Innovative Breast Cancer Awareness and Advocacy Campaign.

Breast cancer is a major disease in Nigeria; in 2012, 27,304 new occurrences were diagnosed, and the number of mortalities was 13,960. Greater than 70% of patients present with advanced disease, which has a poor survival outcome. The mortality rates are high mainly because of a lack of awareness about breast health, screening guidelines, and treatment centers, and because of sociocultural barriers. In Nigeria, health care professionals remain the backbone for the provision of medical information to the public. This is a study of the innovative ways that breast health and cancer awareness were promoted across communities and institutions in Lagos State, Nigeria, in 2015. Several community awareness campaigns were carried out in the forms of health talks, breast cancer screenings, radio and television interviews, and campaigns on social media. Anomalies noticed during the screenings were promptly referred to appropriate hospitals for additional treatment. The campaign culminated in the #12KLLP, or 12,000 people light Lagos pink, which was a Guinness World Record attempt for the largest human awareness ribbon formed for breast cancer. There was a total reach of 28,774,812 people across platforms: 285,318 were on social media, 3,620 were in communities, 7,466,276 were on the website, 20 million were through media events, 12,000 were through publications, 7,598 were verified participants at the Guinness World Record, and approximately 1 million were through blogs. Eighty partnerships were made with various private and government institutions to facilitate different aspects of the campaign. The community members were able to learn about the need for early detection and awareness; volunteerism and corporate social responsibility were promoted among individuals and corporate institutions.

INTRODUCTION

Cancer refers to any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue.[1] Cancer cells are abnormal because they divide uncontrollably. A life-threatening characteristic of these cells is their ability to spread to distant vital organs such as the lungs, liver, brain, and bone.

Worldwide, cancer is a leading cause of morbidity and mortality; there were approximately 14 million new occurrences and 8.2 million cancer-related deaths in 2012.[2] On average, in Nigeria, cancer has an annual incidence of 102,100 per year and a mortality rate of 71,600.[3] In 2012, Nigeria recorded an incidence of 27,304 breast cancer occurrences and a mortality rate of 13,960.[4] It has been estimated that 52,728 new occurrences will be recorded by the year 2035.[4]

The majority of patients with breast cancer present with stages III or IV disease, which is associated with lower survival rates. Some of the factors that account for late presentations include lack of awareness and information about basic symptoms of cancer as well as poor access to early screening and treatment.[5]

According to WHO, “Cancer mortality can be reduced if cases are detected and treated early,” because there is a higher chance of a cure.[2] Knowledge about cancer, public awareness programs, and national screening initiatives will increase earlier stages of presentation for patients. Also, cancer morbidity and mortality can be reduced and controlled by implementation of evidence-based strategies for cancer prevention, early detection of cancer, and appropriate management.[6]

To address the lack of awareness and to improve information about cancer screening services, Sebeccly Cancer Care, a national breast cancer charity, implemented an innovative public awareness program called the #12KLLP (12,000 people light Lagos pink). The overall goal of the #12KLLP campaign was to promote awareness of breast cancer and of the availability of breast cancer screening services. The #12KLLP was a Guinness World Record (GWR) attempt to form the largest human pink ribbon made up of 12,000 people. The awareness program was a 10-month-long event that began in February 2015 and ended in November 2015.

During the preparatory phase, a local organizing committee was formed to give strategic direction and planning. The #12KLLP featured community awareness programs, social media campaigns, and radio and television interviews, and it culminated with the GWR attempt on October 10, 2015. The campaign attracted people of all social classes and walks of life.

The existing record that the #12KLLP attempted to break stood at 6,487 individuals and was held on April 2, 2014, at the New Grain Market in Karnal, India.[7] Other GWR attempts for awareness about breast cancer include a largest shirt record in Brazil for breast cancer awareness.[8] Previous awareness campaigns at Sebeccly Cancer Care included the light Lagos pink campaign in 2014, in which various notable landmarks and buildings in Lagos were illuminated pink to raise awareness of breast cancer.

The objectives of this effort were to address the lack of awareness about cancer screening services and to improve information about cancer screening services.

PRE-CAMPAIGN STRATEGY

Awareness Before the Campaign

In preparation for the world breast cancer month of 2015, it was decided that a program to increase awareness of breast cancer should be carried out. The local organizing committee was set up to decide on a strategy that was based on innovation and that increased community involvement. The option of breaking a GWR and reaching women through the ensuing publicity was suggested and agreed upon. Partnership and endorsement was sought from the Lagos State government and the Nigeria police force to host and secure the campaign.

Major components of the campaign were community mobilization (in charge of recruitment and provision of information to the participants, who were corporate representatives, individuals, and volunteers), project management (in charge of overseeing the different aspects of the planning of the campaign), operations (in charge of procurement and logistics, including transportation, feeding, miscellaneous needs), administration, fundraising (in charge of sourcing funds, in-kind gifts, and technical support from donors and partners), and the medical unit and media (who were in charge of providing medical information and screenings and who attended media interviews and public relations). Publicity for the campaign was carried out by social media, television and radio interviews, electronic and print media, flyers, publications, community events, and word of mouth.

Training.

Training on social media management, fundraising, and project management was carried out in June 2015 by Niidasat Technologies and Sesor Africa. Seven team staff members were recruited, of whom five were on contract and two were volunteers, in addition to three full-time staff. The training by Niidasat Technologies lasted 4 days, and the training by Sesor Africa was held in 1 day.

Recruitment of team captains was done with the snowballing technique, in which a volunteer, upon hearing about the event, would tell and invite other volunteers to join. Criteria for inclusion as the team captain was age older than 18 years, commitment, place of work/residence, and capacity to mobilize at a community level. Volunteers were also recruited with the snowballing technique on the basis of their place of work/residence, commitment to work in selected units of their choice, and age older than 18 years. Several meetings were held to ascertain the volume of participants expected on the day of the record attempt and to prepare logistics of transport to the venue, food, security, and promotional materials, as well as media considerations (photography, videography, press releases, and social media platforms). Attendance records at the meetings were used to track the number of volunteers. Community awareness campaigns were carried out before the event to sensitize the communities in Surulere, Shomolu, Iganmu, Idi-Araba, Eti-Osa, Ikeja, Akoka, Yaba, and other areas.

Field work and visits had been conducted by the surveyor and security personnel at the chosen venue before the event. The chosen venue was the Teslim Balogun Stadium which is a 24,360-seater stadium of international standards; its turf dimensions are 120 meters by 80 meters. The stadium is located in Surulere, Lagos, opposite the National Stadium. The outline of the ribbon was marked out in chalk by the surveyor 2 days before the event, and calculations and projections on the population expected were made. In October 2015, the Sebeccly office moved to the Teslim Balogun Stadium for closer proximity and ease of logistics. Several high-level meetings were held with the stakeholders of the event, such as the heads of security agencies, Lagos State government officials, volunteers, medical services personnel, and members of the Sebeccly team. Letters and emails were sent to popular blogs in Lagos State to partner with Sebeccly Cancer Care in spreading the word online.

Selection and recruitment of ambassadors and witnesses.

Criteria for selection of witnesses and ambassadors included the size of the social media following, willingness to partner, interest, and commitment. In line with the rules and regulations of the GWR, witnesses were chosen on the basis of their willingness to function at the campaign without any form of remuneration from Sebeccly Cancer Care and by their occupations. Only occupations such as accountants, attorneys or judges, and senior police officers could be recruited to function as witnesses. Gbenga Badejo & Co, an auditing firm, was the independent auditor for the event. Witnesses were employees from other auditing and accounting firms in Lagos who voluntarily agreed to witness the record attempt, free of charge. An independent auditing firm was randomly selected from a list of firms that had been approached to partner with the effort. The witnesses and the auditing firm were all provided with the GWR guidelines for the record attempt in advance of the event.

The ambassadors were selected on the basis of the above-mentioned criteria. There were 10 ambassadors. Three ambassadors were entrepreneurs, two were media personnel (publishers in newspapers), and the remaining five were actresses in Nigeria (Nollywood). Awareness began in approximately May 2015; some of the venues where events occurred are listed in Table 1.

Table 1

List of Advocacy Activities in 2015 at Sebeccly Cancer Care

RESULTS

There were a total of 70 team captains who helped to speak to and gather the participants at the event, and there were 400 volunteers who were involved in different areas of organization, like transport, registration, and ushering.

There were approximately 9,000 participants present at the event; 7,598 were registered participants, and greater than 1,000 were unregistered. This number was verified by independent witnesses and an independent auditing firm (Gbenga Badejo & Co).

Sixteen meetings were held with the volunteers and team captains between February and October 2015. A total of 890 volunteers and staff were present during the meetings.

Areas of Innovation

The innovative nature of the campaign was apparent in the use of social media to recruit participants and disseminate information and in the use of a GWR attempt to generate interest and raise awareness about breast cancer. In addition, this was the first GWR attempt of its size in Nigeria and West Africa; it was the first largest human pink ribbon GWR attempt in Africa; and it was the first time that community members showed up in such numbers to support breast cancer awareness and explain the need to reduce stigmatization. Also, we had partnerships with 49 corporate bodies to help cut costs, and we had the ability to gather a crowd and educate them by leveraging good will. Last, it was the first campaign to have a robust network of cancer stakeholders, and this also helped us cut costs and leverage resources of our partners.

How Awareness Was Raised

Existing social media accounts for Sebeccly Cancer Care were used to raise awareness. During the 2015 campaign, the total reach on Twitter was 217,395, and it was 67,923 on Facebook (Fig 1).

Fig 1

Online reach across social media and the Web site #12KLLP, 12,000 people light Lagos pink.

Twenty community events held prior to the #12KLLP campaign raised awareness through distribution of breast health publications and conduction of breast cancer screenings and health talks. When abnormalities were detected in patients, appropriate referrals were made. There was a total community reach of 3,620, as recorded by the attendance taken at the events.

The website had 7,466,276 views in the year 2015 (between February and November). Views increased as the awareness for the program started and increased (Fig 2).

Fig 2

Web site reach in 2015 for the awareness program.

More than 50 media events promoted awareness; these included media interviews, press releases, press conferences, and advertisements granted by TV and radio houses and published in newspapers and magazines. The total reach estimated from the media events is about 20 million people from about 500,000 people reached per media interview.

A total of 5,000 copies of various publications about breast awareness and the #12KLLP were made. Through publications, short message service (SMS), and blog topics, there was an estimated reach of 12,000 people from the events where the publications were shared.

At the #12KLLP event, a record of 7,598 verified participants, as validated by the independent auditors and witnesses, was achieved. Health talks were given by a radiation oncologist, a survivor, and a representative of the Lagos State Ministry of Health.

Details of the event and breast awareness promotions were sent online on a weekly basis to subscribers of a #12KLLP e-newsletter.

Short text messages (bulk SMS) were sent on a weekly basis from September to November 2015 to disseminate information about the campaign, such as the instructions for participants at the venue and the directions to the venue. The text messages were funded by Sebeccly Cancer Care.

The campaign was featured on five popular blogs that had national coverage. Each of the blogs had an estimated reach of 200,000 in Lagos, so an estimated total of 1 million people were reached by blogs.

The total estimated reach for the awareness campaign in 2015 was 28,774,812 people.

Partnerships

Partnerships in the form of technical, mobilization, media, and financial sponsorships were secured with several stakeholders. The partnerships were sources of funds, kind gifts, and services. Fundraising was done through crowdfunding, corporate donations, and sale of merchandise to generate funds from the event (exhibition booths and advertisements).

A total of 20 corporate organizations (Fig 3) financially sponsored the logistics and planning of the #12KLLP. Ten product sponsors partnered with Sebeccly Cancer Care to provide products for the campaign. Media consideration was provided through the services of 19 media outfits that partnered with Sebeccly Cancer Care in areas of granting interviews, advertising the campaign, and broadcasting radio and television jingles. We had ambassadors who were prominent citizens to lend the #12KLLP their community followership and public image. The ambassador role was to influence the general public about cancer awareness. We had 10 ambassadors at the campaign, and we had a representative of the first lady of Lagos State.

Fig 3

Pie chart of sponsors and partners.

After inclusion of technical and mobilization partners, the total number of partnerships, in addition to 10 ambassadors, was greater than 80.

Technical Partners

Our technical and mobilization partners ranged from government agencies to local partners. They are listed in Table 2.

Table 2

List of Technical and Mobilization Partners for #12KLLP

DISCUSSION

Social media is now an important tool to disseminate information about cancer prevention and screening.[9] As seen from the results of our campaign, and as reflected by the number of people who accessed and shared details on cancer on the website and on the social media pages, the awareness of the Lagos population about breast cancer was increased.[10] The increase is seen graphically in Figures 1 and 2: the number of people who viewed the information increased steadily throughout the campaign. With a reach of greater than 28 million people, the information about cancer risk factors and treatment options available in Nigeria reached a substantial amount of the population.[11] At Sebeccly Cancer Care, there is a history that spans many years of helping patients who have cancer with their health care by sourcing funds for their drugs and treatment.[12] A workforce that consists of doctors, dedicated office staff, and volunteers work toward provision of services that will increase cancer awareness and help patients.[12]

The opportunity for members of the public as well as office staff to give voluntarily and generously to the cause of helping patients with cancer was made available by enabling various means of giving through the account, the website, and online payment pathways.[12] Subsidies provided at some hospitals for some cancer treatment procedures were an innovative means of handling financial obstacles. This, with the support of the hospitals, goes a long way to re-duce the financial load on the patient and the group.[12]

Perseverance and professionalism are our traits seen by our partners and patients, who have come to appreciate these attributes in their dealings with us in preparation for our campaigns and for patient care.[12]

There are some limitations to this campaign. The political landscape was unpredictable because of the 2015 election period and was unstable because of the time taken to appoint government officials by the new government. Also, threats of insurgency in gatherings and minimal manpower were added obstacles that were overcome by the security personnel on ground.

The impact of the effort was broad. Through various speakers, including a survivor, we educated greater than 7,500 participants on breast cancer at the event venue and more than 20 million on social media platforms and in communities, with activities like community-awareness campaigns and trends on social media. The #12KLLP campaign promoted and encouraged community social responsibility; team captains were members of the communities where they recruited participants.

Team captains and volunteers gave individuals the opportunity to give back to the community. The #12KLLP campaign promoted corporate social responsibility by fostering partnerships among 49 companies. We collaborated with up to 49 companies to aid in different aspects of the campaign, including provision of food, security of the venue, event security, marking out the ribbon, and ensuring the event ran smoothly. We helped promote volunteerism in Nigeria: greater than 400 volunteers participated in the campaign, and countless others volunteered in the planning but were unavoidably absent at the event. The campaign promoted awareness about the need for the community to support cancer management. Partnerships were formed with the Lagos State government in a bid to influence cancer policies and to help facilitate any future cancer awareness events.

Many lessons were learned in this campaign. The road to reduction of the cancer burden is not an easy one. There is a need for more collaboration between well-meaning citizens and institutions to help increase the availability of screening services and treatment options available. This need is especially apparent in developing countries. Volunteers are an important aspect of any campaign. As such, they should be effectively trained for their responsibilities. This is important when such responsibilities include health information dissemination and screening. Social media is a major agent of connection in the world and has been used for countless campaigns in many places. Nongovernmental organizations and other institutions that provide cancer care can use social media to share details about early access to screening services and treatment options. This will help to reduce the overall burden.

In conclusion, there is a need to present cancer information through an engaging platform, to promote awareness and empower the community to actively fight cancer by early presentation and initiation of treatment. To this end, the #12KLLP breast cancer awareness campaign was able to disseminate information and raise awareness effectively by the community events and the GWR attempt, in which approximately 9,000 individuals gathered together for the cause.

The need to access cancer screening was communicated effectively by doctors, cancer survivors, and celebrities at the event and at the awareness campaigns throughout the year. However, there is much to be done. There needs to be greater cooperation among the government agencies, private institutions, nongovernmental organizations, and individuals to spread information about cancer. This will go a long way in reduction of the overall burden on the populace.