**1. Introduction**

Strategic health communication efforts can help reduce cancer risks, incidence, morbidity and mortality, and improve quality of life for at-risk populations. However, providing relevant information about cancer prevention and control to vulnerable populations is fraught with difficulties. Just the ability to get members of at-risk populations to pay attention to information provided about cancer can often be a challenge. Most people do not want to hear or think about cancer unless they are forced into it because they or someone they care about has been diagnosed with some form of the dreaded disease. Since the term "cancer" is surrounded by a significant stigma in modern society that equates cancer with death and suffering, communication about cancer makes many people uncomfortable, forcing them to think about their potential to suffer and die.1 Strategic cancer prevention and control communication campaigns should be designed to overcome the pervasive social stigma that influences public attitudes towards cancer education.

The good news for health communicators is that the extremely negative social stigma surrounding cancer as an unavoidably deadly disease does not reflect the reality of cancer care in the modern world. Increasingly, those who are diagnosed with cancers are able to get helpful treatments and live productive lives as cancer survivors. Some public health scholars have suggested that with the advent of viable cancer treatments, cancer is becoming a chronic, rather than a terminal, disease due to increases in long-term cancer survivorship.1 There are also many good evidence-based health promotion strategies available to help people reduce their risks for developing cancers, to help them detect cancers early when the cancers can be most effectively treated, and to get the best care for living with cancer.2 However, consumers who have elevated cancer risks need access to the relevant information about cancer prevention and control to make their best health promoting decisions. While the pervasive negative social stigma surrounding cancers makes communicating about cancer prevention very difficult to do well, cancer communication efforts can be strategically planned and executed to encourage key audiences to attend to and respond to relevant cancer prevention information. Access to relevant and persuasive health information is essential for helping vulnerable population members reduce their risks for cancer-related morbidity and mortality by guiding evidence-based decision-making about cancer prevention and control.

Strategic Communication for Cancer Prevention

and Control: Reaching and Influencing Vulnerable Audiences 377

prevention and control seem to change all the time, further confusing them. 2 To counter these communication challenges, cancer communicators should develop clear, easy to understand, and consistent communication strategies for breaking through the confusion. They need to reduce the inertia caused by public fatalism concerning cancer with the use of engaging and persuasive messages that motivate adoption of evidence-based cancer prevention recommendations. This chapter examines the challenges to communicating relevant cancer prevention and control information to vulnerable populations and suggests best practices for designing meaningful messages and effectively using relevant media to

Communication is the central social process in health promotion and care for informing cancer prevention and control for vulnerable populations.1,2 The process of communication is the primary social mechanism used to both seek and deliver cancer care. Communication is the primary process for delivering cancer education and influencing cancer-related health behaviors. Communication is the coordinating process used to manage health care delivery systems. It is also the social process used to establish and reinforce health policies and practices. Health care consumers and providers depend upon communication to gather relevant health information for guiding evidence-based health decision making, encouraging participation in health care and health promotion activities, reducing uncertainty about cancers and increasing understanding about relevant health issues, as

Vulnerable populations are those groups of health care consumers who are most likely to suffer significantly higher levels of morbidity and mortality from cancers than other segments of the general population. 3 These vulnerable population members are typically the poorest, least well educated, and most disenfranchised members of modern society, including members of many immigrant and minority groups, the elderly, the socioeconomically deprived, the disabled, and people suffering from serious chronic diseases. 3 Many members of these vulnerable populations are likely to experience key health communication barriers such as health literacy challenges, limited access to and ability to use key channels of communication (such as new information technologies), as well as suffer from serious social and economic problems that can limit their ability to get needed care and to follow cancer prevention and control recommendations. 4,5 There are a broad range of significant health risks confronting members of vulnerable populations today, including risks from cancers, heart disease, diabetes, stroke, HIV/AIDS, and other serious health threats.6,7 Effective health communication is needed to help those members of the public who are at greatest risk (most vulnerable) for suffering from these health threats to

well as promoting needed cooperation and collaboration to achieve health goals.

recognize, minimize, and respond effectively to potential health problems.8,9

It is particularly important to effectively communicate clear, accurate, and persuasive information about cancer prevention and control to audiences who are at greatest risk for negative cancer outcomes, those who suffer from cancer health disparities.10,11,12,13 Unfortunately, current efforts to educate the most vulnerable segments of society about cancer prevention and control strategies have been insufficient to significantly reduce cancer incidence, morbidity, and mortality for members of these groups by helping them make informed decisions about their best health care and health promotion choices. 15,16,17,18 The

reduce cancer-related health disparities and to promote public health.

**2. Vulnerable populations and health communication** 

In addition to the negative stigma surrounding cancer and the reluctance to communicate about cancer, the complex nature of cancer etiology and treatment needs to be attended to when disseminating relevant cancer prevention and control information to health care consumers. Helping consumers make sense of the complexity of cancer-related information can often be a major challenge for consumers. Many consumers perceive cancer as one general disease and do not clearly differentiate between the unique forms, stages, and responses to different forms of cancer. Yet, cancer is not just one health care problem, but a complex set of diseases. The word cancer is an umbrella term that refers to a broad range of different forms and stages of cancer. These different forms of cancer typically are caused by a range of different factors, affect different parts of the body in unique ways, are displayed in distinct ways, produce a variety of symptoms and effects, are detected and treated in very different ways, and are likely to result in quite distinct prognoses depending on the kind of cancer diagnosed, its stage of detection, the treatments that are available, and the unique health histories and other co-morbidities experienced by the specific individuals who are confronting the cancer diagnosis.

The terminology and concepts related to cancer research and care can also be quite complicated, making it difficult to communicate relevant cancer information fully and clearly. It is not easy for most laypersons to understand the science behind cancer prevention and control recommendations. This can be especially problematic when communicating with representatives of vulnerable populations, such as many immigrants, people with limited education, those with lower socioeconomic status, some minority group members, and elderly individuals who may have limited levels of health literacy. 1 The need for effective communication about cancer risks, early detection, prevention, care, and survivorship is particularly acute for these at-risk populations, yet it is also tremendously challenging.2 Effective cancer communicators must develop culturally sensitive communication strategies for addressing health literacy challenges, explaining cancer information clearly to targeted audiences, and promoting full understanding about how to use the relevant information to promote cancer prevention and control. Strategic cancer communication efforts can help reduce the many uncertainties concerning cancer for at-risk consumers. It can provide vulnerable consumers with a rationale for making informed health decisions. It can facilitate participation in cancer prevention and control efforts, empowering consumers to engage in relevant health behaviors, such as adopting healthy living activities (such as recommendations for exercise, nutrition, and risk avoidance), and to seek early detection and screening tests. It can also encourage consumers to seek the best treatments for cancer and to cooperate with prescribed therapeutic regimens.2

However effective cancer communication efforts are further complicated by the sense of fatalism about cancer control that is widely held by many members of at-risk populations. Data reported from recent administrations of the Health Information National Trends Survey (HINTS) conducted by the National Cancer Institute suggest that many members of the American public believe there is little that can be done to prevent cancers and even less that can be done to treat cancers once they are diagnosed.2 A large numbers of HINTS respondents reported that they are confused by all the different recommendations they encounter concerning cancer prevention and control and are not sure what to do to reduce their risks for contracting cancers. 2 The range of competing recommendations about cancer that consumers often encounter gives them the impression that "everything causes cancer." What is worse, consumers report that the recommendations they hear concerning cancer

In addition to the negative stigma surrounding cancer and the reluctance to communicate about cancer, the complex nature of cancer etiology and treatment needs to be attended to when disseminating relevant cancer prevention and control information to health care consumers. Helping consumers make sense of the complexity of cancer-related information can often be a major challenge for consumers. Many consumers perceive cancer as one general disease and do not clearly differentiate between the unique forms, stages, and responses to different forms of cancer. Yet, cancer is not just one health care problem, but a complex set of diseases. The word cancer is an umbrella term that refers to a broad range of different forms and stages of cancer. These different forms of cancer typically are caused by a range of different factors, affect different parts of the body in unique ways, are displayed in distinct ways, produce a variety of symptoms and effects, are detected and treated in very different ways, and are likely to result in quite distinct prognoses depending on the kind of cancer diagnosed, its stage of detection, the treatments that are available, and the unique health histories and other co-morbidities experienced by the specific individuals who are

The terminology and concepts related to cancer research and care can also be quite complicated, making it difficult to communicate relevant cancer information fully and clearly. It is not easy for most laypersons to understand the science behind cancer prevention and control recommendations. This can be especially problematic when communicating with representatives of vulnerable populations, such as many immigrants, people with limited education, those with lower socioeconomic status, some minority group members, and elderly individuals who may have limited levels of health literacy. 1 The need for effective communication about cancer risks, early detection, prevention, care, and survivorship is particularly acute for these at-risk populations, yet it is also tremendously challenging.2 Effective cancer communicators must develop culturally sensitive communication strategies for addressing health literacy challenges, explaining cancer information clearly to targeted audiences, and promoting full understanding about how to use the relevant information to promote cancer prevention and control. Strategic cancer communication efforts can help reduce the many uncertainties concerning cancer for at-risk consumers. It can provide vulnerable consumers with a rationale for making informed health decisions. It can facilitate participation in cancer prevention and control efforts, empowering consumers to engage in relevant health behaviors, such as adopting healthy living activities (such as recommendations for exercise, nutrition, and risk avoidance), and to seek early detection and screening tests. It can also encourage consumers to seek the best

treatments for cancer and to cooperate with prescribed therapeutic regimens.2

However effective cancer communication efforts are further complicated by the sense of fatalism about cancer control that is widely held by many members of at-risk populations. Data reported from recent administrations of the Health Information National Trends Survey (HINTS) conducted by the National Cancer Institute suggest that many members of the American public believe there is little that can be done to prevent cancers and even less that can be done to treat cancers once they are diagnosed.2 A large numbers of HINTS respondents reported that they are confused by all the different recommendations they encounter concerning cancer prevention and control and are not sure what to do to reduce their risks for contracting cancers. 2 The range of competing recommendations about cancer that consumers often encounter gives them the impression that "everything causes cancer." What is worse, consumers report that the recommendations they hear concerning cancer

confronting the cancer diagnosis.

prevention and control seem to change all the time, further confusing them. 2 To counter these communication challenges, cancer communicators should develop clear, easy to understand, and consistent communication strategies for breaking through the confusion. They need to reduce the inertia caused by public fatalism concerning cancer with the use of engaging and persuasive messages that motivate adoption of evidence-based cancer prevention recommendations. This chapter examines the challenges to communicating relevant cancer prevention and control information to vulnerable populations and suggests best practices for designing meaningful messages and effectively using relevant media to reduce cancer-related health disparities and to promote public health.
