Introduction

Ethnic media outreach can be a promising approach for increasing coverage of cancer information among minority communities [1, 2] and a potential mode for dissemination of cancer control messages [3]. Ethnic media provides news and information to racial and ethnic communities as its primary audience and consists of an extensive communication landscape, including newspapers, radio and television outlets, Web, and social media sites. With many of these media outlets specifically serving African Americans, Asian Americans, American Indians, Alaska Natives, Hispanics, and others, ethnic media has become a viable channel for reaching these audiences and regularly reaches 57 million people in the US [4]. Ethnic media outlets cover stories not always deemed newsworthy by the mainstream press on the activities of those ethnic groups in the US, and have been viewed by their audiences as leaders in their communities [5]. Ethnic media organizations also show a greater commitment to disseminating cancer prevention and education messages compared to the mainstream media and focus more on cancer awareness and education, reflective of their role in the community [3].

The National Cancer Institute (NCI) developed the Multicultural Media Outreach (MMO) program, which utilizes an integrated approach of both traditional (print, radio, and television) and social media (web, Twitter, YouTube, and RSS feed) to disseminate evidence-based cancer education information tailored to minority communities. This paper describes the Multicultural Media Outreach program, provides an overview of the development and dissemination of cancer content through the Lifelines® cancer education series, and shares several lessons learned to date.

Multicultural Media Outreach Program

Established in 2008, the MMO program at the NCI's Office of Communications and Education is the contact point for multicultural media outlets seeking evidence-based cancer information, education materials, minority spokespersons, and news tailored to minority communities affected by cancer health disparities (see Fig. 1). NCI works with media partners to disseminate culturally relevant information through media interviews, drop-in articles for ethnic newspapers, video vignettes, and other web-based and social media.

Fig. 1
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Multicultural Media Outreach program general process model

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Prior to the establishment of MMO, NCI's minority media outreach program proactively reached out to the media—primarily to ethnic and cultural radio outlets. Through this approach, NCI minority researchers served as spokespersons on ethnic radio, giving interviews that were broadcast in their respective communities, and thereby introducing NCI as a resource for cancer information. By promoting feature stories around cancer awareness observances, NCI made headway in earning regular media coverage for important cancer topics and NCI resources. This enabled better outreach to minority communities across the country and offered NCI the opportunity to explain its role in cancer research, establish itself as a source for cancer news and information, and direct members of underserved populations to NCI's resources and information.

The Lifelines® cancer education series (discussed later) represents the evolution of that approach, taking NCI from a radio-focused outreach initiative to a full-fledged multimedia package of cancer content for racial and ethnic minorities. While MMO continues to proactively support radio interviews, its primary focus has shifted to content creation and mass dissemination of specially produced ready-to-use content through “push” strategies and self-distribution venues. MMO has been able to expand the reach to multicultural audiences through traditional and social media channels (Fig. 2).

Fig. 2
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Multicultural Media Outreach program primary channels

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Lifelines® is a registered trademark of the US Department of Health and Human Services.

Lifelines® Cancer Education Series

As the cornerstone of the MMO program, Lifelines® is a series of cancer education articles, video, and audio files addressing cancer prevention, treatment, survivorship, health disparities, clinical trials, and other cancer-related topics. Originally started as a bimonthly newspaper article series on cancer, tailored to the African American and Hispanic press, Lifelines® has now expanded to include video (for online and TV audiences) and prerecorded audio segments (for radio and online listening). Currently, Lifelines® reaches out to Asian American and American Indian and Alaska Native populations in addition to the two original audiences. Social media provides opportunities to disseminate Lifelines® videos through NCI's channel on YouTube (www.youtube.com/ncigov), and to rapidly share cancer information and other cancer education resources through Twitter (@NCImcMedia).

Lifelines® topics are generated from research findings and cancer statistics (e.g., Surveillance, Epidemiology, and End Results data), as well as from published scientific literature and through ethnic media representatives who provide insights to the needs of their community. Topics range from the impact of specific cancer types or risk factors in minority communities (e.g., high risk for hepatitis B in Asian Americans [6]) to information across the cancer continuum (e.g., prevention, diagnosis, treatment, and survivorship), cultural myths related to cancer (e.g., some African Americans' perception that menthol cigarettes are less harmful [7]), and other disparities issues.

MMO's evidence-based print and web-posted Lifelines® articles provide key cancer statistics related to race and ethnicity, educate about specific cancer types or issues affecting their community, and provide cue-to-action messages such as informing readers/listeners about cancer screening or how to talk with their physician about a cancer-related concern. NCI resources are provided at the end of each article, with links to additional evidence-based information such as www.cancer.gov and contact information for NCI's Cancer Information Service (1-800-4-CANCER).

Lifelines® articles are written in a style that is similar to newspaper articles and incorporates plain language principles including health literacy, numeracy, terminology, and length. Cultural norms and values (such as focusing on family or the role of tradition) as identified in the literature are elements that are incorporated into the articles. These articles can be used as drop-in articles or adapted for a particular audience. Lifelines® videos feature prominent minority researchers and health professionals speaking to their own communities about topics across the cancer control continuum. Additionally, some articles and videos are available in Spanish. In 2012, MMO expanded its radio outreach with the introduction of a web-based broadcast initiative called Lifelines® on National Institutes of Health (NIH) Radio that provides radio outlets access to broadcast-ready and population-specific segments on culturally relevant cancer control and prevention information. All article and script content is reviewed for scientific accuracy through the NCI content clearance office. All Lifelines® educational materials (e.g., articles, videos, and audio files) are available to the public and are free of charge.

Lifelines® articles are disseminated through contracted news media distributors (e.g., wire services) that focus on ethnic media outlets. Any media outlets could choose to use the story or not. Other Lifelines® articles for specific communities (e.g., American Indian and Alaska Native) are directly placed with media outlets serving these communities. Lifelines® video and prerecorded audio segments are disseminated via social media (primarily Twitter), email announcements to various media organizations, and embedded links in select articles.

MMO has built many relationships and accumulated numerous minority media contacts across the country as part of its ongoing work to disseminate cancer education and awareness information to minority audiences. The MMO program hosts several webinars and workshops throughout the year for ethnic media outlets to inform these organizations about cancer issues impacting their communities. This outreach effort helps sustain MMO's media partnerships as well as enhance opportunities for media coverage. In addition, these relationships help MMO keep abreast of what communities want to know about cancer, in addition to published literature.

MMO Coverage in Ethnic Media

During 2008 to 2012, several new technologies, platforms, and other dissemination opportunities became available. As a result, MMO implemented a number of strategies to increase dissemination of MMO-generated cancer information including engaging in social media by releasing its first YouTube video and tweeting from its own Twitter account (2009), launching a new web page (2010), establishing an RSS feed (2011), and expanding Lifelines® content to NIH Radio (2012). The number of media placements from 2008 to 2012 was examined from a variety of media reports provided by ethnic media wire services, individual media outlets, web analytics, online searches, and internal logs to assess the use of MMO-generated cancer information. A media placement as a measure of coverage is operationally defined as a cancer story or segment—in article, video, or audio format—which is posted (online), broadcast (on different radio or television stations), or printed (in different newspapers). Results illustrate that since 2008, MMO has increased the volume of its cancer information in ethnic media. Based on available data, media placements increased from 282 placements from the inception of the MMO program in the fall of 2008 to 3,390 placements through the end of 2012 (see Fig. 3).

Fig. 3
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MMO media placements (based on available data) from 2008 to 2012

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From 2008 through 2012, approximately 10,684 media placements were reported. Over half (59 %) of the media placements were identified with the African–American audience, over one-third (37 %) with the Hispanic audience, and the remainder (4 %) with Asian–Americans, American Indians, and Alaska Natives and multicultural audience combined (see Fig. 4).

Fig. 4
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Cumulative MMO media placements by audience (based on available data) from 2008 to 2012, rounded to nearest percent. Additional audiences include Asian Americans, American Indians and Alaska Natives, and multicultural audience

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Lessons Learned

Several lessons learned have emerged based on our observations from implementing the MMO program as follows:

  1. 1.

    Timing. Because MMO content is not news in the traditional mainstream media sense, it was important to tie the articles, videos, and audio segments to cancer awareness periods (e.g., Breast Cancer Awareness Month) in order to obtain placement within media outlets. These awareness periods served as timely opportunities to post or broadcast cancer information, giving the information a more relevant context for these special audiences.

  2. 2.

    Ready-to-use information. The likelihood of a media outlet posting a story or video increased when content from a credible source was already available and ready to use as-is. Thus, a tenet of the MMO program has become creating media that is completely ready to use by a range of information dissemination organizations. This is especially important, since many ethnic media outlets are very small operations [5] and may not have the resources or expertise to prepare this type of content and/or a particular format.

  3. 3.

    Collaboration. Collaborating with the editor, journalist, or radio interviewer is important and may help increase the reception of the cancer information to their audience. This is done by providing key talking points and cancer background information specific to the audience served. Working in conjunction with journalists may help to reframe the cancer news coverage [3] in a way that is engaging, easy to understand, and culturally relevant.

  4. 4.

    Population-specific. Health information and messaging should be presented with more emphasis on the “real life” outcome of cancer research and what it means for members of the community/audience. Minority communities may look to their ethnic media to provide population-specific insight and information that explains cancer news and research findings as it relates to their communities. Tailoring messages to meet the unique needs and communication styles of specific audiences is an important factor in strategic health communication [8].

  5. 5.

    Multiple channels. With advances in communication technology, the ways in which people get information are constantly evolving. As a result, we need to be adaptive in our dissemination approach in order to maximize reach into various communities. Racial and ethnic minorities are engaging in online activity at an increasing rate. In a recent survey, a large majority of African Americans (71 %) and Hispanics (72 %) reported using social networking sites, and Twitter use was found to be more popular among African Americans and Hispanics, both reporting higher usage than Whites [9]. Integrating traditional and social media outreach, in our experience, can help maximize cancer education opportunities by delivering cancer information through a broad range of channels.

Conclusions

Cancer education is a critical component when addressing cancer health disparities, and efforts to engage in a more direct approach to reaching underserved audiences through ethnic media should be considered by health educators and health communicators. Outreach through ethnic media provides a valuable opportunity to access multicultural audiences. Providing specialized and credible cancer information resources in readily presentable formats to ethnic media outlets can increase coverage of cancer information among minority communities. Using these resources, ethnic media journalists can localize interesting, meaningful, and culturally-relevant stories that feature the latest cancer research and then provide placement for those stories, thereby increasing access to cancer information for underserved populations.