Communication Campaigns: Social Communication Campaigns: Social Marketing Practices and Dissemination Marketing Practices and Dissemination

of Breast Cancer Risk Information to the of Breast Cancer Risk Information to the Lay Public Lay Public 

Chuck Atkin, Ph.D.Chuck Atkin, Ph.D.Kami Silk, Ph.D.Kami Silk, Ph.D.

Department of CommunicationDepartment of CommunicationMichigan State UniversityMichigan State University

OverviewOverview

► Identify fundamental campaign Identify fundamental campaign componentscomponents

►Discuss social marketing practicesDiscuss social marketing practices►Present options for risk Present options for risk

representationsrepresentations►Provide a dissemination plan for risk Provide a dissemination plan for risk

messagesmessages

Communication Campaign Communication Campaign StrategiesStrategies

Basic model of communication:Basic model of communication:

SSOURCE OURCE MMESSAGE ESSAGE CCHANNEL HANNEL

RRECEIVERECEIVER

Overview of componentsOverview of components

►SOURCE:SOURCE: SPONSOR & MESSENGER SPONSOR & MESSENGER

►MESSAGE:MESSAGE: PERSUASIVE APPEALS & PERSUASIVE APPEALS & . INFORMATION CONTENT . INFORMATION CONTENT

►CHANNEL:CHANNEL: MEDIA & INTERPERSONALMEDIA & INTERPERSONAL

►AUDIENCE:AUDIENCE: Social Marketing Social Marketing conceptsconcepts

Health Message Health Message SourcesSources

SPONSOR SPONSOR

Creates and disseminates messagesCreates and disseminates messages

MESSENGER MESSENGER Models who are featured in messagesModels who are featured in messages

SPONSORING ORGANIZATIONSPONSORING ORGANIZATION

►Government agenciesGovernment agencies

►Associations and foundationsAssociations and foundations►Medical and educational institutionsMedical and educational institutions►CorporationsCorporations

High vs. low visibilityHigh vs. low visibility

High vs. low credibilityHigh vs. low credibility

Credibility of BC Sources Credibility of BC Sources (0-10 scale)(0-10 scale)

►10 American Cancer Society10 American Cancer Society► 9 Federal agencies9 Federal agencies► 9 Medical centers9 Medical centers► 9 Komen Foundation9 Komen Foundation► 8 Universities8 Universities►3 Pharmaceutical firms3 Pharmaceutical firms

Messenger = PersonalizationMessenger = Personalization

► Credibility: Credibility: Expertise, Trust Expertise, Trust

► Relevance:Relevance: Identification Identification

► Attractiveness:Attractiveness: Attention-getting Attention-getting

Health MessengersHealth Messengers

►Expert specialistExpert specialist doctor… doctor… researcher researcher

►Specially experienced personSpecially experienced person GG

victim… survivor… successful role victim… survivor… successful role model model

►Public officialPublic official gov leader… agency director gov leader… agency director

Source MessengerSource Messenger

►CelebrityCelebrity GG athlete… entertainer athlete… entertainer

►Average person Average person GG typical girl… typical girl…

mommom

►Professional performerProfessional performer

►Unique character Unique character GG

Channels: Channels: Comprehensive ArrayComprehensive Array

► Television:Television: NewsNews, PSA spots, Talk , PSA spots, Talk GG

► RadioRadio: : PSAsPSAs, News coverage, Call-in, News coverage, Call-in

► NewspaperNewspaper: : NewsNews, Editorial comment , Editorial comment

► Magazine: Magazine: FeatureFeature stories, stories, NewsNews

ChannelsChannels

►Internet Web pagesInternet Web pages GG

►Billboards/PostersBillboards/Posters GG

►Pamphlets/BookletsPamphlets/Booklets GG

►Direct mail/email materialsDirect mail/email materials

BC stories seen per yearBC stories seen per year

►9 TV public service spots9 TV public service spots

►8 Magazine stories8 Magazine stories

►8 TV newscast stories8 TV newscast stories

►7 Newspaper news/feature items7 Newspaper news/feature items

►4 TV content in talk shows/dramas4 TV content in talk shows/dramas

► 20% have searched internet for BC20% have searched internet for BC

Channels: Channels: InterpersonalInterpersonal

►Informal Informal family… friends family… friends

►Internet chat roomInternet chat room

►Professional Professional doctor… teacher doctor… teacher

TWO-STEP FLOWTWO-STEP FLOW

Direct vs. Indirect ImpactDirect vs. Indirect Impact

Message Message Target audience Target audience

Message Message InfluentialsInfluentials Target Target audienceaudience

Message Message PolicymakersPolicymakers Target Target audienceaudience

Campaign message Campaign message environment environment

MEDIA STORIES ABOUT… MEDIA STORIES ABOUT…

►Breast Cancer Breast Cancer ►Environmental risksEnvironmental risks►NutritionNutrition►ExerciseExercise

NEWS COVERAGE in National MediaNEWS COVERAGE in National Media

Environmental risk factors: Environmental risk factors:

► 12% Use of Hormones/Estrogen/Progesterone/HRT12% Use of Hormones/Estrogen/Progesterone/HRT► 6% Use of other pharmaceuticals 6% Use of other pharmaceuticals ► 3% Obesity 3% Obesity ► 2% Exposure to chemical contaminants 2% Exposure to chemical contaminants ► 2% Eating certain unhealthy foods 2% Eating certain unhealthy foods ► 1% Exposure to pesticides 1% Exposure to pesticides ► 1% Lack of exercise1% Lack of exercise► 1% Exposure to second-hand smoke1% Exposure to second-hand smoke Note: Heredity = 16% Note: Heredity = 16%

KEY NEWS CATEGORIESKEY NEWS CATEGORIES

38% TREATMENT (surgical, chemo, radiation)38% TREATMENT (surgical, chemo, radiation)

35% 35% PREVENTION (mostly aspirin… 10% obesity, exercise, food)

30% PREVALENCE of BC (number, odds, 30% PREVALENCE of BC (number, odds, trends)trends)

23% DETECTION SCREENING (self, mammo)

2% PARENT ACTIONS to PROTECT DAUGHTERS

Environmental Factors Environmental Factors LimitedLimited

► Lifestyle practices & environmental Lifestyle practices & environmental contaminants infrequent; HRT dominates contaminants infrequent; HRT dominates coverage at expense of other risk factors coverage at expense of other risk factors

► Likely to limit perceptions of susceptibility to Likely to limit perceptions of susceptibility to the neglected risks (although emphasis on the neglected risks (although emphasis on prevalence should contribute to vulnerability)prevalence should contribute to vulnerability)

► Almost no information to educate parents Almost no information to educate parents about how to protect daughter or how to take about how to protect daughter or how to take collective actioncollective action

Persuasive AppealsPersuasive Appeals

► Physical health incentivesPhysical health incentives

-- general disease vs. breast cancer -- general disease vs. breast cancer

► Psychological (e.g., Psychological (e.g., security) security)

► Social (e.g., Social (e.g., normative)normative)

Persuasive appealsPersuasive appeals

Positive promise vs. Negative threat Positive promise vs. Negative threat

Expectancy vs. ValueExpectancy vs. Value

Negative:Negative: Susceptibility vs. Severity Susceptibility vs. Severity

Positive:Positive: Promise vs. PayoffPromise vs. Payoff

Self Efficacy vs. Response EfficacySelf Efficacy vs. Response Efficacy

Implications of Treatment Implications of Treatment EmphasisEmphasis

► Based on positive treatment news, 90% of Based on positive treatment news, 90% of women perceive that survival rate is high or women perceive that survival rate is high or rising… do they infer less severity? rising… do they infer less severity?

►Does belief of lower fatality risk lead women Does belief of lower fatality risk lead women to have a lower level of concern and to have a lower level of concern and consequently less focus on prevention consequently less focus on prevention behavior? behavior?

► Are mothers be less likely to take action to Are mothers be less likely to take action to protect their young daughters?protect their young daughters?

Social MarketingSocial Marketing

►Adapting commercial marketing Adapting commercial marketing strategies to plan, develop, strategies to plan, develop, implement, & evaluate pro-social implement, & evaluate pro-social programs/campaigns.programs/campaigns.

►Emphasis is on selling an idea rather Emphasis is on selling an idea rather than a productthan a product

►Uses a traditional marketing mix that Uses a traditional marketing mix that incorporates the “Four Ps”incorporates the “Four Ps”

Social Marketing and Breast Social Marketing and Breast CancerCancer

► ProductProduct Prevention; engage in healthy behaviors as a Prevention; engage in healthy behaviors as a

protective functionprotective function► PricePrice

Uncertainty and fear; time and resources to Uncertainty and fear; time and resources to engage in healthy behaviorsengage in healthy behaviors

► PlacePlace Interpersonal channels, media vehicles,Interpersonal channels, media vehicles,

► PromotionPromotion Integrate media campaigns, school-based Integrate media campaigns, school-based

programs, physician and family interactions, programs, physician and family interactions, media advocacy effortsmedia advocacy efforts

Social Marketing and Breast Social Marketing and Breast CancerCancer

► PublicsPublics Adolescent girls, mothers, policymakers, health Adolescent girls, mothers, policymakers, health

educatorseducators► PartnershipPartnership

Schools, community-based organizationsSchools, community-based organizations► PolicyPolicy

Need an environment that supports prevention; Need an environment that supports prevention; e.g., school lunch and physical education programse.g., school lunch and physical education programs

► Purse StringsPurse Strings Where will $$$ come from for prevention and Where will $$$ come from for prevention and

promotion?promotion?

Risk CommunicationRisk Communication

Risk CommunicationRisk Communication

The National Research Council (1989) defined The National Research Council (1989) defined risk communication as:risk communication as:

► ““...an integrative process of exchange of ...an integrative process of exchange of information and opinions among individuals, information and opinions among individuals, groups, and institutions; often involves groups, and institutions; often involves multiple messages about the nature of the multiple messages about the nature of the risk or expressing concerns, opinions, or risk or expressing concerns, opinions, or reactions to risk messages or to the legal reactions to risk messages or to the legal and institutional arrangements for risk and institutional arrangements for risk management.”management.”

Risk CommunicationRisk Communication

ExpertsExperts► Similar to technical Similar to technical

estimates of annual estimates of annual fatalitiesfatalities

► Logarithmic in characterLogarithmic in character► Concerned with Concerned with

probabilityprobability► Unrelated to many Unrelated to many

dimensions of riskdimensions of risk

The PublicThe Public► Risk Perceptions Risk Perceptions

strongly affected by strongly affected by several ideasseveral ideas Threat to future Threat to future

generationsgenerations How CatastrophicHow Catastrophic ControllabilityControllability If Voluntary or NotIf Voluntary or Not Obtained BenefitsObtained Benefits

►More qualitative in More qualitative in naturenature

Risk CommunicationRisk Communication

““Risk perceptions” include [Weinstein]:Risk perceptions” include [Weinstein]: Beliefs about the Beliefs about the naturenature of the potential of the potential

consequencesconsequences Beliefs about the Beliefs about the probabilityprobability of these of these

consequencesconsequences Beliefs about Beliefs about personal riskpersonal risk and the and the

factors that modifyfactors that modify one’s risks one’s risks

Risk CommunicationRisk Communication

►Different properties associated with risk Different properties associated with risk impact lay public perceptions.impact lay public perceptions.

► Increased Perceived RiskIncreased Perceived Risk InfrequentInfrequent CatastrophicCatastrophic InvoluntaryInvoluntary

►Decreased Perceived RiskDecreased Perceived Risk FrequentFrequent FamiliarFamiliar VoluntaryVoluntary

Seven Cardinal Rules of Risk Seven Cardinal Rules of Risk Communication Communication (Covello & Allen, 1988)(Covello & Allen, 1988)

►Accept and involve the public as a partner.Accept and involve the public as a partner.►Plan carefully and evaluate your efforts.Plan carefully and evaluate your efforts.►Listen to the public's specific concerns.Listen to the public's specific concerns.►Be honest, frank, and open.Be honest, frank, and open.►Work with other credible sources.Work with other credible sources.►Meet the needs of the media.Meet the needs of the media.►Communicate clearly and with compassion.Communicate clearly and with compassion.

How do we communicate How do we communicate risks?risks?

RISK FACTORSRISK FACTORS

Breast CancerBreast Cancer

Objective of Risk MessageObjective of Risk Message

►Screening detectionScreening detection►Prevention behaviorsPrevention behaviors

► Individual vs. Collective action Individual vs. Collective action ►Protecting Self vs. OtherProtecting Self vs. Other

Conveying BC Risk FactorsConveying BC Risk Factors

PRESENT RISK FACTOR IN PRESENT RISK FACTOR IN

ISOLATION:ISOLATION:

-- SIMPLY IDENTIFY FACTOR-- SIMPLY IDENTIFY FACTOR

-- SPECIFY DEGREE (Verbal) -- SPECIFY DEGREE (Verbal)

-- SPECIFY DEGREE (Numerical)-- SPECIFY DEGREE (Numerical)

-- SPECIFY and EXPLAIN (Rationale)-- SPECIFY and EXPLAIN (Rationale)

MultipleMultiple Risk Factors Risk Factors

PRESENT RISK CLAIMS IN CONTEXTPRESENT RISK CLAIMS IN CONTEXT::

-- RANK ORDERING-- RANK ORDERING

-- NUMBER OF OTHER RISK FACTORS-- NUMBER OF OTHER RISK FACTORS

-- COMPARISON WITH FAMILIAR RISK-- COMPARISON WITH FAMILIAR RISK

Options for Representing Options for Representing RiskRisk

►Risk time frame: 5 Years vs. LifetimeRisk time frame: 5 Years vs. Lifetime

►Odds (1 in 9) vs. Percent (11%)Odds (1 in 9) vs. Percent (11%)

►Authority statement vs. evidenceAuthority statement vs. evidence

►Self vs. loved oneSelf vs. loved one

Other strategy Other strategy considerationsconsiderations

►Provide intuitive explanation / rationale Provide intuitive explanation / rationale to convince audience of risk claim?to convince audience of risk claim?

►How to overcome time lag between How to overcome time lag between behavior and disease?behavior and disease?

►What if actual risk is less than What if actual risk is less than expected risk?expected risk?

NCINCI Risk Assessment Tool Risk Assessment Tool

►Current age Current age ►Age first menstrual period Age first menstrual period ►Age first full pregnancy Age first full pregnancy ►First-degree BC relativesFirst-degree BC relatives►Benign biopsiesBenign biopsies►LCISLCIS►Race / ethnicityRace / ethnicity

CALCULATES 5-YEAR AND LIFETIME ODDS (CALCULATES 5-YEAR AND LIFETIME ODDS (%%))

NCINCI Comprehensive List Comprehensive List

1.1. AgeAge2.2. Personal history of BCPersonal history of BC3.3. Family historyFamily history4.4. LCISLCIS5.5. Gene changes Gene changes (BRCA1 BRCA2)(BRCA1 BRCA2)

6.6. Age of menarcheAge of menarche7.7. Age of first child birthAge of first child birth8.8. HRT (E+P)HRT (E+P)

NCI List NCI List (continued)(continued)

9. White race9. White race

10. Radiation therapy10. Radiation therapy

11. Breast density11. Breast density

12. Took DES12. Took DES13. Overweight (13. Overweight (post-menopause)post-menopause)

14. Lack of physical activity 14. Lack of physical activity

15. Drinking alcohol 15. Drinking alcohol

Note at end of NCI list:Note at end of NCI list:

““Other Other possiblepossible risk factors are risk factors are under study…” under study…”

► “ “eeffect of diet” ffect of diet” ► “ “physical activity”physical activity”► “ “whether certain substances in whether certain substances in

the environment can increase the the environment can increase the risk of breast cancer”risk of breast cancer”

NCI caveats re risk factorsNCI caveats re risk factors

►Most women who have known risk Most women who have known risk factors do not get breast cancerfactors do not get breast cancer

REASSURANCE? COMPLACENCY?REASSURANCE? COMPLACENCY?

►Most women with breast cancer do not Most women with breast cancer do not have a family history of the disease… have a family history of the disease… they have no clear risk factors they have no clear risk factors except except for growing olderfor growing older

UNCERTAINTY? VIGILANCE? FEAR? FATALISM? UNCERTAINTY? VIGILANCE? FEAR? FATALISM?

BC Risk FactorsBC Risk Factors (0-10 scale)(0-10 scale)

►9 Smoking cigarettes9 Smoking cigarettes►9 Genetics / Family history9 Genetics / Family history►7 HRT7 HRT►7 Secondhand smoke7 Secondhand smoke►6 High-fat foods in childhood6 High-fat foods in childhood►6 Obesity in childhood6 Obesity in childhood►4 Chemicals / Pesticides4 Chemicals / Pesticides