Health Education and the Media II: Proceedings of the 2nd International Conference Organized Jointly by the Scottish Health Education Group, Edinburgh and the Advertising Research Unit, Department of Marketing, University of Strathclyde, Edinburgh, 25–29 March 1985

Health Education and the Media II is a collection of papers that covers the various issues in utilizing media for promoting health education. The materials in the book are organized according to their respective theme. The first part of the selection presents papers about the theorecal issues of use of the media for health education, such as the application of market segmentation in alcohol and drug education, as well as social context of alcohol consumption and sources of information among high school alcohol abusers. Next, the title covers articles that deal with the practical issues, such as an analysis of media coverage and effective communication strategies with older people. The remaining papers discuss the areas for future developments, including more constructive use of existing resources and the potential for tabloid newspapers as vehicles for promulgating health promotion messages at district level. The book will be of great interest to health professionals, public health government officials, and individuals in the mass media industry.

• Language: English
• Publisher: Elsevier Science
• Release date: Oct 22, 2013
• ISBN: 9781483190815

Book preview

ISSUES

The Cancer Information Service: Marketing a Large-scale National Information Program Through the Media

J.A. Stein*,     National Cancer Institute Blair Building, Room 414, 9000 Rockville Pike, Bethesda, Maryland 20205, U.S.A.

ABSTRACT

This paper will describe the process through which a national health information program is marketed to the American public and the ways in which the media can be used to target information to different population groups.

KEYWORDS

Health/cancer information

marketing

publicity and promotion

communication strategy

INTRODUCTION

Scarcely a day goes by without some mention of cancer in the mass media. In fact, an American Cancer Society (ACS) survey revealed that 93% of those interviewed heard something about cancer from either television, newspapers, magazines or radio within the year (American Cancer Society, 1979). Despite this bombardment of information, surveys have indicated that the level of knowledge about cancer among the public is quite low. For example:

• Few survey respondents were able to identify more than two or three of cancer’s seven warning signs. In addition, only 29% of whites and 53% of blacks were able to name at least one possible cause of cancer (e.g., smoking) (Michelutte and Diseker, 1982).

• Of 16 and 17 year old students surveyed, only 3% of boys and 9% of girls recognized the cervical smear test as a preventive measure for cervical cancer (Charlton, 1983).

• Only one-third of women surveyed correctly identified age (women over 50) as a risk factor for breast cancer. In fact, 27% believed that women under 50 years of age had the highest risk for breast cancer (NCI, 1981).

In addition, misconceptions about the disease are still prevalent (Wagenfeld, et. al., 1979; NCI, 1981). For example, the National Cancer Institute (NCI) survey revealed that 50% of women and 64% of men held to the mistaken notion that a blow or injury to the breast can cause breast cancer. In addition, 10% of women in samples of urban blacks and Hispanics said that breast cancer might be contagious, with an additional 9% unsure. Added to that is fear of the disease. In the ACS study, almost one-half of interviewees responded affirmatively to the statement, the word cancer itself scares me.

Recognizing the abovementioned problems associated with cancer information dissemination, the NCI, a government agency, established the Cancer Information Service (CIS) in 1976. The CIS is a telephone information program designed to provide accurate, up-to-date information on cancer to the concerned general public, cancer patients and their families, and health professionals. Information on cancer prevention, risk factors, symptoms, detection, treatment, and rehabilitation is provided on a one-to-one basis by health educators and trained volunteers. While the service does not provide diagnosis or treatment recommendations, information may be provided which is specific to the caller and their situation.

The CIS consists of 21 regional offices covering 65% of the U.S. population. Most offices cover a single state or large population area (e.g., Colorado; New York City). Some offices cover several states (e.g., Minnesota, North Dakota and South Dakota). A national office handles inquiries from remaining areas and provides nationwide coverage after hours and on weekends. Each regional office collects information for and maintains an extensive set of directories on cancer-related resources in their service area. Physicians and other health professionals located at regional cancer centers serve as consultants to provide the offices with advice as needed. In addition, each CIS office is routinely provided with information by the NCI reflecting new research and program developments. The offices are administered by health communications specialists with an advisory committee providing recommendations on program activities and plans.

Over the years, the CIS has evolved from a program that was simply reacting to the public’s concerns to an increasingly proactive role. Steps have been taken to identify target populations and issues of concern and design strategies to encourage public response to specific messages. Adding impetus to this proactive role for the CIS was the announcement of a new overall goal for the NCI: to reduce cancer mortality by 50 percent by the year 2000. It is clear that meeting this goal will depend to a great extent on encouraging the public to take health related action such as smoking cessation, diet modification, and immediate attention to possible cancer symptoms. In addition, information on state-of-the-art cancer treatment recommendations should be available to cancer patients and their families. The CIS can take this information directly to the public.

This paper will describe the CIS publicity and promotion activities, including some successes and failures; offer some suggestions for effective promotion campaigns; and examine the media channels most likely to provoke particular population groups to call the CIS.

PUBLICITY AND PROMOTION ACTIVITIES

Background: The CIS has handled over one and one-half million calls since its inception in 1976. The number of calls increased at a slow, steady pace through 1981, and has increased substantially since that time. In the last three years, calls rose 176% (from 135,600 in 1981 to 375,000 in 1984). Experience has taught us that the number of calls to the CIS is directly related to how well the program is publicized and promoted both locally and nationally.

The group process has always been used to develop CIS publicity and promotion plans and products. Early in the program, a publicity and promotion task force was formed, consisting of the CIS Project Officer at NCI and representatives fron regional CIS offices and the NCI’s Office of Cancer Communications. Over the years, the task force recommended a variety of products and messages to draw attention to the CIS, with varying degrees of success (e.g., television and radio public service announcements; posters in public settings; print ads for magazines or newspapers; news releases). Until recently, these efforts were hampered by the need to promote 34 separate telephone numbers of regional offices. This made national promotion next to impossible and local tagging of nationally developed materials unwieldy. It also became apparent that activities were proceeding without enough advance planning and with little research into effective messages and media to reach particular audiences. Target audiences were often identified based on program priorities rather than significant demographics. As a result, target groups chosen were often those least likely to call the CIS.

For example, in 1982 a public service announcement (PSA) was developed based on two key points:

• There has been tremendous progress in the treatment of childhood cancer over the last ten years.

• You can call the Cancer Information Service for facts about cancer.

A beautifully-produced 30-second television PSA featuring a mother and son was distributed nationwide, tagged with the CIS telephone number. Pretesting results were impressive and bounceback postcards from public service directors indicated a very favorable response and strong intent to provide air time. The number of CIS calls in response to the PSA was a great disappointment — only a handful nationwide. The lack of response may have been due to the relatively small number of people with a particular interest in childhood cancer. In addition, no specific instructions for action were offered to the viewer; they were simply urged to call for the facts.

While planned promotion had little effect on calls, events over which we had no control were periodically flooding offices with unexpected calls. These included an announcement in 1979 that some hand-held hair dryers contained cancer-causing asbestos. In many areas the CIS telephone number was given as a resource for information and an overwhelmed staff had to deal with the ensuing inquiries. Immediate access to NCI staff enabled local offices to obtain information necessary to respond to questions resulting from fast-breaking news stories such as this one.

CIS Marketing Plan: To rectify these problems and bring publicity and promotion of the program under control, the task force developed a comprehensive promotion plan based on social marketing techniques (Sciandra and Stein, 1983). The basic premise of social marketing is to apply marketing concepts and techniques to the promotion of a socially beneficial cause rather than commercial products or services. One must also recognize the balance between the product or service being offered and the needs and wants of the consumer. We had to admit that our offering (cancer information) is not inherently desirable to everyone. Different population segments are in varying stages of readiness to accept the information and therefore require varying incentives. The marketing plan identified several target audiences for promotion campaigns based on literature review, focus group analysis *, and past experience. The groups identified for special promotion campaigns were smokers who want to quit, persons over 50 years of age, cancer patients and their families, and blacks. Promotion campaigns directed at the first two are now complete.

Development of these national promotion campaigns was greatly facilitated by the introduction of a single toll-free telephone number for the CIS, 1-800-4-CANCER. Customized call routing automatically forwards each call to the appropriate regional or national office, depending upon the area code of the originating call. The introduction of this telephone number eliminated the need for multiple tagging of PSA’s and presented new opportunities for national promotion. The mnemonic number was found to be easily remembered by callers even after some time had passed since their exposure to it.

The Smoking Campaign: This campaign was the result of a cooperative effort between NCI and the Office on Smoking and Health (OSH), an agency of the U.S. Department of Health and Human Services. The OSH developed four separate television PSA’s using the U.S. Surgeon General, Dr. C. Everett Koop, as spokesperson. Dr. Koop was chosen for several reasons:

• A warning on every cigarette package in the U.S. reads, The Surgeon General has determined that cigarette smoking is dangerous to your health.

• He is recognized as the chief medical officer of the U.S.

• He is a credible spokesman who has a personal involvement in the subject matter.

A totally integrated marketing communications program was undertaken, consisting of television and radio PSA’s, collateral print materials, and the CIS telephone number as a follow-up for obtaining information on local resources, answers to questions, and publications. The messages were aimed at three specific target groups: the confirmed smoker who has tried previously to quit smoking but has now gone back to smoking; the family and friends of smokers; and the parents of children who are either smoking or potential smokers. The messages were very straightforward. For example:

The messages were pretested and all results pointed to the fact that the spokesman was appropriate and the messages were believable. The PSA’s were either hand-carried or mailed to approximately 900 television stations covering the entire U.S. Radio PSA’s using live announcer copy were also sent.

The impact of the PSA’s on CIS offices was quite substantial. As illustrated in Figure 1, calls to the CIS offices rose dramatically. Prior to release of the PSA’s in May, 1983, the number of calls on smoking received by all CIS offices averaged 600 each month. In August, calls were up to 13,500 with over 11,000 directly attributed to the PSA’s. Total calls in response to the television PSA’s from June through September numbered over 30,500. Response to the radio PSA’s was negligible. Only 1,000 calls resulted from the radio PSA’s over a three-month period.

Figure 1 Calls to the CIS in response to the Smoking PSA’s

The 50+ Campaign: A second successful campaign was targeted to persons over fifty years of age. Research indicated that older Americans have a marked interest in health topics. It was also felt that they would be responsive to a message targeted to their age group with a positive tone, and directed not at a risk but at good health. A fact sheet, Cancer Facts for People Over Fifty, served as the primary offering. In question and answer format, issues regarding general health and cancer symptoms were discussed. Other agencies and organizations were approached and agreed to provide support, co-sponsorship, and assistance in campaign development. These included the National Institute on Aging and the American Association of Retired Persons.

Due to the success of the Smoking PSA’s, the Surgeon General was again approached as a spokesman. With his interest in health promotion, and as a representative of the target age group, he agreed. Both television and radio PSA’s were distributed. In this case, the radio PSA’s were taped by Dr. Koop instead of the live announcer copy used previously.

Again, the messages were simple and straightforward:

Once more, the PSA’s produced a good response, more than tripling the number of calls received by CIS offices from people over age fifty. From 2,800 calls from people over fifty in December, 1983, the calls jumped to almost 9,000 in January, 1984, and were still almost 6,000 as late as June, 1984. In this case, response was much better to the radio PSA’s, almost equalling TV for the first two months of the campaign.

Why were these campaigns successful ? These two campaigns had a number of common elements which may have attributed to their success:

• A clear, concise message, not cluttered with gimmicks or subtelties.

• A credible spokesperson who has an obvious interest in the topic.

• A tangible offer, a pamphlet or fact sheet in each of these cases. Simply asking the public to call with your questions or call for information is not sufficient.

• A source to obtain additional information. An easy-to-remember telephone number to call.

• Participation and input from appropriate groups in the planning stages of activities.

A PROFILE OF CIS CALLERS

A common Call Record Form, in use since January, 1983, documents each CIS inquiry. This standardized form allows both regional and national assessment of information such as the type of caller, the subject of inquiry, and user demographics including age, level of education, sex, ethnicity, and the source from which the caller obtained the CIS telephone number. The result of the Call Record Form use has been the creation of a large, nationwide descriptive data set cataloguing user information for all CIS interactions. For the purposes of this paper, only very limited data will be presented.

Who Calls the CIS ? Females used the CIS to a greater degree than did males, accounting for 71% of all calls. Users aged 30 to 39 used the CIS most frequently, having made nearly 26% of the calls. Following were those users in the 20 to 29 age group, who made over 19% of the inquiries. Users in the age 40 to 49, 50 to 59, and 60 plus categories accounted for 16%, 18%, and 17% of all inquiries, respectively. Children and teens comprised only 7% of the total. Only 13% of users had less than 12 years of education, and 33% were high school graduates. Over 26% had completed some college training, an additional 19% held a bachelor’s degree, and 9% had some post-graduate training. CIS usage was favored more by the white population than by blacks or Hispanics. Nearly 89% of all users were white, 6.7% black, and 2.8% Hispanic, while the U.S. population representation of these groups is 80.5%, 11.5% and 6.5%, respectively. This represents an under-utilization of the CIS by blacks and Hispanics when compared to their representation in the total population. Asians, Pacific Islanders, American Indians and native Alaskans utilized the CIS in a similar proportion to their population representation.

How Did Callers Learn of the CIS ? Callers first learned of the CIS through a variety of sources. Table 1 lists the sources through which users first found out about the CIS. Over 60% of users learned of the CIS through the media. Television was the most common source, having reached 35% of the users. Radio was considerably less important, accounting for about 5% of calls. The print media category includes newspapers, magazines, pamphlets, brochures, books and newspapers. This category accounted for almost 20% of calls. The telephone book and directory assistance generated a substantial number of calls, with over 10% of all callers reporting they first learned about the CIS by consulting their telephone books. Health professionals, such as physicians, and health agencies were responsible for informing more than 10% of callers about the service. Word of mouth, through friends, relatives, neighbors and co-workers informed an additional 7.2% of CIS