Are Public Awareness Campaigns Effective?

From prostate cancer screening to a new vaccine that prevents cervical cancer, public awareness campaigns are developed around different types of cancer to promote cancer screening or raise cancer awareness and knowledge. Campaigns are strategically planned to reach a target audience and to communicate a specific message tailored to that group.

“Communication campaigns are more successful if they are tailored to the context, values, language, and resources available to local audiences,” says Brad Hesse, PhD, chief of the Health Communication and Informatics Research Branch at the National Cancer Institute. “Priorities for which audiences to reach are usually set by an understanding of who is most vulnerable.”

Andy Goldsmith, vice president of creative and brand strategy for the American Cancer Society, says an important aspect is consumer understanding and “being able to speak in the language and voice of the consumer in a way that they understand.”

Wording and content of the message depends on what it is supposed to achieve. Hesse says the goal of early detection campaigns is to raise public awareness, but also to prepare the health care system to follow through with screening tests. He says health promotion messages should focus on what can be gained by changing behavior, while detection behavior messages should focus on what could be lost if they don’t go through with the screening, such as radical surgery if the disease is caught at an advanced stage.

Another type of campaign isn’t aimed at a behavior, but at raising public awareness. “The Lance Armstrong yellow band campaign and the breast cancer pink ribbon campaigns are examples in this category,” says Hesse.

Mass media are good for short, persuasive messages that can be squeezed into a 30-second television ad, says Hesse, but “it gets a little bit more complicated when you’re talking about screening stuff because there’s so much more involved in interacting with the health care system. It’s good for raising awareness, but it’s not as good as a follow-up. You need to connect that with some other channels.”

He recommends brochures and computer media for tailoring and for presenting more complex information, and says a mass media commercial should include a website or toll-free number for people to get more information.

Merck launched a national print, television, and online awareness campaign in 2006 soon after the Food and Drug Administration approved the drug company’s human papillomavirus (HPV) vaccine Gardasil, which is effective in preventing the types of HPV that cause cervical cancer.

Targeting teenage girls and their mothers, the Gardasil ads show teens making a decision to be “one less” by getting the HPV vaccine. (View the TV ads for Gardasil) The commercial ends with a recommendation to ask your doctor about the vaccine, and gives a website and 800 number.

Hesse says once a campaign’s message gains the target’s attention about a risk, it must be precise about what that person can do to reduce that risk. The Gynecologic Cancer Foundation cervical cancer campaign involves posters that focus on three actions: vaccination, regular Pap tests, and testing for HPV. (View the GCF ads)

“If we don’t give a clear behavioral message,” says Hesse, “people will use psychological tricks to discount the importance of the risk,” such as blaming the victim to relieve themselves of the responsibility, ignoring or altering part of the story with exceptions that don’t follow the evidence, and adopting a sense of helplessness that there is nothing they can do to prevent harm.

“Most techniques are various types of rationalizations — ways of tricking ourselves into not believing what we are hearing in a communication campaign.”

People age 50 and older are at an increased risk for colon cancer, so naturally, they are the target of colon cancer awareness campaigns. The ACS campaign takes it a step further by specifically targeting women in this age group, appealing to the idea that women are the health care decision-makers and social conscience in the family. And, says Goldsmith, there is a myth that colon cancer strikes men more frequently than women despite incidence being practically the same for each gender—the ACS estimates there will be 53,760 diagnoses in men and 54,310 in women in 2008.

The ACS campaigns consist of paid advertising, interactive web advertising, and public relations. They use TV programs and magazine editorial to reach women 50-plus to ensure the message is delivered strongly to the immediate target audience.

Another sure-fire way to get a message out is to have a well-known spokesperson, Hesse says, citing Katie Couric’s televised colonoscopy in March 2000. He says it had all the facets of a successful early detection campaign.

“It showed what could be lost for not getting a colonoscopy (Couric’s husband died from colon cancer), but then showed in specific detail what people could do to reduce their risk. The effect was so profound that we picked it up in our cancer registry data.” Indeed, a study by researchers at the University of Michigan Health System and the University of Iowa showed an increase in colonoscopies after Couric’s procedure aired.

Goldsmith explains a clear message isn’t enough if you lose the target’s attention. The ACS used the same creative platform for its colon cancer awareness campaign two years in a row. It was very successful in 2005, but by 2006, a drop-off was seen in telephone and Internet responses as well as in key market research measures, such as awareness and intent to get screened. Research confirmed that the campaign message, “Getting tested for colon cancer can actually prevent it,” was still 100 percent appropriate, Goldsmith says, but it needed to be presented in a new way.

In order to convince people to want to get tested for colon cancer, he says, they needed to understand “the polyp story”—removing polyps early helps prevent colon cancer.

“When we found an engaging way to tell that story,” Goldsmith says. “It really turned a lot of heads, and as a result we managed to stimulate tremendous rises in personal awareness of colon cancer and intention to get screened for colon cancer among the target that we selected.” (View 2007 ACS polyp story advertisements)

With so much message “noise” in the market, Goldsmith says it took a fresh look and new creative platform, like the polyp story, for the 2007 campaign to regain the target’s attention.

Hesse calls this noise “data smog.” Every time a news outlet grabs the latest and greatest controversial finding, they run with it as “news” even if it contradicts accepted public health guidelines, he says. The NCI hosts the Health Information National Trends Survey (HINTS), which Hesse says shows most people are confused when it comes to messages from mainstream media for preventing cancer.