Evaluation of a Social Marketing Campaign Based on a Risk Factor Model for the Early Detection of Oral Cancer in a High Incidence Country: Sri Lankan Experience

Abstract

Background: Oral cancer is a major public health problem in Sri Lanka. Most are preceded by a potentially malignant disorder (OPMD) visible in the mouth. The present study evaluates a national social marketing campaign (SM) conducted in 2012 designed to increase public awareness of risk factors and to encourage early detection of disease by self referral to dental clinics. Methods: A cross-sectional community-based cluster survey was carried out to evaluate the SM and other oral cancer control activities in two Districts by interviewing 491 subjects >25 years of age to assess the level of disease awareness and the prevalence of risk factors associated with oral cancer. The Ministry of Health has established a surveillance system for oral cancer and OPMD by introducing registries and collecting returns at Outpatient Dental Clinics. We have evaluated the SM using the returns obtained from the dental clinics in these districts and also returns obtained through the national surveillance system as published in the Annual Health Bulletins of Sri Lanka. Findings: A random sample of 491 subjects was interviewed; 44% males, 99% Sinhalese, 37% skilled workers and 7.5% pensioners. Most (93%) were aware of oral cancer; but only 45.4% of OPMD. Statistically significant improvements were observed on awareness of OPMD (P < 0.04) and of the risk factors for oral cancer): smoking (P= 0.000) and alcohol use (P< 0.002), compared to the base line study in 2008. A marked increase in the detection of leukoplakia and oral cancer was observed in the years 2012 and 2013, at the time the SM campaign was implemented. Interpretation: This campaign was successful in improving public awareness and changed behavior by increasing attendance at a health care facility. Such Risk Factor-based approaches to social marketing are suitable for control of oral cancer in countries with a high burden of disease. Funding: Funds for these activities were obtained through Government of Sri Lanka Budget released to the Ministry of Health. It is Ministry of Health funding the activities. Declaration of Interest: None declared. Ethical Approval: Ethical approval was obtained from the Ethical Review Committee, Faculty of Medicine, University of Colombo and all subjects signed their informed consent before data collection.