarithmic in character
► Concerned with
probability
► Unrelated to many
dimensions of risk
The Public
► 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
► Different
properties associated with risk impact lay
public perceptions.
► Increased Perceived Risk
 Infrequent
 Catastrophic
 Involuntary
► Decreased
 Frequent
 Familiar
 Voluntary
Perceived Risk
Seven Cardinal Rules of Risk
Communication (Covello & Allen, 1988)
► Accept
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.
How do we communicate risks?
RISK FACTORS
Breast Cancer
Objective of Risk Message
►Screening
detection
►Prevention behaviors
► Individual
vs. Collective action
► Protecting Self vs. Other
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
► Odds
(1 in 9) vs. Percent (11%)
► Authority
► Self
statement vs. evidence
vs. loved one
Other strategy considerations
► Provide
intuitive explanation / rationale to
convince audience of risk claim?
► How
to overcome time lag between
behavior and disease?
► What
risk?
if actual risk is less than expected
NCI Risk Assessment Tool
► Current
age
► Age first menstrual period
► Age first full pregnancy
► First-degree BC relatives
► Benign biopsies
► LCIS
► Race / ethnicity
CALCULATES 5-YEAR AND LIFETIME ODDS (%)
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
►4
(0-10 scale)
Smoking cigarettes
Genetics / Family history
HRT
Secondhand smoke
High-fat foods in childhood
Obesity in childhood
Chemicals / Pesticides