Agenda-Setting Research on Media for Cancer Prevention

Abstract

We can never forget our family, friends, neighbors, colleagues and so many others, who have lost their lives to cancer. Despite the development of medical technology and medical policies for cancer prevention and treatment, humanity still has not been able to conquer cancer, especially considering the increasing economic burden of cancer treatment on patients and their families. Cancer is still a disease that instills fear in people, thinking that “the next may be me”. This cancer-induced fear has led to the word ‘anti-cancer effect’ being used in media content as a form of relief. And yet at the same time, we often forget that fear because so many people’s lives have ended because of cancer. In an effort to prevent cancer, many countries around the world are implementing health policies and promoting healthy lifestyles, South Korea included. The South Korean government has been implementing cancer prevention programs, such as the national cancer screening program (NCSP) which is population-based. Through the government’s efforts, the country has seen a steady increase in cancer screening rates and a steady reduction in mortality from cancer. However, despite the statistics regarding the South Korean government’s successful implementation of prevention programs, the level of public awareness about the NCSP is lower than expected, with only half of the respondents of a previous study showing awareness (e.g. Kim et al., 2016). In addition, another study found that there were more respondents who believed that the government was not investing in improving the health of citizens than respondents who said that the government was investing (MOHW, 2021a). Therefore, it can be said that government’s policies for cancer prevention are successful in terms of the results of cancer prevention but that the perception and satisfaction of those policies are far from successful. In other words, the results from those studies demonstrated that it is necessary to explore what individual factors (not policy factors) actually affect people’s adherence to cancer preventative behaviors in order to close the gap between the government’s actions and the public’s perception. One previous study (e.g Kim, 2015) that explored the individual factor of income level found that, when dividing income level into four parts (high, upper-middle, lower-middle, and low), the population with high income showed a higher cancer examination rate than the population with low income. Alberts and Hess (2019) explained that health disparity factors can have a greater influence on the adherence to cancer preventative behaviors in high-income countries, including South Korea, than in low-income countries. Therefore, a study to analyze health disparity factors that have an impact on cancer prevention is essential. An and Lee (2019) explored media effects’ relation to health disparity factors and found the influence of the amount of cancer coverage on cancer screening rates. They observed that media effects were more powerful for people with an income level in the top 50% than for people in the bottom 50%. However, the reason behind these media effects were not addressed in that study. In order to find the reason, this study considered motivational factors and health disparity factors and their effect on cancer prevention. NFO in agenda-setting theory was used for motivational factors, and seven variables—including age, gender, marital status, education, income, employment, and region—were considered as health disparity factors in this study. Furthermore, in this study, the effects of these factors on the use of media for acquiring cancer information, on cancer related perception (cancer knowledge and perceived importance of cancer issues) and on cancer preventative behaviors (cancer screenings, weight management, alcohol intake, smoking, fruit and vegetable consumption) were analyzed. Since cancer preventative behaviors are usually recommended for middle-aged people in particular, this study targeted people in their 40s through 60s. This study was conducted by dividing the analysis into three stages. The first stage of ‘health communication factors’ analyzed motivational variables and health disparity variables of respondents. The second stage of ‘health communication process’ analyzed the effects of motivational variables and health disparity variables on media use when acquiring cancer information (seeking and scanning). The third stage of ‘health outcomes analyzed the effects of motivational variables, health disparity variables, and media use for acquiring cancer information on cancer perception and cancer preventative behaviors. This research design is based on the core assumption of agenda-setting theory, that media sets the public’s thoughts leading to changes in behavior. In the first step (‘health communication factors’), participants’ health disparity variables were measured and their levels of motivations for finding cancer information were found. The relationship between these two was then investigated. As a result, it was found that respondents’ prime motivations for finding cancer information were the ‘intellectual’, ‘topical’, situational’, ‘surveillant’, and ‘self’ motivations and that age and gender were significantly related to motivations for finding cancer information. In the second step (‘health communication process’), the effects of the participants’ motivational variables and health disparity variables on their degrees of media use were analyzed according to the type of media used and method of acquiring information. Search engines and informational TV programs were found to be the types of media that were mainly used to seek and scan cancer information. In addition, respondents’ health disparity status and their motivations for using media to find cancer information affected the determination of the type and way of using media. Furthermore, this study addressed elaborated definitions of seeking and scanning cancer information. Seeking cancer information is defined as finding information in frequently used types of media to search for a topic of interest (‘topical’), to search for high quality information to gain for background knowledge (‘intellectual’), and to search for useful information to understand current situation (‘situational’). In terms of infrequently used types of media, it is defined as finding information to search for information without a specific purpose (‘hedonic’) and to search for information as an escape from reality (‘evasive’). Scanning cancer information is defined as finding information to search for information that should be monitored as a member of society (‘surveillant’) regardless of frequency of use. In the third step (‘health outcomes’), the influences of participants’ motivational variables, health disparity variables, and media use to acquire cancer information on cancer knowledge, perceived importance of cancer issues, and cancer preventative behaviors (cancer screenings, weight management, alcohol intake, smoking, fruit and vegetable consumption) were examined. Cancer knowledge about liver cancer was the lowest for men, and cancer knowledge about cervical cancer was the lowest for women. Furthermore, the average level of cancer knowledge increased when respondents were older, or when they searched for cancer information through search engines. Cancer issues were ranked as having the highest perceived importance among health issues, and that perceived importance was mainly affected by the ‘situational’ motivation. Furthermore, information scanning via social media was seen to play an important role in recognizing the perceived importance of cancer issues, whereas information seeking via social media was seen to function in a different way. In the general results, participants who were in their 60s and participants who were married showed higher levels of adherence to cancer preventative behaviors. Usage of search engines and TV entertainment programs had a positive impact on cancer preventative behaviors. However, the ‘belonging’ motivation had a negative impact. Additionally, it was found that further action needs to be taken by the government regarding several cancer preventative behaviors and policy targets. Specifically, liver and colon cancer screenings need to be more focused on middle-aged South Korean women, and smoking and drinking need to be more focused on males in their 40s. This study provides evidence for understanding middle-aged South Koreans’ characteristics of media utilization for acquiring cancer information—characteristics that are affected by motivational and health disparity variables and that had an effect on their perception related to cancer issues and on their behaviors for cancer prevention. From the results of this study, an effective way of promoting the public’s adherence to cancer preventative behaviors was presented. In order to prompt people’s voluntary participation in cancer prevention, rather than using compulsory actions of cancer prevention, the government should consider the public’s needs toward cancer information and utilize their preferred method of media use.;의학 기술과 의료 정책의 발전에도 오늘날 암은 여전히 정복하지 못한 질병이며, 이에 따라 많은 사람이 지금, 이 순간에도 목숨을 잃고 있다. 한국을 비롯한 세계 여러 국가의 주요 사망원인은 암이며, 암으로 인한 의료비 부담은 점점 증가하고 있다. 이러한 손실을 줄이기 위해, 많은 국가에서는 암 예방과 관련한 의료 정책을 시행하고 있으며, 국민에게 암 예방을 위한 건강한 생활 습관을 장려하고 있다. 한국의 경우에는 ‘국가암검진’ 사업을 비롯해 전 국민을 대상으로 암 예방을 위해 정부가 노력하고 있으며, 이러한 정부의 노력 덕분에 암 검진 수검률의 지속적인 증가와 암으로 인한 사망률의 감소라는 긍정적 결과를 얻을 수 있었다. 그러나 이러한 고무적 결과와 다르게 국민의 ‘국가암검진’ 사업에 대한 인식이나 보건 정책 전반에 대한 만족도는 다른 양상을 보였다. 정부와 국민 간의 간극을 줄이기 위해서는 관련 정부 부처, 학계, 현장 등에서는 국민의 능동적이고 적극적인 참여를 끌어낼 방안을 모색해야 한다. 특히 미디어는 대중이 건강과 관련한 정보를 손쉽고 빠르게 얻을 수 있는 주요 정보원이기도 하다. 그러므로 본 연구는 방안 모색의 하나로서 미디어 이용자의 암 정보에 대한 욕구와 암 정보 획득을 위한 미디어 이용 특성 등을 이해하고자 한다. 본 연구에서는 중장년층의 암 예방과 관련한 인식(암 지식과 암 이슈에 대한 인지적 중요성) 및 행위(암 검진, 체중 관리, 음주, 흡연, 과일 및 채소 섭취)에 미치는 요인을 탐색했다. 그에 대한 요인 탐색을 위해 미디어 정보 획득 동기인 의제설정 이론의 정향욕구, 건강 불평등을 초래할 수 있는 요인(성별, 나이, 소득, 학력, 결혼상태, 고용 상태, 거주지역) 등이 활용됐다. 또한 본 연구는 분석 단계를 암 이슈에 대한 헬스 커뮤니케이션 (1) 요인, (2) 과정, (3) 결과 단계로 구분했다. 첫 번째 ‘요인’ 단계에서는 참여자의 암 정보 획득 동기 수준과 건강 불평등 요인의 수준을 확인했다. 그 결과 객관적 차원에서 지적(intellectual), 화제적(topical), 상황적(situational), 사회 감시적(surveillant) 동기가 주관적 차원에서 자아적(self) 동기가 주요 암 정보 이용 동기로 확인되었다. 또한 동기 요인과 불평등 요인 간의 관계를 확인했으며, 그 결과 연령은 화제적(topical), 자아적(self), 소속적(belonging), 회피적(evasive) 동기와 정적 관계를 맺는 것으로, 성별은 남성일수록 소속적(belonging), 회피적(evasive) 동기와 정적 관계가 있는 것으로 확인되었다. 두 번째 ‘과정’ 단계에서는 참여자의 암 동기 변인과 건강 불평등 변인이 암 정보 획득을 위한 미디어 이용에 미치는 영향력을 확인했다. 구체적인 탐색을 위해 본 연구에서는 이용되는 미디어의 종류와 미디어 이용 방식을 세분화했다. 이용되는 미디어의 종류는 남한의 중장년층이 주로 이용하는 매체 8가지(포털사이트, TV 홈쇼핑, TV 시사/교양 프로그램, TV 예능 프로그램, 신문, 동영상 공유 사이트 등)를 고려했으며, 그들의 정보 탐색의 방식을 능동적 방식인 정보 추구(information seeking)와 수동적 방식인 정보 스캐닝(information scanning)을 고려했다. 분석 결과, 정보 추구에서는 이용 수준이 높은 미디어와 이용 수준이 낮은 미디어별로 유의미한 효과를 보인 동기 유형에 차이가 확인되었다. 이용 수준이 높은 미디어에서는 화제적(topical), 지적(intellectual), 상황적(situational) 동기가, 이용 수준이 낮은 미디어에서는 회피적(evasive) 동기가 유의미한 정적 효과를 보였다. 따라서 암 정보 추구는 화제성이 높은 정보, 지적 수준을 높일 수 있는 정보, 상황적으로 필요한 정보에 대해서도 발생했지만, 오락적이고 일탈적 정보에 대해서도 이뤄짐을 확인했다. 정보 스캐닝과 관련한 분석 결과에서는 여러 미디어 유형에 걸쳐 사회 감시적(surveillant) 동기가 유의미한 정적 효과를 보였음을 확인했다. 즉, 암 정보 스캐닝은 주로 사회 감시적 목적에서 이뤄지는 것으로 확인되었다. 세 번째 ‘결과’ 단계에서는 참여자의 암 정보 획득 동기 요인, 건강 불평등 요인, 암 정보 획득을 위한 미디어 이용 요인이 암 지식, 암 이슈에 대한 인지적 중요성, 암 예방 행위에 미치는 영향력을 확인했다. 그 결과, 암 지식은 주로 암 정보 추구를 통해, 암 이슈에 대한 인지적 중요성은 암 정보 스캐닝을 통해 이뤄짐을 확인할 수 있었다. 또한 여러 예방 행위 중 여성의 대장암 검진과 간암 검진, 40대 남성의 음주, 흡연, 과일 및 채소 섭취에 관한 중재가 시급한 것으로 확인되었다. 본 연구에서는 암 예방 행위를 실천하지 않는 대상의 특성을 구체적으로 보여주고 있으며, 그들에게 효과적인 채널이 무엇인지, 해당 채널에서 어떻게 접근해야 하는지도 함께 밝히고 있다. 이를 바탕으로 미디어를 활용한 암 예방 중재가 이뤄지길 바란다. 또한 본 연구는 미디어의 건강 이슈에 대한 미디어 효과를 설명하는 데 의제설정 이론의 활용이 효과적임을 보여주고 있다. 추후 다양한 건강 이슈에 대한 의제설정 연구가 이뤄지길 기대한다.