Abstract 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 cost‐effective, 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.