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...