Covenant University
Abstract
Breast cancer is a leading female malignancy and a major health concern in the world today. In Nigeria, breast cancer is one of the leading causes of death in women aged 30 years and above. It reduces the life expectancy of the population at risk, especially those between 31 and 50 years of age. This paper examines the use of mass media to create awareness of breast cancer among women in Nigeria. In addition, the paper explores the theoretical understanding of the importance of mass media in creating awareness of health issues. The author further suggests various pathways whereby mass media strategies could be used in creating awareness of breast cancer in Nigeria.
Keywords: awareness, mass media, breast cancer, women and Nigeria
Introduction
Breast cancer is the most common cancer in women worldwide; it is a major cause of deaths among women aged 30 and above. It is the most common form of cancer among women in both high- and low-resource setting countries (Bray, McCarron, & Parkin, 2005; Dumitrescu & Cotaria, 2004; WHO Global Burden of Disease, 2004). Presently, breast cancer constitutes a major public health issue globally, with over one million new cases diagnosed annually, resulting in over 400,000 annual deaths and about 4.4 million women living with the disease (Bray, McCarron, & Parkin, 2005; Dumitrescu & Cotaria, 2004). It also affects one in eight women during their lifetimes (Dumitrescu & Cotaria, 2004; Bray, McCarron, & Parkin, 2005; Okobia, Bunker, Okonofua, & Usifo, 2006).
There have been various qualitative and quantitative analyses of mass media coverage of breast cancer in Nigeria. Some have reported the rise and fall of media coverage on breast cancer in Nigeria (Okobia, Bunker, Okonofua & Usifo, 2006; Sandelin, et al., 2002; Salaudeen, et al., 2009), whereas others have focused on the relationship of health communication and breast cancer in Nigeria. Another stream of research is based on surveys of public opinion on breast cancer. Many scholars have analyzed the issue of breast cancer in terms of public perception (Adebamowo, et al., 2003; Adebamowo & Ajayi, 2000; Bray, McCarron, & Parkin, 2005; Dumitrescu & Cotaria, 2004; Salaudeen, et al., 2009). Most of these studies have focused on how the public, as receivers of mass media messages, understand the issue of breast cancer. However, few studies have focused on mass media strategies for public awareness of breast cancer. The locus of this paper examines the use of the mass media in creating awareness and knowledge of breast cancer in Nigeria.
Women, Lifestyle, and Breast Cancer
Women are often considered the decision-makers and healthcare givers in the family across the globe (National Partnership for women and families, 2007; National Women Health Resource Center, 2006; Ojeda, Ranji & Saiganicoff, 2003). The multiple roles women play in the home profoundly influence the health of both their families and of themselves (Wyn, Ojeda, Ranji, & Saiganicoff, 2003). In other words, the roles that a woman plays in the family not only influence the health of family members but may also influence the health of the woman herself. Researchers and health professionals argue that women often neglect their own health for a number of reasons, usually associated with their care-giving roles within the family (Wyn, Ojeda, Ranji, & Saiganicoff, 2003).
The health of women is of great concern because of several negative lifestyle behaviors, including higher intake of animal and hydrogenated fats and lower intake of fiber (Popkin, 2006). These negative lifestyle behaviors are placing women at an increased risk of lifestyle-influenced causes of death. The Center for Disease Control and Prevention (2007a) identifies ten leading causes of death among women: cancer (27.2%), heart disease (22%), stroke (7.5%), chronic liver (3.9%), respiratory disease (5.2%), Aizheimer’s disease (3.9%), unintentional injuries (3.3%), diabetes (3.1%), influenza and pneumonia (2.7%), kidney disease (1.8%) and septicemia (1.5%). The top four categories – diseases of the heart, all forms of cancer, stroke, and respiratory diseases – are considered to be chronic lifestyle-influenced diseases.
Numerous health agencies and researchers agree that the major causes of death among women have shifted away from diseases such as tuberculosis, malaria, and cholera, to more chronic lifestyle-related diseases such as heart diseases, cancer, and stroke (Kennedy, 2006; National Center for Health Statistics, 2006). This dramatic shift has largely been influenced by human behaviors and lifestyle choices that are non-conducive to health (Belaal, 2006; Cannon, 2001; Popkin, 2006; Waximan & Norum, 2004).
Across the globe and particularly in resource-limited societies, breast cancer and its treatment constitute a great physical, psychosocial, and economic challenge. The hallmarks of the disease in Africa are patients presenting themselves at an advanced stage for treatment in hospitals. Awareness and knowledge of breast cancer vary among communities and population groups worldwide. While studies conducted to assess the knowledge of breast cancer among women have revealed satisfactory levels in some places, (Grunfeld, Ramiez, Hunter, & Richard, 2002) other reports – especially from developing countries such as Nigeria – have revealed inadequate knowledge and awareness of the disease (Adebamowo, et al., 2003; Adebamowo & Ajayi, 2000).
The Mass Media and Nigerian Society
The mass media play a pivotal role in the development process of a country. The mass media are generally regarded as channels of communication that are capable of reaching heterogeneous audiences simultaneously with uniform messages. The mass media in Nigeria regularly cover all sorts of issues such as health, music, fine art, crime, sports, and political events (Meyer, 2002; Soola, 2004). The mass media transmit ideas and new information to target audience in the society. Tosanwumi (1994) has observed that the mass media educate, inform, and entertain. Beyond these functions, they also persuade and catalyze social mobilization. In other words, the mass media can be regarded as powerful sources of information because they have the capability to penetrate every segment of the society. They have the ability to disseminate messages about issues, ideals and products. Furthermore, the mass media have the capacity to create awareness and knowledge about issues of national interest.
The traditional mass media usually consist of radio, television, newspaper, and magazine. The radio has been regarded as the most pervasive and most effective medium in reaching the country’s widely dispersed, heterogeneous audience. It is reputed worldwide for being the cheapest, simplest and most portable medium of mass communication for reaching people. Soola (2009) has reasoned that the radio is not limited by electricity, which is hardly available and epileptic in its supply when available. In addition, the radio is as extremely mobile: people could listen to a radio program in their car, home, or office. However, due to the downturn in the Nigerian economy and its toll on people’s purchasing power, both the hardware and software of this medium has become expensive for an average income earner. Soola (1999) has observed that radio sets and batteries are expensive in Nigerian society. He also added the batteries of these radio set are becoming less long-lasting. Nevertheless, it is important to note that the radio, being ubiquitous in nature, can be regarded as a powerful source of information.
Television possesses the unique characteristics of sound, sight, and motion, which it combines with simultaneity. It also transcends the bounds often imposed by illiteracy on information and knowledge acquisition. In addition, its status conferral on individuals or demonstrated practices is unrivaled (Soola, 2009; Soola, 1999). In other words, television has the capacity of audio-visual presentation of programs and, by virtue of its ownership and operational structure, can be regarded as an urban medium. In addition, television has the ability to reach a heterogeneous audience in both rural and urban settings. However, television has its limitations in Nigeria; Soola (1999) has argued that television stations in Nigeria suffer from poor production capability, declining economic fortunes, and cheap foreign alternatives. He also observed that a stocktaking of a typical evening program offering on most Nigerian private television stations reveals that most of the programs are entertainment-centered. It is pertinent to note that most of the limitations of the electronic media are man-made and systemic and not a creation of electronic technology. It is believed that all these limitations can be overcome, when the government, media owners and managers are committed to socio-economic development and growth of a nation.
The print media, on the other hand, can be used to educate, enlighten, and mobilize people to a particular issue of national interest. The print media primarily refers to newspapers and magazines, though other forms of print media include billboards, posters, handbills, pamphlets, and brochures. Two unique advantages of the print media are its permanence and the possibility of information custody and storage for close reading and future use. Soola (2009) has, however, noted that certain user requirements often limit print media reach. The first user requirement is that he or she must be literate, at least in the local language. Among a predominantly non-literate rural population, print media reach is severely limited, particularly as more than 70 percent of them are published in the English language. In addition, it should be noted that newspapers and magazines in Nigeria are becoming increasing endangered by the anxiety to survive at all cost. This can be observed as most of the pages of a newspaper are clustered with advertisements. Nevertheless, the use of newspapers and magazines for development purposes is essential to enlighten and mobilize people.
The internet with its multimedia capabilities has affected the traditional ways individuals access the mass media in the society (Adaja, 2005). With the rise of internet as a new media, the possibility to express one’s self has become easier. The internet is increasingly being defined by new digital technologies that empower users to develop, create, rate, and distribute internet content and applications (O‘Reilly, 2005). Generally, the internet is a worldwide network of computer networks, connected to each other by telecommunication links. It is made up of an ever-growing number of organizations and individuals who have decided to share information in this giant, interconnected open system (Norton & Smith, 1996). Okpoko (2006) argued that the principal functions of the internet are communication (e-mail), information gathering, and electronic marketing. The advent of multimedia devices such as smartphones, iPads, and others have revolutionized the ways in which individuals access information. Individuals can have access to their radio and television programs with the use of their multimedia devices. People can also get sports updates and news reports on their cell phones.
The Role of the Mass Media in Creating Awareness
There is wide agreement that awareness leads to knowledge, and knowledge leads to behavior modification (Rimal, 2000). Various theories and models acknowledge the importance of the mass media in creating awareness in society. One such theory is the agenda-setting theory, which holds that the media have the ability to advise or tell audiences what issues are major and relevant, thus setting the agenda. They can achieve this by choosing what stories to consider newsworthy and how much prominence and space they give those stories (Folarin, 1998). In other words, this theory explains that the mass media through their presentations of event(s) and other kinds of information selected for publication ascribe prominence to the stories selected. The underlying assumption is that the mass media force attention to certain issues; they build up public images of political figures, they constantly present objects, suggest what we should think about, know about, have feelings about, agitate about, and eventually call for legislation about (McCombs & Shaw, 1972; Folarin, 1998; Anaeto, Onabajo, & Osifeso, 2008). However, Davis and Robinson criticized previous agenda-setting research for neglecting possible effects on what people think concerning who is important, where important things happen, and why things are important. In sum, the mass media has the influence to pre-determine issues that people should be aware of in society. The precaution adoption model also recognizes that the media plays a major role in disseminating information and raising awareness. According to this theory, awareness is an essential component that moves an individual in various stages. For example, stage one stresses when an individual becomes aware of a health issue; stage two focuses on when an individual decides to act or not to act. In stages three and four, the individual either acts or does not (Weinstein and Sandman, 2002).
The mass media not only informs individuals about health issues, but its message can also be used to influence individuals to action. The diffusion of innovation theory holds that the mass media can be a crucial component in influencing beliefs and attitude that will eventually lead to a behavior. Similarly, one of the major constructs of the health belief model is the cue to action that helps trigger a particular behavior. A cue to action is something that helps move someone from wanting to make a health change to actually making the change. These cues to action range from bodily events to environmental factors that stimulate an individual to act. The health belief model recognizes media campaign and promotion as one of the effective environmental cues to action (Janz, Champion, & Strecher, 2002). It should be noted that the knowledge gap theory proposes that there can be appreciable differences in learning as a result of exposure to media information. Individuals with distinct backgrounds frequently demonstrate differential learning from the mass media. Individuals with prior information to media and higher education frequently learn more when exposed to media information. In contrast, individuals with lower education and less prior information tend to learn less, thus representing an increase in the knowledge gap.
Mass Media Strategies for Creating Awareness
Against the backdrop of various theories and models that emphasize the importance of the mass media in creating awareness, it’s clear that the mass media can be used to create awareness of breast cancer in Nigerian society. Breast cancer is one of the major public health concerns in the country. Using the mass media in creating the awareness of breast cancer has become imperative. The mass media can be used in the following ways:
- The use of electronic media in creating awareness: The radio and television can be used in the vanguard of creating awareness of breast cancer. Effective broadcast media use requires that both program type and time of airing be given due consideration. In other words, radio and television use for breast cancer awareness must be targeted at peak periods or “primetime,” when most audience members stay tuned to their sets. In essence, the electronic media can apply its agenda-setting function by spearheading a campaign that would create the awareness of breast cancer in the Nigerian society. For example, television can be used to set an agenda by creating awareness of breast cancer through scrolling messages on primetime news bulletins and programs. The radio can also be used to set an agenda by introducing musical commercials about breast cancer during prime-time periods. Furthermore, the television can be used to create cues to action by showing documentaries that focus on the nature, causes, and consequences of breast cancer. Also, a program could feature an episode in which a character gets cancer, which could help to enlighten and educate persons on the nature and causes of breast cancer
- The use of the print media in creating awareness: the print media can serve as an effective way to create awareness, or to remind the public of critical information about breast cancer. The print media are unique in being able to quickly reach a mass audience with a standard message. The print media can thus create awareness of an innovation and may be able to provide “how-to” information. For example, magazines and specialized journals can publish photo reports on how women can engage in breast self-examinations. Based on one of the constructs of the health belief model, young women can receive reminder cues to action in the form of pamphlets that create awareness of breast cancer. Furthermore, newspapers and magazines can apply the agenda-setting function in publishing news reports of breast cancer on the front and back pages. In addition, public service advertisements on breast cancer can be published at vital parts of the front and back pages.
- The use of community media: The Asia Institute of Journalism (1983) defines community media as those media that are developed and managed by people who share common values and aspirations in a small, geographically defined area and that promote access and participation for development. Community media are essential to bridge the gaps in knowledge between literate and illiterate people, as well as the appreciable differences in learning in both urban and rural settings. Community media comprises rural community newspapers, community radios, and community viewing centers. Community media provide alternative channels through which people’s needs and interests can be articulated.
- The use of rural community newspaper: We have international and national newspapers and magazines, yet there is a dire need for rural community newspapers. Soola (2003) declares that “a rural /community newspaper is a regular publication which carries news stories, features, editorials, illustrations, and pictures, as well as advertisements for rural and urban people. It is put together and published by rural folks in their own place…” (p. 58). Rural community newspapers have a great potential for stimulating literacy and social development and for helping to integrate rural dwellers into national life. There are various rural newspapers in Nigeria published in the local languages of the people in their various communities. Breast cancer issues can be published in the forms of news reports, articles, and editorials as they relate to rural circumstances to aid understanding, assimilation, and ultimately create the needed knowledge in the rural areas to aid the prevention of breast cancer.
- The use of rural community radio: According to Ememaku (2003), a community radio is “a system of radio broadcasting whereby a community establishes, operates and manages a radio station for the ultimate objective of meeting the communication needs of its members” (p. 126). The content of community radio programs originates from the local community people; it is community-specific and situation-relevant. In addition, indigenous radio dramas can be used to educate people about the nature, causes, and consequences of breast cancer in Nigeria.
- Community viewing centers: These are effective forums for explaining efforts of rural development to the rural populace. Onabanjo (2003) noted that the community viewing center is a controlled theater for imparting knowledge and also serves as a rallying point for people in rural areas to be adequately informed. Importantly, the effectiveness of the community viewing centers is in carefully selecting the materials to be viewed relative to the peculiar needs of a given local area. For example, the community viewing center can serve as a platform for showing documentary programs aimed at creating awareness of breast cancer. These documentary programs should be produced in the indigenous languages of the audiences.
Conclusion
The magnitude of the threat posed by breast cancer to women’s health in Nigeria could be damaging if not curtailed. Consequently, developing countries have higher mortality ratio for breast cancer than the United States. Against the backdrop of various theories and models of health communication, which moves that the mass media have the ability to create awareness of health issues in the country, this paper recommends the use of the mass media in creating awareness of breast cancer in Nigeria. In addition, it is suggested that appropriate mass communication channels are used as they relate to the socio-cultural environment of the people in the Nigerian society. In other words, mass media strategies can be used to set agendas, bridge the gap in knowledge between people who reside in the rural and urban settings, and remind people about issues of their health.
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