International Journal of Nonprofit and Voluntary Sector Marketing

Int. J. Nonprofit Volunt. Sect. Mark. 12: 338349 (2007)

Published online 8 January 2007 in Wiley InterScience
(www.interscience.wiley.com) DOI: 10.1002/nvsm.294

Consumer attitudes towards

self-referral with early signs of
cancer: Implications for symptom
awareness campaigns
Douglas Eadie* and Susan MacAskill
Institute for Social Marketing, University of Stirling and The Open University, UK

Traditionally, secondary prevention programmes have employed mass screening

approaches to assess for asymptomatic signs of cancer. It has been suggested that early
detection strategies, involving public education and self-referral may prove more costeffective, with low-risk populations for cancers with symptomatic presentation. The
success of public education approaches is dependent on careful consideration of the
psycho-social factors of self-examination and referral. This paper presents the findings
from an exploratory study, using qualitative methods with an at-risk population of older
people living in deprived communities in west-central Scotland. The study examines
consumer perceptions of the early detection of cancer and the cultural barriers to
self-referral, as well as response to aspects of communication strategy. The implications
for design of symptom awareness campaigns, including use of message appeals, specification of target symptoms, identification of target audience and selection of communication
channels, are discussed.
Copyright # 2007 John Wiley & Sons, Ltd.

Introduction
Cancer is now the most common cause of
death in the UK. Around a third of all people in
the UK will develop cancer, with the majority
of cancers occurring later in life64% of
cancers occur in people aged 65 or over
(Quinn et al., 2005). Cancer rates for some of
the major cancers are significantly higher in
more deprived regions. One such area is the
central belt of Scotland, where incidence and
*Correspondence to: Douglas Eadie, Institute for Social
Marketing, Department of Marketing, University of Stirling, Stirling FK9 4LA, UK.
E-mail: douglas.eadie@stir.ac.uk

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2007 John Wiley & Sons, Ltd.

mortality rates for cancer are 15% above the

national average.
Whilst the UK has witnessed a growth in
the incidence of cancer, mortality for the
disease has decreased. Key to these improvements has been developments in secondary
prevention approaches and early diagnosis
of the disease. In the UK, like most other
developed countries, major advances have
been made in mass screening of at-risk
populations to identify cancers at a pre-symptomatic stage. However, the costs associated
with mass screening can prove prohibitive,
particularly when targeting populations at
relatively low risk (Bloom, 1994).

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Cancer prevention and symptom awareness campaigns

Given these constraints, recent attention

has focussed upon the value of promoting
symptom awareness. In the UK, efforts have
been made to promote early recognition of
signs by doctors in primary care, as part of a
package of measures to speed up the referral
process (Department of Health, 2000). However, evidence indicates that the majority of
delays are accounted for by patient failure to
self-refer when symptoms present (Anderson
et al., 1995; Ristvedt and Trinkaus, 2005).
This raises important issues about the use of
mass media to inform people about cancer
symptoms and the appropriate use of health
services, where accurate identification and
speed of response to symptoms are critical
measures of success (Bloom, 1994).
The mass media are an established source of
information about cancer (Signorielli, 1990).
They are also an important influence on public
attitudes: setting the public agenda by, for
example, putting certain cancers on the
public radar; conferring status and legitimacy
on specific topics or points view; and providing a framework for public discourse about
disease (Wallack and Sciandra, 199091). In
this way, the media have the potential, not only
to reduce the stigma, fear and embarrassment
associated with cancer, but also more fundamentally to give people permission and a
vocabulary for discussing specific cancers and
their symptoms.
However, it is also important to recognise the
limitations and risks associated with interventions which seek to exploit the media, whether
directly through media campaigns or indirectly
by influencing unpaid media. There is abundant
evidence in the field of primary prevention of
media interventions bringing about changes in
awareness, knowledge, and, to a lesser extent,
attitudes to modifiable health risk factors such
as smoking (e.g. Flay, 1987; Campion et al.,
1994; Hafstad et al., 1997). However, evidence
that the media can influence health behaviour is
less conclusive, with many evaluations showing
limited, short-term or no impact (e.g. Murray
et al., 1994; Bauman et al., 1989, 1991). In
view of this evidence, it is suggested that
symptom recognition is more suited to media
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339

intervention than lifestyle behaviour change,

as it involves affecting what Pasick and
Wallack (198889) refer to as one-time behaviours eliciting a request for information
(p. 93). Indeed, the ability of media campaigns
to increase intentions and attendance for cancer
screening would appear to support this assertion (e.g. Turnbull et al., 1992; Byles et al.,
1996; Jenkins et al., 1999), although there are
important differences both in terms of motivation and information specificity between mass
screening and symptom awareness campaigns.
While the benefits of symptom awareness is
accepted for cancers where early signs are
recognisable, for example with malignant
melanoma (Rhodes, 1995), it is also hypothesised that poorly designed and implemented
campaigns have the potential to do more harm
than good. More specifically, health service
providers express concern about their ability
to cause delays in diagnosis and treatment.
Observers warn that campaigns, intended to
raise awareness of the early signs of disease
can arouse fear in patients with appropriate
symptoms, leading to delays in self-referral,
and encourage the so-called worried well to
seek reassurance with inappropriate symptoms, blocking the system for those patients
with genuine need (MacKie, 1997).
Others have warned against the risk of
increasing social disadvantage and health
inequalities. As higher income and more
educated groups tend to derive more from
health information campaigns than do disadvantaged groups (e.g. Windahl et al., 1992;
McQuail, 1994), mass media campaigns which
address the whole population risk widening,
rather than narrowing inequalities by disproportionately benefiting those with better
access and who are more disposed to exploiting preventive services (Arblaster et al., 1996).
Evidence from cancer screening programmes
suggests that with careful attention to campaign design, it is possible to narrow inequalities in health knowledge, behaviour and
access to health care (e.g. Dignan et al.,
1994; Sugg Skinner et al., 1994).
In order to realise the benefits and avoid
the pitfalls of media interventions intended to

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Douglas Eadie and Susan MacAskill

improve symptom awareness, formative research is critical to ensuring campaign development is shaped by an in-depth understanding of the factors which influence consumers
help-seeking behaviour and the social context
in which these take place (Eadie and Smith,
1995). This paper describes the results to
emerge from an exploratory study, examining
attitudes towards cancer recognition and the
factors which facilitate and hinder self-referral
with suspicious symptoms. The study was
conducted with an at-risk population of
older people living in deprived communities
in west-central Scotland, and formed part of a
broader programme of research which aimed
to inform the development of cancer-specific
symptom awareness campaigns in the study
communities.

Method
The researchers adopted a positivist approach
to the enquiry, using qualitative focus groups
to provide the necessary flexibility to understand the range of behavioural issues under
investigation, a method other studies have
found useful for examining cancer prevention
issues (e.g. Beeker et al., 2000; Wolf et al.,
2001).
A total of eight focus groups were conducted with a mean of seven participants
per group (n 57). A discussion guide was
devised to ensure moderators covered the
topics relevant to the research. Topics were
not explored in a prescriptive manner. Instead,

participants were given the freedom to express

their own feelings and views, as part of an
open and free-ranging discussion. This flexible
format enabled the researcher to develop
original lines of enquiry, allowing salient topics
and behavioural insights to emerge. Table 1
lists the main discussion themes.
Each focus group lasted approximately
one and a quarter hours and was held in a
neutral venue, such as a community centre or
local hall. With the participants consent, the
discussion was recorded on voice tape, and the
tapes transcribed in full for thematic analysis.
Transcripts were organised, using a thematic
framework, based on topics specified in the
discussion guide and emerging themes identified through a process of familiarisation with
transcript texts.
In order to produce a relaxed atmosphere
conducive to open discussion, it is usually
desirable for focus groups to be as homogeneous as possible in socio-demographic
and/or other characteristics (Parasuraman,
1991). It is also important to quota-sample
sub-groups which represent relevant positions
on the issues being researched, so that any
differences between these sub-groups can be
identified (Atkin and Freimuth, 1989). Taking
into account these requirements, the sample
incorporated the following quota variables:
gender, age, socio-economic group and place
of residence (see Table 2).
The research sought to sample a subpopulation whose age, socio-economic status
and lifestyle placed them at elevated risk to

Table 1. Discussion themes

Theme 1Cancer awareness
Awareness and perceptions of cancer, including: signs and symptoms, seriousness and survival rates,
perceptions of who is at risk and awareness and understanding of measures to help detect and prevent cancer
Theme 2Presentation with potential symptoms of cancer
Preparedness to undertake regular self-examination and to present to primary care or other health care providers,
with suspicious signs and symptoms. Particular emphasis was placed on examining the social and structural
barriers (perceived and real) which could deter self-referral
Theme 3Health information campaigns
Attitudes towards, and experience of, health information campaigns: factors which enhance response with
regards to message, channel, language and tone of communication. A selection of cancer awareness materials was
used to stimulate discussion and to examine alternative message and media formats

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Cancer prevention and symptom awareness campaigns

Table 2. Study sample
Group
number

Gender

Age

Socio-economic
group

Place of
residence

1
2
3
4
5
6
7
8

Male
Female
Male
Female
Male
Female
Male
Female

4055
5670
5670
4055
4055
5670
5670
4055

C1C2
C1C2
DE
DE
DE
DE
C1C2
C1C2

Rural
Urban
Urban
Urban
Urban
Rural
Urban
Urban

cancer. As well as the socio-economic variables

described in Table 2, participants were
recruited as tobacco smokers (10 or more
cigarettes per day), drinking alcohol in excess
of the recommended weekly limit (14 units
for women and 21 units for men) and eating
less than the recommended five portions of
fruit and vegetables per day. Participants were
recruited from four health authority areas
in west-central Scotland, a region with high
rates of deprivation and a higher than average
incidence of cancer.

Results
The results presented here are organised
into four discrete study themes: perceptions
and attitudes to early detection of cancer,
experiences of early intervention campaigns,
response to different message appeals and
sources of advice about suspicious symptoms.

Cancer was regarded as a common disease

which could affect all sectors of Scottish
society. The majority of participants knew of
at least one person in their social network,
typically an elderly relative or family friend,
who had cancer or who had died from
the disease. A smaller number had personal
experience of the disease. Attitudes towards
the disease were characterised by a sense
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of fatalism and underlying fear, particularly

amongst older participants, although there
was a general belief that people were less
reluctant to talk about the disease, compared
with previous generations, with the media
appearing to have a normalising effect.
You never heard about it years and years
ago. Its the same as other illnesses like
Alzheimersthey were just put under the
carpet.
A lot of things are out in the open compared
to what they used to be. (Female, 5670,
DE, Rural)
Now you see it on the telly all the time.
If somebody famous died with anything like
bowel cancer, if it goes on the news,
everybody will be in the pub . . . Did you
hear so-and-so died of bowel cancer? . . .
Everybody would be talking about it. (Male,
5570, DE, Urban)
Early detection was a familiar concept, more
so amongst women, many of whom were
regular participants in mass screening programmes. It was also widely recognised that
early detection and treatment improved
chances of survival, and that the individual
had the potential to affect their own health by
presenting early if they experienced suspicious
symptoms.
If you leave it too late, its curtains anyway.
They tell you nowadays if they catch it in
time they can do wonders. (Male, 5570,
DE, Urban)

Perceptions and attitudes to early

detection of cancer

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341

Fear of cancer and high levels of mortality

associated with the disease were a recurring
theme in the discussions and had a negative
impact on peoples willingness to consider
self-detection strategies and to seek the
opinion of a health professional or to discuss
symptoms with family or friends. This pattern
of response was expressed in different ways.

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Douglas Eadie and Susan MacAskill

Women were more likely to recognise and

verbalise these fears:
Everything would put me off. Id be
petrified.
You just suffer it. Its the only chance
youve got. (Female, 56-70, DE, Rural)
Men, on the other hand, were more inclined
to deny these fears, which in some instances
led them to adopt extreme and entrenched
positions on the issue as the following quote
illustrates:
I believe that once youve got cancer youve
got it. Ive known people who have had
cancer and not one of them is this day living.
Nothing can be done. (Male, 4055, C1C2,
Rural)
So whilst the benefits of early presentation
and diagnosis were widely accepted at a
rational and objective level, when viewed at
a personal level, the strong emotions which
cancer can arouse appeared to act as a barrier
to confronting the issue.
Its always in the back of your mindyou
say to yourself, Ive got this ache/pain.
Im in agony, but Im no in enough agony
to phone the doctor.

Thats the usual, isnt itsee what its like

tomorrow. (Male, 4055, DE, Urban)

Early intervention campaigns

In keeping with peoples objective evaluation

of the benefits of early detection, participants
were generally supportive of interventions
designed to promote secondary prevention,
although understanding of the concept and its
relationship with curative procedures was
sometimes limited.
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It is a wee prompt that, to go and get seen to

if you think youve got a problem.
I think there should be something like that,
yeah. (Male, 4055, DE, Urban)
Participants also supported the principle of
patient education and raising public awareness
of the early signs and symptoms of cancer. This
was a familiar idea with some recalling having
seen information posters in health care premises and patient waiting areas raising awareness of specific cancers and their symptoms.
I think in a lot of the surgeries now have
signs up saying if there is any change in your
bowel habits get it seen to. Make sure it is
nothing. (Male, 5570, C1C2, Urban)
Support for these campaigns was premised
on the belief that the individual could benefit
in one of two ways: either from peace of mind
from knowing that they were cancer free or,
more significantly, from improved chances of
survival where the cancer is diagnosed and
treated early.
If it is cancer you get it early and they can
deal with it. (Male, 4055, C1C2, Rural)

See what its like tomorrow.

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I think they should [run a campaign],

something you should always be made
aware of.

. . . there is always a strong possibility that it

will be clear. It puts your mind at ease.
(Female, 5670, C1C2, Urban)
However, consistent with earlier findings,
when participants considered how they were
likely to react to this type of message, if subject
to the symptoms highlighted at time of
exposure, responses were characterised by
feelings of angst and uncertainty, and led some
to question the likely impact on demand for
health services.

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Cancer prevention and symptom awareness campaigns

I think the doctors might find they are

suddenly being inundated by people
taking up their time because they are
panicking. I think doctors have got too
much on their plate as it is. (Female, 5670,
C1C2, Urban)
Cultural factors appeared to have an important role in determining how the different
genders were likely to respond to this kind of
health information, with female participants
showing a greater propensity to seek professional advice than male participants. This
difference appeared to reflect womens greater
familiarity and use of primary health care
services through, for example, participation in
mass screening programmes and responsibility
for childrens health care. In contrast, men,
particularly men living in rural areas, were less
inclined to acknowledge health problems.
Where illness was recognised, men generally
preferred to self-treat than to consult a doctor
or health professional.
A man is more likely to sit there for months
and say, Itll go away, whereas a woman
will go down to a Well Woman clinic or
something like thatthere are eight of us
here, if you go round the eight of us and say
how many of you would go down to a Well
Man clinic wed be looking at each other to
see which one is the poof.
Its not within their psyche, especially in
the west of Scotland.
Its their make-up.
If you find a wee lump, like the bloke was
saying, you say, Itll go away. You ignore it
. . . and before you ken where you are it is
the size of a football. (Male, 4055, C1C2,
Rural)
I think really when you have got something
wrong with youthe first thing you do is
try and doctor yourself. (Male, 4055, DE,
Urban)
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343

Message appeals

A range of message appeals were examined,

using proposition boards and promotional
materials from existing campaigns. These
included fear, humour, survivor testimonies,
and celebrity endorsement; and in some
instances, combined messages, for example
celebrities talking about their personal experiences of cancer.
Whilst fear emerged as an underlying theme
in discussions about the disease, its use in
raising awareness of symptoms was widely
challenged. Indeed, the use of the term cancer
was often sufficient on its own to trigger this
type of response:
You see cancer and you dont read it.
(Female, 4055, DE, Urban)
I think the thing you dont really want to see
is cancer. Everybody thinks of cancer but
they dont really want to be talking about it.
(Female, 40-55, DE, Urban)
In contrast, humour had the potential to
engage people by ameliorating underlying
fears, although the type of humour and its
execution was critical to eliciting audience
support, and some cancers appeared to lend
themselves, more to humour than others.
For example toilet humour provided a useful
vehicle for addressing the embarrassment
and fear associated with colorectal cancer as
the following response to an image of man
sitting on a toilet seat, under-scored with the
caption Do not sit on the problem demonstrates:
Thats good.
I think that is quite funny.
You need to make light of things and not to
make it the fear factor.
That might make me go actuallyyeah that
takes it away.

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Douglas Eadie and Susan MacAskill

Its not as frightening, its the kidology . . .

Yeah I think that is really good. (Male,
4055, C1C2, Rural)

News messages, particularly those employing incidence and mortality statistics were
capable of capturing audience attention and
stimulating some debate about the scale of the
disease. However, the nature of the information led participants to depersonalise the
message and the potential risks.
M: Last year 6,000 Scots died of bowel
cancer
R: But I wasnt the one who died and I dont
know anyone who did die of that so it
wouldnt affect me personally. I know that
sounds terrible but . . . (Male, 40-55, C1C2,
Rural)

how it happened. (Female, 5670, C1C2,

Urban)
Interestingly, whilst celebrity testimonials
help to highlight human vulnerability to the
disease and to raise the public profile of the
cancer, the focus on celebrity can undermine
peoples ability to personalise the threat.
That is the only time you hear about
cancerwhen one of these celebrities or
one of these pop stars has it.
John Thaw (actor) took it and it was
publicised right left and centre because of
who he was.
His wife has done a great job because she
was on the television. She does a lot of good
work. She set up a fund and everything.
(Male, 5570, DE, Urban)
Sources of advice

In contrast, personal testimonies, whether

from a carer or someone who has been
diagnosed with the cancer, brought a sense
of realism to the debate and enabled participants to relate more directly to the disease,
breaking down some of the emotional barriers
to public discussion.
Youre not so scared because you are
getting inside what is happening to a person
and you are actually seeing them still there
and they are telling you what exactly it was
like and how they feel now.
I think you would need to have someone
who had been through it before it registered.
They could have a discussion like that on
telly and having people like ourselves that
know bits and pieces about it and having
experts that deal with it day in and day out.
But also maybe having a couple of people
who have actually gone through it to give
you their version of what has happened and
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A variety of sources emerged as first point of

contact for advice about suspicious symptoms.
These included primary care professionals,
telephone helplines and lay sources such as
partners and close friends. The family doctor
or GP (general practitioner) was widely
regarded as the most likely point of contact
with the health care system for concerns
relating to cancer. Other primary care professionals, most notably community pharmacists and primary care nursing staff, also had a
role to play in raising awareness of potential
serious symptoms and directing patients to
seek advice from their GP.
Even pharmacists can help people a lot of
ways, cant they?
He can advise youTake this. If its
still there in a couple of days then its time
to see the doctor. So you can use him as the
first port of call. (Male, 4055, DE, Urban)
Lay sources of advice emerged as an
important part of the consultation process.

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Cancer prevention and symptom awareness campaigns

Participants, particularly female participants,

cite lay networks as an important source
of reassurance prior to seeking professional
advice, in some instances providing additional
emotional support when attending for
appointments. Lay sources also appeared to
have a critical role in encouraging men to
confront their symptoms and to seek professional advice.
I think if you had these symptoms you
would go and talk to another woman about
bowel cancer . . . before you would go to
your doctor.
But deep down in your mind you know you
have got to go.
Youre frightened in case you are wasting
the doctors time.
Whereas if it is a friend and they say, No, I
think you should go to the doctor.
(Female, 5670, C1C2, Urban)
Men are big cowardsbad patients and big
cowards.
Theyd need a bit of nagging to go.
(Female, 5670, DE, Rural)
In addition to relying on social networks
for support, participants also had strong ties
with their local communities and some were
regular participants in local events and activities. Limited mobility and a community-centric
ethos meant that some rarely ventured outwith
their local area. In view of this, a community
level approach, for example, combining the
open-ended discussion format of the research
focus group with input from a local cancer
specialist, could be a useful way of stimulating
local interest and raising awareness of cancer
symptoms and the consultation procedure.
If you had a Macmillan nurse (palliative
care nurse) or a health visitor who has
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345

specialisedand advertise a meeting or

something.
Just like were having tonight.
Something like were doing tonightin a
group.
Where I live the community centre holds a
lot of things and the churches have that kind
of thing. (Female, 56-70, C1C2, Urban)

Conclusions
The results from the study suggest widespread
support for media campaigns, designed to
raise awareness of the early signs of cancer.
However, their success is dependent on
careful consideration of the psycho-social
factors of self-examination and referral. Previous
studies have found that patient-generated delays
account for the largest proportion of delays in
the diagnosis of cancer, and that those with
higher levels of socio-economic deprivation are
more reluctant to seek help (e.g. Eiser et al.,
2000). This study enhances our understanding
of the individual level factors and, in particular,
the importance of gender and lay networks
to early presentation (Burgess et al., 2001).
The results also have implications for those
wishing to use mass media approaches to
encouraging people to self-refer with suspicious
symptoms. Four aspects of campaign strategy
are discussed: message appeals, symptom
specificity, target audience and channel selection.
Successful communication needs to be
customised to the needs of its target audience.
The findings from this study guard against the
use of fear appeals in symptom awareness, since
fear can stimulate maladaptive responses such
as avoidance, discouraging those with genuine
symptoms from seeking professional advice.
Similar results have been found with their use
in cancer screening (Jones and Owen, 2006).
Messages which offer reassurance and confidence are more likely to prove beneficial.
Social modelling approaches such as personal

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Douglas Eadie and Susan MacAskill

testimonies, and careful use of humour have

the potential to aid identification with the
issue, ameliorate underlying fears and normalise
help-seeking behaviour. While celebrity testimonies have been shown to have a powerful
agenda-setting effect and are helpful in raising
awareness of lesser known cancers (Corbett
and Mori, 1999), findings from this study
indicate that the focus on celebrity can
discourage audiences from personalising risk.
Just as important as how to communicate the
message (i.e. which message appeals are best
to employ), is what to communicate, or
in this instance, what symptom or combination
of symptoms will trigger appropriate referrals.
Clearly, this is dependent upon the particular
cancer being addressed. However, media
strategy and communication channel also
have a critical to role to play in informing
these decisions. In communication terms, symptoms need to be simple to recognise and easy
to differentiate from other inappropriate or
benign symptoms, since poor communication
increases the risk of inaccurate referrals or of
symptom information simply being ignored.
The risks are greatest where the target
symptoms can be confused with other benign
symptoms that are relatively common, leading
to large numbers of inaccurate referrals and
potential overloading of diagnostic services.
Given peoples resistance to acting on early
symptoms, campaigns which exploit social
networks by encouraging word-of-mouth communication and personal recommendation
could prove more effective at encouraging
entry into the health care system than campaigns which seek to promote self-referral
directly. Such an approach involves directing
messages towards key opinion formers and
could prove an effective means of targeting
high-risk groups with low propensity to present. This study identified older men living
in rural communities as one such group,
and their wives and partners as key opinion
formers. Communication theory, such as stepflow models of communication (e.g. Katz
and Lazarsfeld, 1955), could provide useful
constructs for developing communication
strategy.
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A community level approach, exploiting

word-of-mouth communication, also has strong
synergies, when targeting older populations
living in more deprived areas, since study
participants can have strong ties with their
local communities and are receptive to locally
co-ordinated activities and events. These findings are consistent with other studies conducted in disadvantaged communities in the UK
(e.g. Johnston et al., 2000) and highlight the
potential of working with community networks
to reinforce campaign messages delivered
through wider media channels. For example
mobilising local health care workers to act as
advocates, linking with local clubs and organisations to promote word-of-mouth communication and engaging with local media, such as
local radio and free-sheets, to generate news
stories pitched at a community level. Evidence
indicates that a multi-faceted approach combining media, interpersonal and community
components is more effective than media alone,
as the different components reinforce and
amplify one another, and combine to generate
more persuasive messages and more enduring
effects (Fortmann et al., 1995; Pentz et al.,
1997).
Finally, in summing up, given the fears and
limited readiness to change, great awareness
and sensitivity is required when developing
interventions which seek to engage people in
the prevention of cancer. The study findings
clearly illustrate how careful attention needs
to be given to all aspects of communication
strategy if target audiences at heightened
risk are to benefit from advances in cancer
treatments and new diagnostic procedures. It
is also important to recognise that whilst
these findings represent the views and needs
of the at-risk population in the study communities, consideration needs to be given to
underlying cultural factors, when assessing
how they might be generalised for other
at-risk populations and symptom awareness
campaigns. In addition, the findings described
represent respondents predicted response to
cancer symptoms. Further qualitative research
is required to examine patient response to
symptoms retrospectively, both to assess for

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Cancer prevention and symptom awareness campaigns

consistency and to develop more detailed

insight into the role played by the patientprofessional relationship on referral and use of
diagnostic services.

Acknowledgements
The research is part of the West of Scotland
Cancer Awareness Project funded by the New
Opportunities Fund, now The Big Lottery
Fund.

Biographical notes
Douglas Eadie is a Senior Researcher at
the Institute for Social Marketing (ISM). Douglas has a background in communications
research and his research interests are in the
application of communication techniques
developed in commercial marketing to the
non-for-profit and public health sectors. He
also has an interest in corporate social responsibility and the relationship between commercial practice and public policy. He specialises
in the use of qualitative methods.
Susan MacAskill is a Senior Researcher
at the Institute for Social Marketing (ISM).
She joined the ISM, after working in primary
care and health promotion. Her research interests include researching sensitive issues
with vulnerable and hard-to-reach groups including prisoners, youths, minority ethnic and
disadvantaged communities and victims of
domestic violence. She also has an interest
in exploring provision of health and social
services from a range of perspectives, including the service users, direct providers and
other relevant stakeholders.

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