Convincing public health messages are difficult to create and to communicate [14, 15]. Health campaigns are an important means of health communication and often focus on the media. The Swiss printed media occupy an important position compared to neighboring countries and the density of newspapers is very high [15]. Therefore, health campaign planners in Switzerland should be knowledgeable about the interplay with the printed media. In Switzerland the presence of three main national languages adds complexity to the situation.
This study was undertaken in an attempt to analyze the printed media response to two colon cancer campaigns in Switzerland. Four main conclusions can be drawn from this work.
First, our results clearly showed a massive reporting of colon cancer in German newspapers (65%), which is not due to an overrepresentation of printed media in the region. There may be a cultural gap between the German and Latin parts of the country in receiving the same health message. The Swiss media are segmented in at least three distribution areas and thus Swiss citizens tend to address the same problems differently [5]. In spite of a large choice of media in various languages, three quarters of the population only consume written media in the official language in their area. It may well be that the reduced impact in Romandie (French-speaking) and Ticino (Italian-speaking) derives from the fact that the campaign was originally designed in German and then translated. Studies in interlinguistic equivalence in the medical field have indeed brought out the question of cultural identities in the translation of health vocabulary [17, 18].
Second, the distribution of types of newspapers is interesting as two thirds of all selected articles were from regional newspapers. We discovered that most of them were local papers whose distribution was limited to small regions within Switzerland. Given the high local impact of this regional press, we offer for interpretation that these newspapers may be an efficient vehicle for public health information [19].
Third, we observed that the media response to both colon cancer campaigns was restricted to the duration of the campaign. Colon cancer is not adequately treated during 10 months per year. Such short term effects of campaigns have already been described [19, 20].
The "5 a day" campaign had the same background level of reporting during the whole observation period. The efficiency of "5 a day" may be explained by its strong identity (an easy-to-remember slogan and a good logo).
Fourth, both loss- and gain-frames were used by the journalists, whereas the campaign itself was merely using gain-frames. According to prospect theory, even if the information within the messages is equivalent, the willingness to incur risk in order to obtain a desirable outcome or avoid an undesirable outcome changes depending on the message framing [20]. Several studies have shown that gain-framed messages, such as those issued by the campaigns, lead to a greater behavior shift then loss-framed ones. The articles show a nearly even distribution of both frames, especially in the Latin newspapers. However, since preferences in the mixed frame condition were virtually identical to the positive frame [21], we can consider media reported messages as gain-framed [22], thus suggesting that messages could be perceived by the reader as a motivation to change behavior.
Moreover, the influence of framing depends on the type of behavior which is promoted, which can be prevention or detection behavior. Among these two behaviors, a different degree of proximal risk is perceived, and prevention behaviors are usually considered less risky that detection ones [23]. For these reasons we hypothesize that "Dramkrebs-nie" and "5 a day" campaigns through their preventive attitude induce more behavior shift than "Self-care" which invites people to perform detection screening. The contents of the articles promote both behaviors, suggesting a prevention package linking a daily consumption of 5 portions of vegetables and fruit with regular physical activity and early detection by screening.
Changing health behaviors requires more than media communication and increasing health literacy. It largely depends on different enabling factors. First, self-motivation and personal skills are necessary to carry out successfully all of the tasks involved in changing behaviour. Second, human and structural health care resources are required to increase array of health information and health-related support services and extend the reach of health communication. Third community and environmental condition should be supportive of that change [24–26].
The next step would be to determine the impact of these messages on the population and ultimately their behavioral change. A pre- and post-campaign questionnaire study could be a first means of testing the uptake of the message as the campaign runs every September. However, the objective of this study was to analyze the quantitative and qualitative aspects of the reporting of the two campaigns; a further study should investigate the effects on awareness in the target population.
