Introduction

According to the World Health Organization (WHO), chronic NCDs such as cancer, diabetes, cardiovascular diseases, and chronic respiratory diseases are responsible for about 41 million annual deaths–representing about 71% of all deaths globally [1]. Of this number, about 77% occur in low- and middle-income countries (LMICs) like Ghana [1]. The report further indicates that over 15 million NCD-related deaths are premature–occurring among individuals between the ages of 15 and 69 years and approximately 85% of these premature mortalities occur in LMICs. The high burden of NCDs in LMICs is consistent with the increasing prevalence of chronic NCD health outcomes. In Ghana, for example, research has shown a prevalence rate of 26.7% among a sample of Ghanaians with a mean age as low as 38 years [2]. A recent study using nationally representative data found hypertension prevalence to be as high as 29.7% [3]. Similarly, a systematic and meta-analyses found diabetes prevalence was about 6.4% [4, 5].

Even though most chronic NCDs are treatable if detected early, a fundamental set back is how most NCD patients especially in the context of developing country settings are unaware of their positive status until such diseases reach tipping points. Research, for instance, has shown that diabetes symptoms whether ophthalmic, neurological, or nephropathic mostly manifest only when they reach levels of permanent damage [6]. Yet, clinical studies in LMIC settings have found up to 50% and 73% of undiagnosed diabetes and hypertension cases respectively at the population level [7, 8]. Using a nationally representative sample, Tenkorang and colleagues found that over 44% of Ghanaians indicated they were not hypertensive when in deed they were based on systolic and diastolic blood pressure measures [9] indicating a mismatch between biometric data and undiagnosed self-reported data.

Indeed, many chronic NCDs develop slowly and imperceptible and are consequently difficult to detect early especially in situations where people do not undertake regular screening services. The high prevalence of undiagnosed chronic NCD cases in settings like Ghana could be attributed to low uptake of regular screening services underpinned by both individual level factors and structural determinants. At the structural level for example, poor doctor-to-population ratio of more than 6 times the WHO standard means significant sections of the population do not receive primary care where such conditions may be diagnosed [10]. Additionally, inadequate information availability on NCD risk factors and services could be crucial especially in an environment where chronic NCDs have not received the required attention at the population level. At a time when there is digitalization revolution in the Ghanaian context, mass media and internet platforms could be capitalized to sensitize the public and create awareness. This is particularly important because low awareness might be contributing to the high undiagnosed cases. The objective of this study, therefore, was to examine whether exposure to social and mass media campaign messages about chronic NCD health conditions was associated with the likelihood of NCDs screening in Ghana and whether the relationship differed geographically.

The Ghana Demographic and Health Survey (GDHS) has over the years recognized the importance of the media in broadcasting health messages and previous analysis of the data has shown access to broadcast media is generally high. For instance, 51% of men and 44% of women watch television at least once a week and 89% of men and 74% of women listen to the radio at least once a week [11]. More recent evidence has shown about 82% and 70% of Ghanaian adults are exposed to radio and television respectively at least once a week [12]. The print media is the one platform that witness the least exposure with only 16.7% of the population having exposure [12]. Given the overall high exposure to mass media, efforts have been made to promote healthy living through mass media platforms. One such campaign is the Stop Aids Love Life HIV/AIDS prevention campaign which has largely been assessed to be successful [13]. Given the taste for social media at the population level underpinned by widespread availability of smart phones and the growing availability of internet services albeit expensive, a well-coordinated health campaign could help improve chronic NCD awareness and best practices for improved health.

In fact, research studies elsewhere that examined the association between exposure to mass media smokeless tobacco warnings and intention/attempt to quit found that exposure to smokeless tobacco warnings in mass media promoted smokeless tobacco cessation [14]. The authors argue that health warnings through mass media could be beneficial to strategic policy programs aimed at reducing morbidity and mortality associated with smokeless tobacco use. Our study contributes to understanding how and in what ways social and mass media could be adopted as a tool for creating awareness and promoting chronic NCDs screening. Moreover, understanding geographical disparities in chronic NCDs screening could contribute to policy designs targeting specific locations for improved health outcomes. This is particularly crucial given the widening inequality between urban neighborhoods in Ghanaian cities. Recent political stability, economic growth and unequal economic opportunities in Ghana have conditioned widening socioeconomic gaps between the rich and the poor evident in emerging differential residential areas. Thus, the current economic landscape has contributed to emerging rich residential neighborhoods with high-quality services including healthcare, recreational centers and better schools [15]. On the other hand, increasing hardships among sections of the population with lower educational attainments and skills drive them to urban areas in search for greener pasture. Many of these new arrivals end up in already crowded and deprived neighborhoods that lack potable drinking water, toilet facilities, health facilities and other quality social amenities. We, therefore, expect that residents of deprived neighborhoods will be less inclined to screen for their NCDs status.

Methods and data source

Results

Univariate results

Results of the univariate analysis presented in Table 1 column 2 show that nearly 71% of respondents reported not having been previously screened for their NCDs status. In terms of exposure, however, 73.9% indicated being exposed to chronic NCD health campaigns on the radio, 74.6% through television stations, 24.5% through the print media and 42.6% through social media. Only 6.4% of the sample rated their health as fair/poor and a higher proportion (46%) rated their health as very good. About 14% of the sample did not attain formal education and 36.7% attained as high as tertiary education. About 31% of the sample reported being unemployed and the mean age of respondents was 41.7 years and a little more than half (51.5%) identified as women. Nearly two-thirds of the sample identified belonging to the Christian religious faith (63.1%) and 61.9% were married at the time of the survey.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 1. Distribution of the study variables and bivariate results of the relationship between the dependent and independent variables.

https://doi.org/10.1371/journal.pone.0302942.t001

Multivariate results

Exposure to radio stations.

The result of the multivariate analysis on exposure to radio stations and chronic NCDs screening was not statistically significant (see Table 2). However, a unit increase on knowledge about the causes of NCDs [OR = 1.59, CI = 1.41,1.79] and social capital [OR = 1.09, CI = 1.01,1.18] were found to be significantly associated with higher likelihood of screening for NCDs. Respondents who rated their health either as very good [OR = 0.25, CI = 0.14,0.44], or excellent [OR = 0.25, CI = 0.13,0.48] were observed to be less likely to screen for NCDs compared to those who rated their health as fair/poor. In terms of location, compared to respondents from the city of Wa, those from Tamale were more likely [OR = 2.33, CI = 1.48,3.67] to screen for their NCDs status. Respondents from neighborhoods classified as low-income neighborhoods [OR = 0.37, CI = 0.21,0.64] and those residing in neighborhoods deprived economically [OR = 0.76, CI = 0.61,0.94] were found to be less likely to screen for NCDs. In terms of socioeconomic characteristics, respondents who attained tertiary education [OR = 2.02, CI = 1.13,3.63] were more likely to screen for their NCDs status compared to their counterparts who did not receive formal education. A unit increase in age was also found to be significantly associated with increased likelihood of screening and women were more likely to screen for their NCDs status compared with men.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 2. Multivariate results of the relationship between the independent variables and NCDs screening.

https://doi.org/10.1371/journal.pone.0302942.t002

Exposure to TV stations.

Unlike exposure to radio stations, respondents who were exposed to television stations were about 1.7 times likely [CI = 1.12,2.58] to screen for NCDs compared to their counterparts who were not exposed to chronic NCD health campaign messages on television. We further found that a unit increase on knowledge about the causes of NCDs [OR = 1.59, CI = 1.41,1.80] and social capital [OR = 1.09, CI = 1.01,1.18] were significantly associated with higher likelihood of screening for NCDs. Compared to respondents who rated their health as fair/poor, those who rated their health either as very good [OR = 0.25, CI = 0.14,0.44], or excellent [OR = 0.24, CI = 0.12,0.46] were less likely to screen for NCDs. Respondents from Tamale were about 2.2 times more likely [CI = 1.42,3.49] to screen for NCDs compared to their counterparts from Wa. Residing in low-income neighborhoods [OR = 0.40, CI = 0.23,0.70] and neighborhoods deprived economically [OR = 0.76, CI = 0.62,0.95] was associated with lower likelihood of screening for NCDs. Compared to men, women were more likely to screen for their NCDs status and a unit increase in age was associated with higher likelihood of screening for NCDs.

Exposure to the print media.

Exposure to the print media did not show any significant difference in NCDs screening, but a unit increase in social capital [OR = 1.10, CI = 1.01,1.18] and NCDs knowledge [OR = 1.60, CI = 1.42,1.81] predicted higher likelihood of screening for NCDs. Consistent with the previous models, respondents who rated their health as very good [OR = 0.24, CI = 0.14,0.43], or excellent [OR = 0.24, CI = 0.12,0.46] were less likely to screen for NCDs. Similarly, respondents residing in neighborhoods classified as low-income neighborhoods [OR = 0.36, CI = 0.20,0.62] and neighborhoods deprived economically [OR = 0.75, CI = 0.60,0.93] were less likely to screen for NCDs. However, residents of Tamale [OR = 2.22, CI = 1.42,3.49] were significantly more likely to screen for NCDs compared to their counterparts from Wa. Women were also more likely to screen for NCDs compared to men and those who attained up to tertiary education were significantly more likely to screen for NCDs compared to those who did not receive formal education.

Exposure to social media.

Results of model 4 show that exposure to social media was significantly associated with higher likelihood of screening for NCDs. For instance, respondents who were exposed to chronic NCD campaigns on social media platforms were about 1.5 times more likely [OR = 1.51, CI = 1.03,2.20] to screen for NCDs. Consistent with the previous models, a unit increase in social capital [OR = 1.09, CI = 1.01,1.18] and knowledge [OR = 1.60, CI = 1.42,1.80] about the causes of NCDs predicted increased likelihood of screening for NCDs. Participants who rated their health either as excellent [OR = 0.22, CI = 0.11,0.43] or very good [OR = 0.24, CI = 0.13,0.42] were less likely to screen for their NCDs status. The relationship between the geographic measures and NCDs screening remained consistent with results of the previous models. Similarly, women remained more likely to screen for their NCDs status compared to men and a unit increase in age predicted higher likelihood of screening for NCDs.

Combined media model.

Model 5 (see Table 2) shows results of the combined media exposure and chronic NCDs screening in Ghana. The results show that respondents who were exposed to social and mass media campaign messages on chronic NCDs were more likely to screen for NCDs. In model 5, for example, those who were exposed were about 2.7 times more likely [CI = 1.61,4.76] to screen for their NCDs status compared to their counterparts who were not exposed. The relationships between knowledge about the causes of NCDs [OR = 1.58, CI = 1.40,1.78], social capital [OR = 1.09, CI = 1.00,1.18] and NCDs screening are consistent with results of the individual media outlets. Respondents who rated their health as very good [OR = 0.26, CI = 0.15,0.47] and excellent [OR = 0.24, CI = 0.13,0.47], however, were less likely to screen for NCDs. Compared to respondents residing in Wa, those residing in Tamale were more likely [OR = 2.21, CI = 1.41,3.48] to screen for their NCDs status. But residing in neighborhoods classified as low-income neighborhoods was associated with lower likelihood of screening compared to those residing in high-income neighborhoods. Similarly, we found that a unit increase in neighborhood structural deprivation [OR = 0.79, CI = 0.62,0.99] and neighborhood economic deprivation [OR = 0.78, CI = 0.63,0.96] were significantly associated with lower likelihood of screening for NCDs. A unit increase in age [OR = 1.05, CI = 1.04,1.06] was also observed to be associated with increased likelihood of screening and women [OR = 1.42, CI = 1.04,1.94] compared to men were more likely to screen for their NCDs status.

Discussion

The high incidence of undiagnosed chronic NCD cases in many developing country settings including Ghana could partly be attributed to low uptake of screening services and more so for people living in deprived environments. In contributing to understanding the pattern of chronic NCDs screening, this study examined the relationship between exposure to social and mass media chronic NCD health campaign messages and the uptake of screening services in Ghana and whether this relationship differed by place of residence. Overall, the results show that exposure to mass media chronic NCD health campaign messages was significantly associated with increased likelihood of screening for NCDs. The results further highlight neighborhood-level disparities in the uptake of NCDs screening services as residents of low-income and deprived neighborhoods were significantly less likely to report being screened for NCDs. Other factors including social capital, knowledge about the causes of NCDs and self-rated health predicted the likelihood of chronic NCDs screening.

The observed positive relationship between exposure to mass media chronic NCD health campaign messages and the uptake of screening services is consistent with existing literature and offers empirical support to ongoing debates about the importance of mass media in disseminating relevant health information and addressing pressing public health issues [16–20]. Mass media has been widely used to reach higher proportions of populations to inform about emerging and ongoing issues including compelling health problems that might require the attention, cooperation, and behavioral responses of the public. Dating as far back as the 1700s, for example, mass media was used to promote inoculation for smallpox in the United States and later to promote healthy eating in the 1800s [21]. Empirical evidence, more recently, continue to show mass media has always been an important source of information about momentous health issues including HIV/AIDS, drug abuse, family planning, weight control and mammography [16–18, 21, 22]. Exposure to health promoting information and the ability to cogently digest such information often ignites a chain of cognitive processes and reactions motivated by self-desire to remain healthy for as long as possible. Such exposure also improves awareness and conscientiousness about the benefits of observing certain healthy practices.

Previous researchers have consequently noted the potential of mass media as a health campaign tool lies in their ability to widely disseminate well crafted messages to audiences repeatedly, over time, in an incidental manner and at a lower cost [23]. While the health impacts of mass media campaigns may be inconsistently realized across locations and even between health issues, appropriate framing of chronic NCD health massages in the Ghanaian context and similar developing country settings could prove effective. The framing of the problem as well as the delivery style are particularly important especially given the proportion of reported exposure to NCDs campaign messages (84.8%) versus those who have screened (29.4%) for their NCDs status in this study. The gap in exposure and screening could consequently be due to contextual factors. For example, previous research in Ghana has shown that the time allocated for health programs on mass media platforms are usually short, which makes it difficult for listeners to learn enough from such programs [24]. Other problems are that the health programs are either presented late in the day or the content is presented using medical jargon that is not readily comprehensible by the ordinary listener [24]. Yet, previous studies have shown that the nature of information conveyed by media outlets, the coverage and the presentation techniques can have powerful effects on knowledge, behavioral changes, and attitudes [25–27] and health campaign programs should be designed targeting these key elements.

The results further highlight geographic disparity in the uptake of chronic NCDs screening services in Ghana. Participants of the more deprived and low-income residential neighborhoods, for example, were less likely to screen for their chronic NCDs status compared to their counterparts from the less deprived and high-income neighborhoods. Annim and Colleages [28] in an earlier study noted that within district inequity in Ghana contributes more to national inequality than between district inequity. Inferentially, inequity within towns and cities in Ghana is more endemic than inequities between these geographic locations. It is consequently not surprising to observe disparities in the uptake of NCDs screening services between neighborhoods. Even though the country has achieved some macroeconomic gains in the past few decades, the gains have not been translated into improving economic wealth at the individual level [29, 30] and in exceptional cases the few people particularly those connected politically benefit from these economic gains. The masses are therefore left with limited opportunities and a significant proportion of these people live in the more deplorable parts of the cities.

As Eriksson [31] previously noted “information constitutes an essential basis for actions and that a crucial component of social capital is the potential information embedded in social relations” (pp.2). Besides information sharing, social/peer influence is another relevant pathway between social network and health [32]. While health knowledge and information sharing among neighbors in the study neighborhoods could be an important determinant of NCDs screening, the positive influence of networking with people who engage in preventative practices including NCD screening could have a trickle-down effect. Putnam [33] has argued that even though social capital could be a private good, it is at the same time a collective and nonexclusive good at the community level. This is because living in a high social capital area could be beneficial even for people who do not have strong social connections or knowledge about certain health conditions since spill-over benefits could accrue to such individuals.

Conclusion

This study examined the connections between exposure to social and mass media chronic NCDs campaign messages and the uptake of NCDs screening in Ghana. The results showed that responds who were exposed were significantly more likely to screen for their NCDs status compared to those who were not exposed. However, respondents from deprived neighborhoods were less likely to screen for NCDs. Despite the potential limitations discussed above, our study is important and offers some policy pathways for improving NCDs screening in Ghana and similar LMIC settings. The findings, for example, suggest that a well composed health media campaign program could improve NCDs screening, which will then lead to early detection and improved treatment outcomes at a reduced cost for individuals and families. Such campaign messages, however, should be presented in local languages to be easily digested by local audiences. The study further demonstrates the need to consciously address neighborhood disparities in the Ghanaian context. High unemployment rate coupled with high cost of living in many Ghanaian cities have led to the emergence of deplorable settlements and the expansion of existing slums which produce conditions for poor health outcomes [34]. Importantly, residents of such spaces do not often have the financial resources to access health service and mostly do not even consider voluntary screening a priority until they are too sick to go about their daily activities. Ongoing media campaigns could be complemented with free screening and counselling services to offer marginalized groups the opportunity to screen. In fact, if media campaigns focus on approaches for which the target population lack the resources to address, the intended objective might never be realized. To this end, the current pro-poor national health insurance program could be retooled and resourced to cover screening costs and medication services for NCDs. In some jurisdictions community health workers have been resourced and deployed to screen people at their homes [35, 36] and this strategy could be adapted and implemented in Ghana to reach out to underserved communities and help overcome bureaucratic procedures at tertiary health facilities where chronic NCD health services are commonly provided.

Finally, given the positive relationship between social capital and NCDs screening, existing social networks could be empowered to be agents of NCD campaign messages. The advantage is that strong social networks already exist at all levels within the Ghanaian society. One of such strong social organization is the religious institution. Many Ghanaians consider themselves as religious people and have trust in their religious leaders and empowering them as agents with a mandate to include chronic NCD health teachings to their sermons could prove a worthwhile bargain. Other local societal unions could as well be empowered to promote healthy practices.

Supporting information

Acknowledgments

We thank all the people who participated in this study for their time and for sharing their experiences with us. We are also thankful to the research assistants for their support during the fieldwork.