Vasudevan Sa, Shaffi FMb
a. Department of Urology, Medical College, Kottayam; Kerala Medical Journal
b. Global Institute of Public Health, Ananthapuri Hospitals, Trivandrum; IMA State Research Cell

Corresponding Author: Dr Vasudevan S, Additional Professor Urology, Medical College, Kottayam; Associate Editor, Kerala Medical Journal Email: periamana@gmail.com

Introduction

There is renewed interest in achieving health policy goals through behavioural changes. Interventions to change health-related behaviour may range from a simple face to face consultation between professional and patient to a complex programme which may involve the use of mass media.1 These interventions seek to change “risky” behaviours by

  1. Increasing knowledge and awareness of risks through information and awareness raising or knowledge and awareness of services to help prevent risks
  2. Changing attitudes and motivations eg through messages to young people about the harmful effects of smoking
  3. Changing beliefs and perceptions eg encouraging testicular self examination
  4. Influencing social norms eg by changing public perception of secondary smoking or public acceptance of breast feeding
  5. Changing structural factors and influencing the wider determinants of health eg by implementing clean air policies to reduce air pollution
  6. Influencing the availability and accessibility of health services

Mass media campaigns help broader health promotion programmes with mutually reinforcing components

  1. Mobilising and supporting local agencies and professionals who have direct access to individuals within the target population
  2. Bringing together partnerships of public, voluntary and private sector bodies and professional organizations.
  3. Informing and educating the public but also setting the agenda for public debate about the health topic hence modifying public opinion
  4. Encouraging local and national policy changes so as to create a supportive environment within which people are more able to change their behaviour.

Mass media campaigns against smoking in the 1990s provided many lessons which are useful when planning mass media campaigns against cancer also

  1. Campaigns need to contain a variety of messages – threatening and supportive messages complement each other
  2. They have to compete for attention in a crowded media market space- hence need to engage the emotions of the target audience
  3. Emotions can be engaged using humour, fear, sympathy and aspirations
  4. TV advertising needs jolting messages rather than supportive or encouraging messages
  5. Smokers need help and encouragement to quit
  6. Advertising should not tell people what to do
  7. Motivation is helped by informing that help and support are available
  8. Content and style of delivery are of equal importance even with unpalatable messages

Mass media campaigns are best utilised in the following circumstances

  1. When wide exposure is desired
  2. Only a short time frame is available
  3. When public discussion is likely to facilitate the educational process
  4. Where awareness is the main goal
  5. When media authorities are “on-side”
  6. When accompanying backup is available on the ground
  7. When long term follow-up is possible
  8. When a generous budget exists
  9. When the behavioural goal is simple
  10. When the agenda includes public relations

Mass media campaigns provide a highly cost effective means of reframing a particular health issue as a public health problem and promoting relevant behaviour change to a larger audience.2 For example, road safety campaigns have been shown to be successful in reducing drunken driving.3

Alcohol and Cancer Mass Media Campaign

The ‘Alcohol and Cancer” mass media campaign targeting women in Western Australia ran from May 2011 to May 2011 and consisted of three waves of paid television advertising with supporting print advertisements. It was carried out in Western Australian women aged 25-54 years and responses were studied before the campaign, immediately after wave I and wave III of the campaign. The outcomes studied were campaign awareness, knowledge of drinking guidelines and the link between alcohol and cancer; intentions toward drinking. The results showed prompted recognition of the campaign increased from 67% following wave I to 81% following wave III. Improvement in women’s knowledge that drinking alcohol in a regular basis increases cancer risk were found following wave I and wave III compared with baseline. Among women who drink alcohol, the proportion expressing intentions to reduce alcohol consumption increased significantly between baseline and wave III. However, no significant reductions in recent drinking behaviour were found following the campaign.4

Be Clear on Cancer – “blood in pee” Mass Media Campaign

An attempt was made to assess the impact on suspected cancer referral burden and new cancer diagnosis through Public Health England’s recent Be Clear on Cancer “blood in pee” mass media campaign.5 This study has shown that the Be Clear on Cancer “blood in pee” mass media campaign significantly increased the number of new suspected cancer referrals but there was no significant change in the diagnosis of target cancers across a large catchment area. Mass media campaigns are expensive, require significant planning and appropriate implementation. Though the findings of this study do not challenge the fundamental objective of these campaigns more consideration needs to be given to the pre-emptive strategies like educational and process mapping across primary and secondary care.

AAMM Pilot Campaign

The Centers for Disease Control and Prevention, Atlanta, USA (CDC) developed the African American Women and Mass Media (AAMM) pilot campaign, which used radio and print media to make more women aware of the importance of getting mammograms to find breast cancer early.6 The campaign also sought to increase use of CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) screening services among African American women aged 40 and 64. The campaign was piloted in Savannah and Macon, Georgia. African American women who get breast cancer are more likely to die of the disease than white women and are less likely to survive five years after diagnosis. This discrepancy in survival is due to African American women being diagnosed at a later stage and also getting treated later after diagnosis. The AAMM pilot campaign aims at:

  1. increasing knowledge about breast cancer and mammography
  2. increasing awareness of the importance of mammography for early detection of breast cancer
  3. increasing awareness of the NBCCEDP’s low or no cost mammogram services
  4. increasing the number of women who get a mammogram through the Breast Test and More Program (NBCCEDP in Georgia) at their local health department

The campaign featured public service announcements (PSAs) that consist of testimonials by breast cancer survivors in Savannah and Macon. The PSAs were broadcast on many radio stations in Savannah and Macon. The AAMM campaign distributed promotional print materials in Savannah Georgia featuring positive images of African American women aged 40-64 years and explained the importance of getting mammograms. They were displayed in and around Savannah in retail stores, pharmacies, grocery stores and the health department. In addition they were widely displayed at events attended by African American women. This campaign aims at reducing deaths among African American women due to breast cancer. The campaign was developed, implemented and evaluated jointly by CDC, Georgian Department of Human services and National Cancer Institute’s Cancer Information Services.

Kerala Can Campaign

The Kerala Can program was jointly conceived by the Indian Medical Association Kerala Branch and the media house Malayala Manorama TV along with Kerala Cancer Care Consortium to combat the exponential rise of cancer incidence in Kerala in the last decade. This program has an ambitious target to reach the 4 million Malayali population in Kerala regarding the risk factors leading to cancer development, changes in life style needed to prevent the development of cancer, awareness regarding the common cancers and the warnings signals that need immediate medical evaluation, the need for early detection to improve results, conduct cancer awareness classes and cancer detection camps and the awareness regarding the treatment facilities available at present. The strengths of the program lie in the fact that IMA being the largest medical professional body with nearly 30,000 members across Kerala can provide the resource persons and MM TV with its phenomenal reach as a prominent media house can provide the platform to reach all Malayalis instantly. The program has as one of its important resource persons Dr M Velayudhan Pillai the Adjunct Professor of Oncology, Thomas Jefferson University, Philadelphia who is well known for leading such programs previously.

Strengths and limitations

The study relating alcohol and cancer was the first published evaluation of a mass media campaign highlighting the link between alcohol and cancer. The results indicate this innovative mass media intervention produced medium to large effects on improving women’s awareness and knowledge regarding alcohol and cancer. The strength of this study was the inclusion of a base line survey assessing women’s knowledge and intentions concerning alcohol and cancer prior to the intervention. The campaign advertisements have potential to be adapted for use and evaluation in other settings.4 The inability to reduce long term alcohol consumption patterns indicate the failure of these mass media campaigns to influence personal behaviour pattern despite understanding the link between alcohol and cancer.

End Note

Author Information

  1. Dr Vasudevan S, Additional Professor Urology, Medical College, Kottayam; Associate Editor, Kerala Medical Journal
  2. Dr Shaffi FM, Assistant Professor and Dean, Global Institute of Public Health, Ananthapuri Hospitals, Trivandrum; Convenor, IMA State Research Cell

Conflict of Interest: None declared

Editor’s Remarks: Checked completely

References

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  4. Dixon HG, Pratt IS, Scully ML, Miller JR, Patterson C, Hood R, et al. Using a mass media campaign to raise women’s awareness of the link between alcohol and cancer: cross-sectional pre-intervention and post-intervention evaluation surveys. BMJ Open. 2015 Mar 1;5(3):e006511.
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  6. CDC – Breast Cancer – What CDC is doing – AAMM Campaign
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