Effectiveness of Pink Ribbon Campaign in Pakistan.
The present study focuses on the effectiveness of Pink Ribbon Campaign in Pakistan. It has been observed that due to lack of education and information poor environment, Breast cancer has become a serious health issue for women in Pakistan and the health sector is suffering badly. Issues like breast cancer are considered social taboos in Pakistani society, especially when it comes to women. According to Pink Ribbon report (2008), every ninth woman in Pakistan is suffering from breast cancer. Pink Ribbon has been working to create awareness in the female segment, using communication appeals through electronic and print media and their main tool is interpersonal communication. Seminars are also being conducted in different areas of the country to enhance the level of awareness about breast cancer.
Results of this study revealed that different sources of communication had different effects at all three levels of effects process. Although, the number of respondents who got information on breast cancer through the Pink Ribbon Campaign was very low but the highest positive change was found in the women who had been exposed to Pink Ribbon Campaign as a source of information. It can be concluded that properly designed effective messages related to the breast cancer issue can definitely contribute positively and can secure the desired objectives but there is a need to contribute more towards bringing change at attitudinal and behavioral levels. The occurrence of positive change is very low especially at behavioral level, which needs to be increased. Therefore, extensive and more efficient efforts in this regard, can help in increasing the level of positive change. Campaigns like Pink Ribbon do not reach the maximum audience which is also one of the reasons of a lesser positive change.
Key words: Pink Ribbon Pakistan, Breast Cancer, Knowledge, Attitude, Behavior, Awareness Campaign.
Health Communication campaigns are basically aimed to raise health standards in societies. To introduce innovations in the field of health, different ways of communication are used. As far as Pakistan is concerned, health care facilities are very poor here; however Ministry of Health Pakistan, WHO, UNICEF, other NGOs and national and international organizations have been launching prescriptive and proscriptive health communication campaigns. There are bulks of information regarding health issues available through the electronic and print media, health journals and Internet resources. But illiteracy, poverty, ignorance and lack of information act as a hurdle, impeding the effects of communication campaigns in Pakistan.
According to a research conducted by Pink Ribbon Pakistan, it is astonishing to know that Pakistan has the highest rate of breast cancer in whole of Asia. In Pakistan, 90,000 cases of breast cancer are diagnosed every year out of which 40,000 die due to late diagnosis (Pink Ribbon Pakistan report, 2008). Every 5th woman in Pakistan develops cancer after the age of 40. One of the basic reasons due to which there is an increase in the disease is shyness in women to talk about breast cancer. The primary aim of Pink Ribbon Campaign is to encourage women to discuss the issue openly, without any hesitancy, so the disease can be tackled effectively in Pakistan. Breast cancer is becoming a challenging health issue in developing countries including Pakistan and is one of the major reasons of an increase in death toll of women around the world. There is a significant level of knowledge about the problem but majority of the women with breast cancer consult the doctor when it is too late.
In our society, issues like breast cancer are taken as social taboos; therefore it is difficult to discuss the issue openly. It is the need of the time to make immediate efforts to overcome breast cancer as the diseases like breast cancer and HIV/AIDS and Hepatitis are becoming common day by day. Different communication vehicles are being used to create awareness about health and social issues, and the basic target is to translate these messages into practices. Extensive efforts are made to spread awareness about different health issues; still it is imperative to expand this area of communication campaigns at a larger extent especially for fatal diseases like breast cancer, HIV and AIDS etc.
Health Communication Campaigns
"Effective health communication contributes to health promotion and disease prevention. Likewise, the dissemination of health messages through health promotion programs and campaigns can cause awareness of an issue, change attitudes towards a health behavior, and encourage and motivate individuals to follow recommended health behaviors" (Fertman and Allensworth, 2010). Health promotion campaigns using mass media is an effective form of persuasion (Stiff and Mongeau, 2003) because they "usually reach a large number of audiences at a relatively low cost per person" (Piotrow et al., 1997).
"Health Communication is the dissemination and interpretation of health related messages. The disseminator may be an individual, an organization or a mass medium. The interpreter may be an individual, a group, an organization or an indiscriminate mass public" (Ray and Donohew, 1990). "Health campaign is a crucial element in a preventive approach to public health care because relevant health information empowers individuals to take charge of their own health" (Kreps and Thorntorn, 1984).
Knowledge, Cognition and Awareness are the words used for the same phenomenon in communication. Zajonc (1968) argues "No social psychologist honestly questions the general assumption that cognitions are organized wholes made up of interdependent parts". Baron, Byrne and Johnson (1998) note that social cognition involves all such processes through which we perceive information, interpret and remember them, and then utilize them in the practical world for personal benefits.
Social psychologists define attitudes as "beliefs that predispose us to act and feel in certain ways". This definition has three components: (a) belief (b) feelings (c) dispositions to behave.
An attitude is the general predispositions, favorable or unfavorable, of a person towards other people, objects and issues. It has achieved its prominent position in the research of influence because it is assumed that the attitude of a person is an important mediating variable between the acquisition of information and behavioral change (Petty and Priester, 1994). Early definitions of attitudes have been based on the concept that attitude is the readiness or predisposition towards responses of the person and there is a consistent relationship between attitudes and behaviors (Chafee and Roser, 1986).
As discussed by Yousafzai (2004), behavior is the desired component in the effects process of all communication campaigns. Behaviors are a visible action of a person. For example, to quit smoking, is an action resulted as consistency in the belief that smoking is injurious to health.
Pink ribbon campaign in Pakistan
Pink Ribbon Campaign is a project of Women's Empowerment Group and Vision 2015 International. WEG is an NGO registered as a trust working on Health, Economic Empowerment, Education, Gender Equity and Equality, Legal and Political Rights and Sustainable Development.
Pink Ribbon Campaign has been working to create awareness about Breast Cancer in the world since the last fifteen years. The "Pink Ribbon" is used as an emblem of hope for victims of breast cancer and for those who are working to fight against the disease. The National Breast Cancer Awareness campaign is a non-funded, self-sustained campaign, driven by a large number of volunteers across Pakistan (Pink Ribbon Pakistan, September, 2008).
Objective of The study
1. To find out the most effective channels of communication, used to reach the target audience.
2. To what extent the campaign is successful in achieving its objectives.
i. What is the level of awareness?
ii. What is the level of attitudinal change?
iii. What is the level of behavioral change?
rQ.1: How the Pink Ribbon Pakistan is disseminating information about Breast Cancer?
rQ.2: What is the level of change in knowledge, attitudes and behaviors in women with regards to Breast cancer?
h1: Campaign is successful in raising awareness about breast cancer amongst women.
h2: Campaign is not successful in bringing attitudinal change about breast cancer amongst women.
h3: Campaign is not successful in bringing behavioral change about breast cancer amongst women.
Theory of Persuasion
Mass mediated persuasive messages are very important and critical in bringing about political and social change. Persuasion is defined as "Human communication designed to influence others by modifying their beliefs, values or attitudes (Simons, 1976, p. 21). There are four models discussed to explain about the theories of persuasion and one of them is cognitive dissonance which explains about the relationship between attitudes and behaviors. Behavior is something which is followed by the beliefs. Persuasive messages, especially in media are designed strategically to change the attitudes of the audience. For these messages there are few things which are very important and the first one is the purpose or intentions of the senders. Interest of the receivers is also an important element while evaluating or designing any persuasive message. Same is with cultural and social values of the audience. Theory of persuasion basically deals with the messages aimed to influence the attitudes of the receivers.
Renee J. Bator and Robert B. Cialdini (2000) applied persuasion theory to the development of pro-environmental public service announcements. They talked about the Public service campaigns on media and concluded that for the success of any campaign or Public service announcements it is very important to first identify the interests, beliefs/attitudes of the public as attitudes correspond to change the behaviors ultimately and all persuasive media campaigns are aimed to change the behaviors actually.
Regarding pro-environmental messages they described that if effects of media campaigns/messages are not considered or neglected then it will be a failure for the designers of pro-environmental messages. Effects of public communication campaigns are being studied by many researchers and proper guidelines to design effective messages to get positive results in desired direction are given by many social scientists. Many factors like structure of the messages, beliefs of the receivers, channel of communication, source and purpose of those messages are very important in determining the success of any campaign.
Theory of Diffusion of Innovation
Diffusion of innovation explains that how new ideas, practices and objects become known and then spread to the whole social system. Rogers (2003, p. 12) defines innovation as "An idea, practice or object that is perceived as new by an individual or other unit of adoption"
In detailed model of diffusion of innovation Rogers (2003) explains that this process takes place in four stages; (1) Invention, (2) Diffusion (Dissemination), (3) Time, and (4) Consequences. In this process opinion leaders play an important role. A new idea on different channels of media like use of condoms to be protected from sexually transmitted diseases, advising breast feeding etc is spread through different sources of communication. Opinion leaders exert influence audience behavior. Moreover change agents and gatekeepers also influence the process of diffusion.
This theory is significant in most of the Health communication campaigns as it highlights the adoption of new ideas notwithstanding inconvenience. In health communication campaigns new ideas or piece of advices are disseminated to be prevented from diseases. Like in the campaign for mother and child care, breast feeding is advised with its benefits to be prevented from consequential diseases if breast feeding is not practiced. As far as the breast cancer campaign is concerned, the campaign transmits the importance of breast self examination for in time detection of the disease.
The theory deals with the dissemination of ideas and adoption by the audience in a systematic way. Application of this theory is seen in health communication campaigns; family planning campaigns, immunization campaigns and other health related messages.
Consistency in Knowledge, Attitude and Behavior
Knowledge, attitude and behaviors are the three components of effects of mass communication process. Earlier it was assumed audience is the passive target of media messages but now different researches have simplified that responses of the target audience to different media messages are different in accordance with their involvement in that specific subject. It is evident that media is being used purposefully and involvement of the audience is active. On the other hand media exposure is one of the factors determining the effects of messages on media.
Media messages have different effects varying across domains, individuals and conditions. Most of the time information on any topic leads to the formation of attitudes and then practices or behaviors. Attitude formation is an intermediate process between information/knowledge and behaviors. Sometimes behaviors are based on experiences not on knowledge or attitudes and sometimes practices are because of some beliefs rather than resulting on the basis of knowledge or in formation.
Consistency in knowledge, attitude and behavior is seen as individual difference and as a response to different situations. This approach in effect differs between two classes of variables: knowledge, attitudes, behaviors and the degree of consistency among them. In the first group there are three univariate variables (K, A and B) for media effects analysis. The second consists of three bivariate relationships, (K-A, K-B, and A-B). Each of these bivariate relationships represents different media campaign effects. While studying the effects of a media campaign on knowledge, attitude and behavior consistency, involvement of the individuals is something very important. If an individual is more involved in a topic then there will be a higher consistency in effects process of communication. Sometimes the effects are otherwise because of the lower involvement of individuals.
People process and respond to information differently according to their level of involvement with a message (Batra and Ray, 1986; Ray et al., 1973). High involvement can lead to greater K-A-B consistency. The hierarchies of effects presented by Ray are:
Low involvement hierarchy
Dissonance or attribution hierarchy
Chaffee (1986) discussed about the proposition, that consistency in knowledge, attitudes and behaviors of the audience are according to their level of involvement in the messages. A health communication campaign on heart problems was taken as case study. Open ended questionnaire was used to gather data from the respondents. He found that K-A, K-B and A-B correlations were found only when the cognitive response was high. Consistency in K-A and B is not found on the basis of knowledge regarding the disease.
As far as health communication campaigns are concerned, a consistency is observed in the effects process if there is a high involvement of the audience in the messages related to a specific health issue. Sometimes people adopt some behaviors related to a health issue on the basis of their own needs. Attitudes are sometimes developed just because of personal experiences. People can have a specific practice towards an issue without any information on that. However according to Ray's integrated model of effects process in the learning hierarchy attitudes are a more reasoned product of knowledge. Strongest correlations among knowledge, attitudes and behaviors can be expected if there is a highest level of individuals' involvement in the messages. If somebody perceives a low risk of a particular disease then strong involvement will be unnecessary.
Health Communication is a vast area and massive research has been conducted on health communication especially on different media campaigns. Atkin and Arkin (1990) discuss about rapid expansion of academic research examining mass media and public health which is going on since last few decades and this area of research is expanding gradually. Kline (2003) discusses that health related messages are very common on media but it is very important to consider the values, beliefs and norms associated with health.
Proper research, planning, authentic information, appropriate construction and presentation of messages are some of the important elements through which any communication campaign is evaluated. Huge amounts of money are used in Pakistan as well to bring social change through strategic communication ways. Different sources of communication as Television, Radio, Print Media and other communication sources are used to create awareness on different issues in the society. However for success of any campaign, selection of media channel and the way messages are disseminated in a particular setup are very important to consider.
Rice and Atkin (1989) said, "Campaigns must make their messages available through a variety of communication channels that are accessible and appropriate for target audience. But the message must also communicate specific information, understandings and behaviors that are actually accessible, feasible and culturally acceptable"
According to Hannan (2009), while addressing issues like HIV/AIDS, the success of the campaign depends upon the extent to which communicators address the audiences for the behavioral change. In his paper he critically analyzes the construction of messages to address the issue of HIV/AIDs in different campaigns run for disseminating information about the disease and cure of the disease. He concludes that regional, national, local and the government, community and the opinion leaders' participation plays a pivotal role for the success of a communication campaign.
He sums up that by providing a forum of discussion and communication, creating supportive environment for positive behavior change, creating knowledge about the services available in target population are, mainstreaming and putting the issue on news agenda, social mobilization with the help of opinion leaders and sharing sources and capacity building especially with the government departments, NGOs and, media outlets can make the campaign more effective.
Fishbein and Ajzen (1975) exemplified theory of reasoned action which assumes, "people consider the implications of their actions before they decide to engage/not engage in a given behavior". Ajzen (1990) expanded the model into a 'theory of planned behavior' and has indicated person's perceptions/beliefs of control over behavior. Sometimes some people adopt behaviors as a result of their attitudes/beliefs.
This study was quantitative in nature and a survey was conducted from the women residing in Rawalpindi and Islamabad. Data was entered into SPSS 16 and correlation test was applied to analyze the data. Due to lack of resources and shortage of time, researchers opted for stratified convenient sampling.
It was a closed ended questionnaire comprised of 25 items in which four questions were designed in simple questions form whereas the remaining were designed as a combination of negative and positive statements based on research questions.
To judge the general information/awareness level on Pink Ribbon Campaign, four questions were asked. Two were about the sources of information on breast cancer and Pink Ribbon Campaign. While statements of questions in second part of the questionnaire were constructed after monitoring the information on breast cancer by Pink Ribbon Campaign through different sources of communication. Nine of the twenty-one questions were about cognition, three were related to attitude and four addressed behavior. The remaining five questions were based on general statements about the media sources usage to propagate information about the issue.
To determine the level of change at cognitive level, the questionnaire had statements related to breast cancer facts, like is breast cancer is a big health issue in Pakistan or not? Statements were also developed to have answers on whether the disease can be inherited, or is it caused by smoking and to analyze the belief that breast-feeding can help prevent breast cancer. The respondents were also asked if they knew that self-breast examination is the best way for early detection of the disease. Through the campaign women are compelled to do self-breast examination in order to avoid late detection of the disease. Another statement was designed to assess if respondents thought men and women both could suffer from breast cancer. Similarly the statements regarding risk of breast cancer after age of 40 years and importance of mammography after this age, even if no change is found in breasts, were placed in the instrument.
To ascertain the attitudes of the respondents, three questions were asked in the questionnaire to measure the attitudes: Questions on the belief that breast cancer is a bigger health issue in Pakistan, shyness to discuss on this issue and lack of confidence to share or discuss this issue openly with others.
Most important part of the instrument was the questions measuring behaviors of the respondents. Many researches in medical field suggested that cautious food habits and physical exercises are helpful to prevent from this disease. Secondly, regular checkups and self-breast examinations are also very important and should be an essential practice in any woman's life. Questions addressing all these behaviors were included in this part of the questionnaire.
The number of questionnaires distributed were 400, out of them 360 were returned from respondents, which indicated that response rate was 90 percent. Out of those 360 questionnaires, 333 were selected for analysis as some important information was missing in the remaining 27 questionnaires.
A question was directed to analyze respondent knowledge about the purpose of Pink Ribbon Campaign, in response to this 125 (37.5 %) said they did not know what Pink Ribbon Campaign is. However 208 (62.5 %) of the respondents knew that this is a breast cancer awareness campaign.
Data revealed (table 1.1) that 73 (22%) respondents had Pink Ribbon Campaign as source of information on breast cancer. Print media was the source of information for 19.6% percent of the respondents; while 143 respondents (42.9 %) got information through Interpersonal communication and 52 (15.6 %) of the respondents had electronic media as source of information on breast cancer. So it can be assumed from the data that interpersonal communication is still more effective to aware women about breast cancer instead of other channels. The reasons behind are the environment, social taboos, religious factor, lack of education and self-confidence and social alienation etc.
Table 1: source of information about breast cancer
###Source of Information on###no. of
Total no. of Pink Ribbon Campaign###73###21.9%
The first question (table 1.2.i) evaluates the level of information held by respondents about breast cancer, whether it is a major health issue for women in Pakistan or not? 270 respondents replied yes, 17 disagreed with the notion and 46 were indecisive on the issue. The second statement questioned the information that can men and women both suffer from breast cancer. 39 % of the respondents agreed to it, 35.7 % disagreed and 25.3 % of the respondents were indecisive.
A question was to get a general view of the respondents on propagation of information regarding breast cancer. 80.5% of the respondents were in favor of propagation, 16.3 % were unable to decide about it and only 3.3 % of the respondents were against the propagation of information about breast cancer.
Fourth question was aimed to investigate about the shyness factor in women regarding discussion on the issue of breast cancer. 49.6 % females were of the view that the issue of breast cancer should be discussed openly, while 35.7 % women said that it should not be discussed openly. 14.7 % of respondents were indecisive on the issue.
A question addressed knowledge level of the respondents regarding self-examination for early diagnosis of breast cancer. The majority of respondents i.e. 77.8 % were aware of the fact that self-examination is a good way for early detection of the disease, while 15.6 % people had no answer on that and only 6.6 % replied in no.
Another question about information level asked about the awareness of the fact that breast-feeding could help prevent breast cancer. 78.7 %t of the women knew about it, while 16.8% were indecisive and 4.5 % did not know about it at all.
To measure the attitudinal change in another question, respondents were asked to tell whether they feel shy to discuss about breast cancer. 36.6 % respondents said they felt shy, while 17.7 % were neutral and 45.7 % were confident that they do not feel shy to discuss about breast cancer.
Another question was about the fact that breast cancer can be a hereditary disease. Only 30.6 % of the respondents were aware of the fact, while 30.2 % were indecisive. The majority of respondents, i.e. 39.2 % respondents denied the fact that breast cancer is a hereditary disease.
There was a question to check the behavioral change in the respondents. In response to the statement about monthly self-examination of breasts at home, only 26.1 % agreed that they do monthly self-examination. 50.8 % of the sample replied in negative and 23.1 %were indecisive about the question.
One more question was on behavior, which asked that in case of any change in breasts, do the respondents visit the doctor immediately or not. 42.3 % of the respondents replied in positive, while 14.2 % were neutral about it. But in majority of the respondents (43.5 %), this behavioral change was not found.
A question was about the practice of physical exercises which should be done regularly to avoid complications like breast cancer. This behavior was found just in 32.1 % of the respondents, while 43 % of the respondents did not have this habit, 24.9 % were neutral on the issue.
The last statement was about food habits. Only 33.3 % of the respondents were found to be cautious about their food habits, while 41.2 % were not careful about their diet, the remaining 25.5 % were indecisive about it.
Table: 2(i) Positive response towards cognition (N=333)
###% of positive
Breast cancer is a major health issue for women in Pakistan###81.6%
Men and women both can suffer from breast cancer###39.0%
Self examination is a good way for early diagnosis of breast cancer###77.8%
Breast feeding can help prevent breast cancer in women###78.7%
After age of 40 risk of breast cancer is higher in women###58.1%
Mammography is a must after age of 40###54.4%
Breast cancer is inherited###30.6%
Tightly fitted undergarments can cause breast cancer###54.1%
Smoking causes breast cancer###42.9%
Table: 2(ii) Positive response towards attitude (N=333)
###% of positive
Issues like breast cancer should be discussed openly###49.5%
Breast cancer is a bigger health issue in Pakistan###33.6%
I do not feel shy to discuss about breast cancer in front of others###36.6%
Table: 2(iii) Positive response behavior (N=333)
###% of positive
I do monthly examination of my breasts as suggested through
Pink Ribbon campaign
Whenever I feel even a slight change in my breasts I
immediately visit my doctor
I am very conscious about regular physical exercises to avoid
complications like breast cancer
I am very much cautious about my food habits to avoid breast
The choice to select multiple options was used to assess the sources of information on Pink Ribbon Campaign. Collected data (table 1.3) revealed that 56% of the respondents used Interpersonal communication as the source of information about Pink Ribbon Campaign. While the remaining 18 % got to know about the campaign through electronic media; radio, TV and Internet. Print media was the source of campaign information for 26% of the respondents.
Table 3: source of information on Pink ribbon campaign (N=333)
source of information on Pink ribbon campaign###Percentage
Print Media###(87 respondents)
Electronic Media###(60 respondents)
Interpersonal Communication###(186 respondents)
For analysis of the respondents (73 out of the total sample of 333), who got information on breast cancer through Pink Ribbon Campaign: It was observed that 90.6% (66) (table 1.3.i) of the respondents were of the view that breast cancer is a major health issue for women in Pakistan. Information level of these respondents was lower on the fact that men and women both can suffer from breast cancer. 32 out of 73 respondents knew that it could happen. Majority of the Pink Ribbon audience agreed that information regarding the Pink Ribbon Campaign needs propagation and they were in favor of propagation of this issue with the help of almost all available sources of media. In a sample of 73, 64.4% (47) of respondents were of the view that health issues of this kind should be discussed openly.
About 66 respondents knew that self-examination is the best way to detect this disease at an early stage. About 89 % of these respondents also knew that breast-feeding could help prevent breast cancer. 52.1 % claimed that they do not feel shy to talk on this topic, while 71.2 % of these respondents had information about the fact that after the age of forty, risks of this disease are greater in women. 47 out of these 73 respondents knew that mammography is a must after age of 40. It is a fact that breast cancer is a hereditary disease and 47 respondents of this segment agreed with that. Tightly fitted undergarments can also cause breast cancer in women and 56.2 percent of these respondents agreed with the notion. Only 30 respondents knew that smoking could also be one of the reasons of breast cancer.
24 out of these 73 respondents claimed that they do monthly examination of their breasts at home and 36 respondents claimed that they immediately visit the doctor in case of a difference felt in their breasts. 33 respondents were regular in physical exercises to avoid complications like breast cancer and 34 respondents were cautious about their food habits.
Table 3(i): Positive response towards cognition (N=73, respondents who got information through Pink Ribbon Campaign)
###% of positive
Breast cancer is a major health issue for women in Pakistan###90.6%
Men and women both can suffer from breast cancer###44%
Self examination is a good way for early diagnosis of breast cancer###90.4%
Breast feeding can help prevent breast cancer in women###89%
After age of 40 risk of breast cancer is higher in women###71.2%
Mammography is a must after age of 40###64.3%
Breast cancer can be inherited###64.3%
Tightly fitted undergarments can cause breast cancer###56.2%
Smoking causes breast cancer###41%
Table 3(ii): Positive response towards attitude (N=73, respondents who got information through Pink Ribbon Campaign)
###% of positive
Issues like breast cancer should be discussed openly###64.4%
Breast cancer is a bigger health issue in Pakistan###90.6%
I do not feel shy to discuss about breast cancer in front of others###52.1%
Table 3(iii): Positive response towards behavior (N=73, respondents who got information through Pink Ribbon Campaign)
###% of positive
I do monthly examination of my breasts as suggested through
Pink Ribbon campaign
Whenever I feel even a slight change in my breasts I
immediately visit my doctor
I am very conscious about regular physical exercises to avoid
complications like breast cancer###45.2%
I am very much cautious about my food habits to avoid breast
260 respondents were those who got information on breast cancer from sources other than Pink Ribbon Campaign. In these respondents, the percentage of positive change at cognitive level was 82.5 %. Out of 260 respondents, 122 (46.9 %) had positive attitudinal change regarding breast cancer.
On the other hand, positive behavioral change also existed in those women who were not exposed to Pink Ribbon Campaign for information on breast cancer. About 36.5 % of 260 respondents had positive behavioral change. Again the difference here on the basis of category of respondents was not that much higher. Significant difference in change at all levels of effects process was not observed in results of the research.
Out of 333 respondents only 73 (table 1.4) females had Pink Ribbon Campaign as source of information; positive change at cognitive level was 95.9%, which is a significant positive change. Change at attitudinal level is lesser, which is 67.1%, and at behavioral level the positive change is 50.7%.
65 out of 333 respondents used Print media as source of information. At cognitive level, the change is 87%, which is a significant change. At attitudinal level, the change is 61.5 % while at behavioral level the change is even lesser, which is 47.4%.
Next source of information in data was electronic media and 52 respondents claimed that they got information on breast cancer through Electronic media. At cognitive level, the positive change is 89.3 % which is again a significant change. At attitudinal level, the change is 65.2% while at behavior level; the positive change is just 39.4%.
Another source of information was Interpersonal communication. Respondents who got information on breast cancer through interpersonal communication were 143 out of 333. In these women, change at cognitive level was significant, which is 85.2 percent. Positive change in the attitudes of these women is 52.2 percent, while at behavioral level, positive change is 41.1 percent.
Table 4: comparative analysis of positive change on cognitive, attitudinal and behavioral level regarding breast cancer awareness
###source of information###Positive###Positive###Positive
###on breast cancer###change at###change at###change at
###(Total number of###cognitive###attitudinal###behavioral
###respondents is 333)###level###level###level
###Pink Ribbon Campaign
###(for 73 respondents)
###(for 65 respondents)
###(for 52 respondents)
###(for 143 respondents)
H1: Campaign is successful in raising awareness about breast cancer amongst women.
H1 hypothesized that Pink Ribbon Campaign is successful in bringing positive change at cognitive level. It means that exposure to Pink Ribbon Campaign increases the knowledge level of the respondents. The results showed that 73 respondents out of 333 got information on breast cancer through Pink Ribbon Campaign and out of these 73 respondents, positive change at cognitive level was 95.9 %. Pearson's correlation test was computed to assess the relationship between the exposure to Pink Ribbon Campaign and cognitive change. There was a correlation between two variables at significant level. Results (r=.151**, p>0.01) show that there is a positive and significant relationship between the knowledge level and Pink Ribbon Campaign in respondents who had been exposed to Pink Ribbon Campaign to have information on breast cancer. Furthermore there were a very small percentage of respondents (2.7 %) who did not show positive cognitive change, despite the exposure to the Pink Ribbon Campaign.
Thus H1 is proven that Pink Ribbon Campaign is successful in bringing positive change at cognitive level.
Relationship of exposure to Pink ribbon campaign and change at cognitive level
###Positive change at cognitive level
Source of Information is Pink Ribbon Campaign###.151
H2: Campaign is not successful in bringing positive attitudinal change towards breast cancer.
H2 hypothesized that Pink Ribbon Campaign is not successful in bringing positive change at attitudinal level. As mentioned earlier, only 73 respondents out of 333 got information on breast cancer through Pink Ribbon Campaign and in these 73 respondents, positive change at attitudinal level was 67.1 %. Pearson's correlation test was computed to assess the relationship between the exposure to Pink Ribbon Campaign and attitudinal change. There was a correlation between two variables at significant level. Results (r=.207**, p>0.01) show that there is a positive and significant relationship between the respondents' exposure to Pink Ribbon Campaign and attitudinal change. Negative attitudinal change was 11 percent. Though positive change at attitude level is less than the change at cognitive level, however the relationship between exposure to Pink Ribbon Campaign and positive change in developing desired attitudes on breast cancer issue is strong.
So H2 does not stand proven. Here it can be interpreted that despite of Pink Ribbon Campaign aware audience is very small in number but they had developed positive attitudes towards breast cancer problem.
Relationship of exposure to Pink ribbon campaign and change at attitudinal level
Source of Information is Pink Ribbon Campaign###.207
H3: Campaign is not successful in bringing positive behavioral change towards breast cancer.
H3 hypothesized that Pink Ribbon Campaign is not successful in bringing positive change at behavioral level. Positive change at attitudinal level in respondents who got information on breast cancer through Pink Ribbon Campaign was 50.7 percent. Pearson's correlation test was computed to assess the relationship between the exposure to Pink Ribbon Campaign and behavioral change. There was a correlation between two variables at significant level.
Results (r=.152**, p>0.01) show that there is a positive and significant relationship between exposure to Pink Ribbon Campaign and behavior of the respondents. Negative behavioral was 32.9 percent. Though positive change at behavior level is less than the change at cognitive and attitudinal levels, however the relationship between exposure to Pink Ribbon Campaign and positive change in practices towards breast cancer issue is significant. So H3 does not stand proven.
Relationship of exposure to Pink ribbon campaign and change at behavioral level
Source of Information is Pink Ribbon Campaign###.152
Discussion and Conclusion
Breast cancer is now one of the most challenging health issues in Pakistan these days and awareness is being enhanced on this issue through different channels of communication. Pink Ribbon Pakistan is the most prominent campaign, playing an important role in creating awareness in this regard. In this study researchers aimed to analyze the effectiveness and contribution made by Pink Ribbon Campaign in bringing positive change at all the three levels of effects process. Breast cancer is one of the issues that is considered as a social taboo in Pakistani society and it is a very difficult to discuss them at a public level. However results of this research revealed that there is a considerable change in the desired direction in the audience who gets information on breast cancer through Pink Ribbon Campaign.
Still there is an urgent need to develop the communication strategies through which maximum population can be reached. If a campaign is not reaching to a representative sample of the population then it cannot be declared successful.
Respondents had different sources of information on breast cancer issue. Results showed that 21.9 % respondents had Pink Ribbon Campaign as source of information on breast cancer. Although it is a small percentage of the sample population however changes at all levels of effects process are higher in this segment of respondents. Results clearly showed that respondents, who had Pink Ribbon campaign as source of information on breast cancer, were more aware as compared to the respondents who had other sources of information.
Different sources of communication, other than Pink Ribbon Campaign, are also being used to address this issue in Pakistan. These sources include electronic media, print media and interpersonal communication. Positive change is also observed in the respondents who had awareness from various sources of information on breast cancer other than Pink Ribbon Campaign. But the percentage of positive change was lower here than in those who were exposed to Pink Ribbon Campaign. Maximum positive change is due to Pink Ribbon Campaign. This campaign is also followed by electronic media, print media and interpersonal communication consecutively.
It is clear from the results that at all levels of effects process there is a positive change but it is squeezed at attitudinal and behavioral levels. Women have information about this serious issue but attitudes and behaviors are not changed in desired direction on the basis of information received. Maximum change is found at cognitive level and minimum positive change at behavioral level. It is generally believed that the higher is the information level then higher is the change at attitudinal and behavioral level in the desired direction. But findings do not follow this popular notion here.
If the effects of sources of information on breast cancer are compared, then at cognitive, attitudinal and behavioral levels, Pink Ribbon Campaign showed maximum positive results. As far as print and electronic media and interpersonal communication are concerned, then electronic media created maximum positive change at cognitive and attitudinal levels. But at behavioral level, maximum positive change is found because of print media.
First hypothesis was about the success of Pink Ribbon Campaign in creating awareness amongst women regarding breast cancer. It was revealed that in 73 (21.9 %) respondents who had Pink Ribbon Campaign as source of information, cognition was 95.9%, though the number of audience is very small here but it assures that Pink Ribbon Campaign can enhance awareness level in women, if it reaches to the maximum audience. Therefore, Pink Ribbon Campaign needs to expand the efforts to reach maximum audience. Second and third hypothesis were about effects of Pink Ribbon Campaign at attitudinal and behavioral levels. Results showed that the percentage of positive change is lesser than the change at knowledge level but the effects of Pink Ribbon Campaign in making desired changes at attitudinal and behavioral levels are higher than other sources of information.
The campaign needs to work more efficiently in convincing people to change their attitudes and practices because information is already there and practices are required to be developed to avoid breast cancer.
According to the data, most of the respondents got information on breast cancer through interpersonal communication. Findings show that interpersonal channel is the most effective channel regarding this issue. Secondly, the Pink Ribbon Campaign is mostly using interpersonal communication channels to reach the masses, so importance of interpersonal communication is reinforced keeping in view the success of Pink Ribbon Campaign. Moreover in societies like Pakistan, where literacy rate is very low and where male chauvinism is evident, interpersonal communication can work as a very effective tool.
All media sources have their own importance and influence in the society, so for getting effective results maximum information should be transmitted by using all communication vehicles. In modern world era no doubt electronic media is considered and used as the most important source of dissemination of information, so it should also be used extensively in an effective mode. Information is there because of the gravity of the disease but desired positive change is required at attitudinal and behavioral levels. There is a need to develop some important practices which can help to prevent from this chronic disease.
Success of any campaign does not only depend on bringing positive change in the society but also on the quantum of that change. Pink Ribbon campaign's messages are effective; still reach of the campaign is very low which needs to be increased very efficiently. Messages should be reached to all segments of the society equally and extensively keeping in view the intensity of the disease.
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