Presentation slides about the literature review - Cancer Research UK

Breakthrough Breast Cancer
Awareness Campaign: ISM
Literature Review
Jo Freeman & Douglas Eadie
6 th December 2007
ISM Institute for Social Marketing

Literature Review Objectives
• Explore current knowledge/perceptions
of breast awareness & screening
• Identify factors which hinder uptake of
screening appointments
• Review intervention studies aiming to
promote screening uptake
• Review existing public info campaigns

Methods
• Six databases searched
• ‘Grey’ literature
• Small archive of materials

Structure of Review
3 main areas:
1. Knowledge, awareness and attitudes
towards breast cancer and screening
2. Intervention studies
3. Public information campaigns

Attitudes Towards Breast Cancer
• Considerable amount of fear regarding
breast cancer
– ‘a death sentence’, ‘the Big C’, ‘disaster’

Awareness of Risk Factors
• Low awareness & confusion about risk
factors
– especially re. age, inherited risk

Breast Awareness
• Limited knowledge of signs & symptoms
– aware of breast lump being a symptom
but very limited knowledge of other
symptoms
– particularly older women, ethnic
minorities & socially disadvantaged
groups

Breast Awareness
• Confusion between breast awareness &
breast self-examination
• Delay in presentation complex but
several predictors
– misattribution of symptoms
– older age
– non-disclosure of symptom to significant
others
– negative attitudes towards GP/treatment
– psychosocial factors, eg. (anxiety /
denial)

Breast Cancer Screening
• Limited / inaccurate knowledge of
screening programme & eligibility
• Attendance at screening predicted by
– perceived importance of screening
– beliefs re. consequences
– attitudes of significant others
• Barriers to screening
– fear of pain/discomfort
– gender/cultural differences

Problem Areas
* Fear – need reassuring messages
* Signs & symptoms – need to increase
awareness of wide range of symptoms
* Risk factor knowledge, particularly re.
age
* Breast awareness v breast selfexamination
* Knowledge of screening programme

Breast Cancer Intervention
Studies
• Wide range of strategies employed:
– interventions aimed at women on an
individual level
– interventions aimed at GPs / health
professionals / health centre staff
– multi-strategy interventions

Breast Cancer Intervention Studies
• Most effective:
– ‘fixed’ invitation appointments
– good evidence for self-completion
‘action plan’
– flagging of patient records
– education / training of health centre staff
– culturally specific-based education /
promotional activities
– multi- strategy interventions

Breast Cancer Intervention Studies
• Less effective:
– ‘open’ invitations
– free transport to screening clinic
– inclusion of self-completion health
questionnaires with invitation

Public Information Campaigns
Main UK campaign organisations
Emphasis on:
– Awareness raising and information giving
(not changing behaviour)
– Unpaid media (PR approaches)
– Stand alone written materials (esp.
leaflets)
– Receptive audiences
– Broad initiatives and partnerships
– Multiple goals and objectives

Public Information Campaigns
• Less on:
– Who is accessing these campaign
materials
– How materials are being used
– Their impact on knowledge and
behaviour

Overview
Messages and materials
• Two broad categories:
– Diagnosis, treatment and therapies
– Risk factors and early detection (inc. primary
prevention)
• Most combine screening and breast
awareness messages (eg. 5-point code)
• Some more narrowly focussed (eg. TLC)
• Self-examination also featured
• Sometimes part of a broader campaign

Overview
Communication formats:
• Mainly written (Internet, posters,
postcards, leaflets etc)
• Some DVD and VHS teaching packs
• Also some innovative reminder products
• Links with personalised support a
common feature

Gaps & Opportunities
Target groups:
• Ethnic minorities (esp. breast awareness)
• Socially disadvantaged
• Over 70s
• Pre-screening age group
Approaches:
• Educational packages (eg. DVD, CD Rom)
• Inter-personal support (eg. link-workers)
• Alternative community channels (eg. community
groups, ethnic media, local authority premises)
• Local publicity events (eg. roadshows)