Analysis of breast cancer organizations’ online presence in different geographical contexts
Abstract
This paper contributes offers a descriptive analysis of the online activity and impact of breast cancer organizations in different geographical contexts, with different economic and technological development levels and different incidence and mortality rates, with a sample of 24 organizations from 24 countries. The analysis considers variables such as posting frequency, time of presence on the social network and number and evolution of likes, views, followers, and subscribers. The results show that the organizations from the more developed countries have an earlier and more varied presence on the online world. Disease’s incidence correlate to a certain extent with the presence of these organizations on social networks and with their reception results while mortality rate is not related to these aspects. Facebook is the most used network; however, Instagram, with better performance and a growing number of users, is a good alternative for organizations that want to strengthen their online activity. These results confirm the need to broaden the perspective of studies on the online communication of breast cancer organizations, considering underdeveloped or developing countries. This will help these organizations to develop more effective practices that, considering the increasing use of social media in these countries, might have a meaningful impact in the medium term.
ANÁLISIS DE LA PRESENCIA ONLINE DE LAS ORGANIZACIONES DE CÁNCER DE MAMA EN DIFERENTES CONTEXTOS GEOGRÁFICOS
Resumen
Este artículo ofrece un análisis descriptivo de la actividad e impacto online de las organizaciones de cáncer de mama en diferentes contextos geográficos, con distintos niveles de desarrollo económico y tecnológico y diferentes tasas de incidencia y mortalidad, con una muestra de 24 organizaciones de 24 países. El análisis considera variables como la frecuencia de publicación, el tiempo de presencia en las redes sociales y el número y evolución de me gusta, visualizaciones, seguidores y suscriptores. Los resultados muestran que las organizaciones de los países más desarrollados cuentan con una presencia más temprana y variada en el mundo online. La incidencia de la enfermedad se correlaciona con la presencia de estas organizaciones en las redes sociales y con sus resultados de recepción, mientras que la tasa de mortalidad no se relaciona con estos aspectos. Facebook es la red más utilizada; sin embargo, Instagram, con mejor rendimiento y un creciente número de usuarios, es una buena alternativa para las organizaciones que deseen fortalecer su actividad online. Estos resultados confirman la necesidad de ampliar la perspectiva de los estudios de comunicación online de las organizaciones de cáncer de mama considerando los países subdesarrollados o en vías de desarrollo. Esto ayudará a las organizaciones a desarrollar prácticas más efectivas que, considerando el creciente uso de las redes sociales en estos países, podría tener un impacto significativo en el medio plazo.
Keywords
eHealth, cancer, breast cancer organizations, communication, social media
INTRODUCTION
Breast cancer accounts for 11.6% of all cancers diagnosed in the world, it is the second most common cancer and the most frequent, by far, among women (Bray et al., 2018). According to Globocan 2018 (International Agency for Research on Cancer & World Health Organization, 2020), breast cancer has an incidence of 46.3 cases per 100,000 among women, followed far behind by lung cancer (14.6 per 100,000). Although incidence rates are higher in Australia, Europe and North America than in most African regions, mortality rate variations are small, and despite the fact that mortality is declining significantly in the richest and most developed countries, it still shows slight increases in developing countries (The Cancer Atlas, n.d; ) (Amadou, Torres-Mejía, Hainaut, & Romieu, 2014). It is, therefore, a widely spread disease (Ponce-de-León et al., 2016), with a high potential for cure in case of early detection.
As is the case with other diseases, audiences that are highly involved in a topic are more likely to actively search for information about it. Thus, people interested in or affected by breast cancer will tend to seek information and/or support through all means at their disposal (Hallyburton; Evarts, 2014; Li et al., 2014; Li et al., 2016; Namkoong et al., 2017) (Li, Orrange, Kravitz, & Bell, 2014; Namkoong, Shah, & Gustafson, 2017). With a worldwide penetration of 57% (We are social and Hootsuite, 2019), the Internet is one of the sources where these interested audiences can seek greater amounts of information quickly and easily, although this information is not always reliable and may have been published by non-health organizations or influencers (Jiménez-Marín, Bellido-Pérez, & Trujillo-Sánchez, 2021).
On the other hand, public awareness on breast cancer, prevention, early detection, fundraising for research or information dissemination on the process of dealing with cancer and its treatments are key elements to reduce the disease’s mortality. Therefore third-sector organizations have been making communication efforts related to some of these aspects and they have found in the Internet, where active audiences seek information urgently, a suitable and cheap way to spread their message.
Approximately 45% of the world population uses networks, although there are huge variations across continents, ranging from 17% penetration rate in Africa (with a 13% increase compared to the previous year) to 66% in America. Facebook (2.1 billion users) remains the most widespread social network, followed by YouTube (1.9 billion users). Excluding messaging networks, the next would be Instagram, which, with a 4.4% increase, reaches 1 billion users. Twitter, with a 2.7% decline, remains at 326 million users (We are social and Hootsuite, 2019).
Over the last few years, there have been abundant studies on the use of these social networks in connection with cancer in general, and particularly breast cancer. Specific research related to Twitter and breast cancer is abundant.Thackeray, Burton, Giraud-Carrier, Rollins, and Draper (2013) analyzed tweets about breast cancer posted by different types of users. Other researchers focused on Twitter include Kim, Hou, Han, and Himelboim (2016), who studied the elements that have an impact on retweeting behavior on breast cancer, Natasi et al. (2017), who focused on Twitter users’ discussions about breast cancer screening recommendations, or Clark et al. (2018), who evaluated the usefulness of the network in addressing patients’ feelings. Regarding cancer in general,Xu et al. (2016) analyzed the frequency of discussions about this disease and highlighted the benefits of social networks as a tool in reducing racial and ethnic disparities.
Research studies related to Instagram are very recent.Vraga et al. (2018) compare traffic about breast cancer, prostate cancer and other reproductive cancers on Twitter and Instagram, whileBasch and Maclean (2019) analyze the content of the posts published on Instagram with the hashtag #breastcancer.
In the case of YouTube, according to Madathil, Rivera-Rodríguez, Greenstein, and Gramopadhye (2015), this network is increasingly being used to disseminate health information. Several studies analyze YouTube videos related to prostate cancer (Basch, Menafro, Mongiovi, Hillyer, & Basch, 2017), mouth (oral) cancer (Hassona, Taimeh, Marahleh, & Scully, 2016), skin cancer (Ruppert et al., 2016; ) (Basch, Basch, Hillyer, & Reeves, 2015; Myrick & Oliver, 2014) or cervical cancer (Adhikari, Sharma, Arjyal, & Uprety, 2016) and gynecologic cancer (Cooper, Gelb, & Chu, 2016), among others.
However, the studies that specifically analyze social network communication efforts undertaken by organizations dedicated to breast cancer are less abundant and largely focused on Facebook and the Western context.
Abramson, Keefe, and Chou (2015) analyzed Breast Cancer Organization’s Facebook posts during October 2010, concluding that they included little information on health, while the research carried out by FFernández-Gómez and Díaz-Campo (2016) on communication about cancer on Facebook by organizations of Argentina, Chile, Colombia and Spain indicated that almost half of the messages were aimed at raising awareness. Other studies are focused on engagement, and both S Strekalova and Krieger (2016), who analyzed National Cancer Institute’s Facebook content, and Theiss, Burke, Cory, and Fairley (2016), who focused on CDC Breast Cancer’s posts, concluded that posts with images generate more engagement than videos, links or status updates. As for Corbacho-Valencia, Dafonte-Gómez, and Míguez-González (2018), they analyzed most engaging posts from 21 organizations (mostly from the United States), concluding that posts most preferred by users are largely aimed at raising awareness.
In the case of Twitter, it is worth mentioning the study by Diddi and Lundi (2017), who analyzed how four organizations used this network during Breast Cancer Awareness Month, in line with the theoretical parameters of the Health Belief Model.
Thus, there is a gap in the description and analysis of the online presence and communication efforts made by organizations specifically related to breast cancer, particularly from the perspective of geographical diversity. By assuming, as advocated by Xu et al. (2016), that social networks help to reduce racial and ethnic disparities, in a context in which the expansion of social networks is increasingly evident even in less developed countries, we are also acknowledging its key role as disseminators of information in a wide range of countries and not only in Western communication models. Therefore, it may be interesting to analyze the patterns of presence and use of online communication by organizations related to breast cancer, as well as the response from their audiences, especially if analyzed in light of statistical data on the disease’s incidence and mortality, in order to understand whether the networks’ informational and educational potential is being leveraged globally.
OBJECTIVES
Based on this approach, the aim of this study is to carry out a descriptive in-depth analysis of the online presence, activity and impact of breast cancer organizations in different geographical contexts, with different economic and technological development levels and different incidence and mortality rates. Taking into account that, as Globocan 2018 (International Agency for Research on Cancer & World Health Organization, 2020) statistics show, breast cancer is a disease with a higher incidence in economically and technologically developed countries and that these countries, with only a few exceptions, are usually the ones with higher Internet penetration and higher percentage of active social network users, it can be expected that organizations from the countries with higher development level will have an earlier and stronger presence on the online world, more diverse in terms of publications and with greater impact. In this sense, the research will also try to determine if any correlation can be established between the presence in social networks of the organizations analyzed and the incidence and mortality rates of the countries to which they belong.
MATERIALS AND METHODS
With a view to achieving geographical heterogeneity, the sample was created using as reference the list of organizations set out on the website of the Union for International Cancer Control (UICC). Through a keyword search process, the organizations specifically dedicated to breast cancer were selected, resulting in a list of 48 organizations from 28 different countries. Given that the sample was intended to include only one organization per country, in the case of the countries with several organizations, the selection was made according to the following criteria, in order of importance:
National organizations were prioritized over regional organizations
2. Organizations dedicated to breast cancer in general were prioritized over those addressing specifically any of its aspects (such as the organizations of mastectomized women or breast cancer patients).
3. Organizations emerging from collective or institutional initiatives were prioritized over those emerging from individual or corporate efforts.
4. Organizations that were present on social networks were prioritized over those that were not, and among them, those with the most up-to-date publications and with the largest number of followers.
The removal of duplications and of organizations not present on social networks led to a final sample of 24 organizations from 24 countries.
Social network analysis focused both on emission, in connection with the posts published (number of posts, evolution of the numbers of publications, type of posts) and with the time of presence on the social network, and on reception (number and evolution of likes or views, in the case of Facebook, and number and evolution of followers and subscribers, also in the case of YouTube). For collecting and analyzing data on Facebook, in addition to using the data on likes and followers provided by the network itself, and since the application does not provide the total number of posts published, a Facebook-native application called Netvizz was used; it allowed the analysis of the posts published in a one-year period, between May 1, 2018 and April 30, 2019, the month prior to the beginning of the study. Regarding other social networks, public data provided by the networks themselves were used; a first collection was made at the beginning of the study (May 2019) and a second one, in February 2020. Netvizz’s suspension made it impossible to collect data from Facebook and to update the number of posts published as expected.
FINDINGS
General data on the sampling
In relation to the disease’s incidence and mortality rates, the former ranges from 94.5 per 100,000 in Australia and 21.3 per 100,000 in Uganda, whereas mortality ranges from 25.4 per 100,000 in Sierra Leone and 7.5 per 100,000 in Saudi Arabia (table 1). In all the countries represented in the sample, except Uganda and Senegal, breast cancer was the most diagnosed type of cancer among women in 2018; five of them were also among the 25 countries with the highest breast cancer incidence worldwide: Australia, the United Kingdom, Malta, the United States and Canada (The Cancer Atlas, n.d.).
Regarding their online presence, only three of the organizations do not have a website. Social networks most used by these organizations are Facebook (92% of the organizations), Twitter (54%), YouTube (46%) and Instagram (37.5%); however, the organizations from Australia, Brazil, Canada, the United Kingdom and the United States are the only ones present on all four networks. Instagram can be understood as a complementary tool to other media, since all the organizations that have an Instagram account are also present on Facebook and on, at least, one more network (YouTube or Twitter). In total, 53.8% of the organizations are present on more than one social network. In all the networks there are cases of accounts that were launched and abandoned or were never used (table 1).
|
Country |
Organization |
I-ASR |
M-ASR |
% active users |
Web |
Join date |
|||
|
|
|
YouTube |
|
||||||
|
Australia |
National Breast Cancer Foundation |
94.5 |
12.3 |
72% |
Yes |
2008 |
2008 |
2007 |
2012 |
|
Brazil |
Federação Brasileira de Instituições Filantrópicas de Apoio à Saúde da Mama (FEMAMA) |
62.9 |
13 |
66% |
Yes |
2012 |
2011 |
2011 |
2018 |
|
Canada |
Rethink Breast Cancer |
83.8 |
12.1 |
67% |
Yes |
2009 |
2009 |
2009 |
2015 |
|
China |
Global Chinese Breast Cancer Organizations Alliance |
36.1 |
8.8 |
71% |
Yes |
2012 |
No |
No |
No |
|
Costa Rica |
Asociación Tour Rosa de Costa Rica |
46.7 |
12.2 |
72% |
No |
2017 |
No |
No |
2015 |
|
Ghana |
Breast Care International (BCI) |
43 |
17.7 |
19% |
Yes |
2013 |
No |
No |
No |
|
Indonesia |
Indonesian Breast Cancer Foundation / Yayasan Kanker Payudara Indonesia |
42.1 |
17 |
56% |
Yes |
2018 |
2013 |
2015 |
2015 |
|
Kenya |
Women 4 Cancer Early Detection & Treatment |
40.3 |
17.8 |
16% |
Yes |
2012 |
2012 |
No |
2016 |
|
Malaysia |
Pink Ribbon Wellness (L) Foundation |
47.5 |
18.4 |
78% |
Yes |
2012 |
No |
Data not available (inactive) |
No |
|
Malta |
Action for Breast Cancer Foundation |
87.6 |
12.7 |
88% |
Yes |
2010 |
No |
No |
No |
|
Mauritius |
Breast Cancer Care |
69.6 |
21.8 |
65% |
No |
2016 |
No |
No |
No |
|
Mexico |
Tómatelo a Pecho, A.C. |
39.5 |
9.9 |
67% |
Yes |
2014 |
2010 |
2011 |
No |
|
Nigeria |
Breast Cancer Association of Nigeria (BRECAN) |
41.7 |
18.8 |
12% |
Yes |
2009 |
No |
2017 (inactive) |
No |
|
Peru |
ALIADA |
40 |
10.3 |
73% |
Yes |
2013 (inactive) |
No |
2013 |
No |
|
Philippines |
I Can Serve Foundation |
52.4 |
17.5 |
71% |
Yes |
2011 |
2010 |
Data not available (active) |
2013 |
|
Saudi Arabia |
Sheikh Mohammed Hussien Al-Amoudi Center of Excellence in Breast Cancer (SMHA-CEBC) |
27.3 |
7.5 |
68% |
Yes |
No |
2011 |
No |
No |
|
Senegal |
Association Cancer du Sein du Sénégal |
32.8 |
16 |
21% |
No |
2013 |
No |
No |
No |
|
Sierra Leone |
Thinking Pink Breast Cancer Foundation |
43.6 |
25.4 |
8% |
Yes |
2012 |
No |
2018 (inactive) |
No |
|
South Africa |
PinkDrive |
49 |
16.3 |
40% |
Yes |
2010 |
2010 |
2013 |
No |
|
Spain |
Federación Española de Cancer de Mama - FECMA |
75.4 |
10.6 |
60% |
Yes |
2010 |
2012 |
No |
No |
|
Tunisia |
Association Tunisienne d'Assistance aux Malades du Cancer du Sein |
32.2 |
10.3 |
64% |
Yes |
2013 |
No |
2016 |
2017 (inactive) |
|
Uganda |
Uganda Women's Cancer Support Organization (UWOCASO) |
21.3 |
10.3 |
6% |
Yes |
2011 |
2017 |
No |
No |
|
UK |
Breast Cancer Now |
93.6 |
14.4 |
67% |
Yes |
2008 |
2009 |
2015 |
2012 |
|
US |
Susan G. Komen for the Cure |
84.9 |
12.7 |
70% |
Yes |
2007 |
2008 |
2007 |
2015 |
|
% of organizations with online or social network presence |
87.5% |
91.67% |
54,17% |
45.83% |
37.50% |
||||
I-ASR: Incidence age-standardized rate in 2018 (International Agency for Research on Cancer, 2020). M-ASR: Mortality age-standardized rate in 2018 (International Agency for Research on Cancer, 2020). % active users: Percentage of active social network users in the country (We are social & Hootsuite, 2019).
Source: author’s elaboration
The integration of the organizations into the online world has been gradual since 2007, with a significant boom in the period from 2010 to 2013. Also, since 2016, the incorporation into new social networks has slowed down, up to the point that no new accounts were created on any of the four social networks in 2019. Some organizations, such as Rethink Breast Cancer, Susan G. Komen for the Cure, National Breast Cancer Foundation or FEMAMA, adopted a unified strategy of integration into social networks, by joining Facebook, Twitter and YouTube in the same year or in two consecutive years, and by joining Instagram much later, in line with the subsequent rise of this network (table 1).
More specifically, regarding Instagram, it is striking that the United Kingdom, Australia and the Philippines created their accounts before 2014 and, therefore, before the boom of this network. In the case of Facebook, even though at the time of the analysis 22 of the 24 organizations have a Facebook account, their entry into the most widespread social network in the world has been highly variable over time. Organizations from countries such as the United States, the United Kingdom, Australia, and Canada were pioneers, creating their accounts in 2007, 2008 and 2009. On the contrary, the Indonesian organization did not join Facebook until 2018, and the one from Costa Rica did it in 2017 (table 1).
A certain correlation is observed between the disease’s incidence and the number of networks on which the organizations are present (r = 0.473). Out of the five countries with the highest incidence, four are present on all the analyzed networks, whereas the organizations from the five countries with the lowest incidence are only present on one or two networks. On the contrary, this is not the case with mortality (r = 0.090); as a matter of fact, the three countries with the highest mortality rates are Sierra Leone, Mauritius, and Nigeria, which are only present on Facebook. A positive correlation is also observed between the percentage of active social network users in each country according to Global Digital Report 2019 (We are social & Hootsuite, 2019) and the number of networks on which the organizations are present (r = 0.638).
Social network activity: transmission data
In line with the normal usage of the different networks, Twitter records the highest average number of posts per day, while YouTube has the lowest average frequency rate. Likewise, Instagram has already surpassed Facebook in terms of posting frequency, although this may be because organizations with an Instagram account are, broadly speaking, more advanced in the use of social networks (table 2).
|
COUNTRY |
Average daily posts during the reporting period |
Average daily posts since the beginning of their activity on the network |
|||||
|
|
|
YouTube |
|
|
YouTube |
|
|
|
Australia |
0.855 |
0.510 |
0.007 |
0.631 |
1.809 |
0.017 |
0.428 |
|
Brazil |
0.800 |
0.622 |
0.070 |
0.587 |
1.122 |
0.029 |
0.570 |
|
Canada |
1.532 |
1.466 |
0.066 |
0.948 |
3.933 |
0.061 |
0.767 |
|
China |
0.233 |
n |
n |
n |
n |
n |
n |
|
Costa Rica |
0.203 |
n |
n |
0.179 |
n |
n |
n |
|
Ghana |
0.132 |
n |
n |
n |
n |
n |
n |
|
Indonesia |
0.866 |
0.247 |
0.115 |
1.179 |
0.409 |
0.047 |
0.861 |
|
Kenya |
0.096 |
0.725 |
n |
n |
1.499 |
n |
0.052 |
|
Malaysia |
0.337 |
n |
n |
n |
n |
n |
n |
|
Malta |
0.258 |
n |
n |
n |
n |
n |
n |
|
Mauritius |
0.071 |
n |
n |
n |
n |
n |
n |
|
Mexico |
1.778 |
3.040 |
0 |
n |
5.351 |
0.068 |
n |
|
Nigeria |
0.178 |
n |
n |
n |
n |
n |
n |
|
Peru |
n |
n |
0.014 |
n |
n |
0.010 |
n |
|
Philippines |
0.690 |
0.534 |
0.031 |
0.651 |
0.630 |
N/A** |
0.465 |
|
Saudi Arabia |
n |
0.287 |
n |
n |
1.022 |
n |
n |
|
Senegal |
0.044 |
n |
n |
n |
n |
n |
n |
|
Sierra Leone |
0.077 |
n |
n |
n |
n |
n |
n |
|
South Africa |
2.252 |
1.594 |
0.059 |
n |
5.357 |
0.064 |
n |
|
Spain |
0.126 |
2.163 |
n |
n |
1.195 |
n |
n |
|
Tunisia |
0.364 |
n |
0.038 |
n |
n |
0.035 |
n |
|
Uganda |
0.252 |
0.382 |
n |
n |
0.575 |
n |
n |
|
United Kingdom |
0.203 |
-79.825 |
0.038 |
-1.262 |
10.547 |
0.147 |
0.432 |
|
United States |
1.104 |
3.733 |
0.268 |
1.631 |
3.513 |
0.101 |
0.613 |
|
Mean |
0.566 |
1.052 |
0.071 |
0.696 |
2.082 |
0.058 |
0.524 |
|
Median |
0.255 |
0.673 |
0.049 |
0.651 |
1.499 |
0.054 |
0.518 |
*The average has been calculated considering only the organizations that have posted during the reporting period. The case of the United Kingdom has not been taken into account for the calculation of maximums, minimums, averages and correlations with regard to Twitter and Instagram, since the total number of posts provided by the networks themselves on the second collection date was significantly lower than on the first one; this seems the result of a voluntary deletion of posts, impeding an actual estimation of the evolution of that organization on the two networks. **Join date not available.
Source: author’s elaboration
The comparison between the average number of daily posts made by the most and least active organizations in each social network during the reporting period shows sharp differences in posting frequency. The U.S. organization is the most active on Twitter, YouTube, and Instagram, but is surpassed by other three organizations as regards Facebook. Other highly active organizations are the one from South Africa, with the highest average number of posts on Facebook and also a high average on Twitter and YouTube, the one from Mexico, which holds the second position in the two networks on which it is present (Facebook and Twitter), and the one from Canada, which is in the top 5 on all four networks. Also, in the top 5 on Facebook, YouTube and Instagram is the Indonesian organization, despite being the least active on Twitter. On the contrary, the organizations from Senegal, Mauritius and Sierra Leone record the lowest activity, almost residual, on Facebook, despite this being the only network on which they have an account (table 2).
On the other hand, some interesting trends are observed when analyzing the average number of daily posts made by each organization since the day they began their activity on Twitter, YouTube and Instagram (Facebook is not included, since the total number of posts is not available). In the case of Twitter, all the organizations have reduced their activity on this network, except Spain, which records a substantially higher average posting frequency during the reporting period compared with the total, and the U.S., which shows a slight increase. On the contrary, all the organizations with an Instagram account have increased their activity on this network. In the case of YouTube, six organizations have increased their average posting frequency during the reporting period, whereas four of them have decreased it (table 2).
Correlation data between the disease’s incidence and mortality rates in each country and their average number of daily posts on their social networks do not yield significant results.
Social network activity: Reception data
There are sharp differences between likes, followers, views, or subscribers accumulated by the organizations with the highest figures (maximums) and those with the lowest (minimums), causing means to be poorly representative. Taking into account that these global data may depend to a large extent on the time of presence on each social network, the table 3 details, for each organization, the average number of likes, followers, views and subscribers per day (since they began their activity on the network).
|
|
|
|
YOUTUBE |
|
|||
|
|
Likes |
Followers |
Likes |
Followers |
Views |
Subscribers |
Followers |
|
Max. |
1962575 |
1897008 |
23263 |
162169 |
10825277 |
4120 |
66761 |
|
Min. |
338 |
359 |
5 |
198 |
2079 |
14 |
745 |
|
Mean |
129716 |
124788 |
3580 |
28574 |
1317043 |
839 |
21601 |
|
Median |
3410 |
3469 |
1252 |
2493 |
82117 |
329 |
12879 |
|
COUNTRY |
Likes per day |
Followers per day |
Likes per day |
Followers per day |
Views per day |
Subscribers per day |
Followers per day |
|
Australia |
24.262 |
24.438 |
1.747 |
3.65 |
201.89 |
0.163 |
3.121 |
|
Brazil |
13.685 |
13.809 |
0.009 |
0.315 |
65.104 |
0.212 |
18.002 |
|
Canada |
8.309 |
8.322 |
1.296 |
2.106 |
2760.142 |
1.05 |
11.336 |
|
China |
0.359 |
0.381 |
n |
n |
n |
n |
n |
|
Costa Rica |
2.641 |
2.645 |
n |
n |
n |
n |
10.258 |
|
Ghana |
0.814 |
0.827 |
n |
n |
n |
n |
n |
|
Indonesia |
1.466 |
1.539 |
0.002 |
0.432 |
5.13 |
0.148 |
7.244 |
|
Kenya |
0.573 |
0.587 |
0.886 |
0.762 |
n |
n |
0.618 |
|
Malaysia |
1.39 |
1.407 |
n |
n |
n |
n |
n |
|
Malta |
1.027 |
1.051 |
n |
n |
n |
n |
n |
|
Mauritius |
1.722 |
1.742 |
n |
n |
n |
n |
n |
|
Mexico |
1.294 |
1.324 |
1.081 |
1.435 |
3.771 |
0.012 |
n |
|
Nigeria |
0.863 |
0.873 |
n |
n |
n |
n |
n |
|
Peru |
n |
n |
n |
n |
32.178 |
0.129 |
n |
|
Philippines |
2.43 |
2.46 |
0.078 |
0.154 |
N/A* |
N/A* |
0.943 |
|
Saudi Arabia |
n |
n |
0.126 |
0.46 |
n |
n |
n |
|
Senegal |
0.482 |
0.49 |
n |
n |
n |
n |
n |
|
Sierra Leone |
0.627 |
0.629 |
n |
n |
n |
n |
n |
|
South Africa |
4.387 |
4.498 |
0.692 |
14.467 |
7.915 |
0.018 |
n |
|
Spain |
0.486 |
0.529 |
0.133 |
0.856 |
n |
n |
n |
|
Tunisia |
4.96 |
5.019 |
n |
n |
1.489 |
0.01 |
n |
|
Uganda |
0.31 |
0.316 |
0.105 |
0.197 |
n |
n |
n |
|
United Kingdom |
213.39 |
199.726 |
5.934 |
41.37 |
452.725 |
0.355 |
21.64 |
|
United States |
441.33 |
426.582 |
0.302 |
29.683 |
338.771 |
0.491 |
36.402 |
|
Mean |
33.036 |
31.782 |
0.953 |
7.376 |
386.912 |
0.259 |
12.174 |
|
Median |
1.428 |
1.473 |
0.302 |
0.856 |
48.641 |
0.156 |
10.258 |
*Join date not available.
Source: author’s elaboration
The comparison of likes between Facebook and Twitter confirms the prominence of the former over the latter, while the data on YouTube views are quite positive, with a median of more than 48 views per day. In the case of Facebook, the U.S. organization records the highest average of likes, far above the others, followed by the British organization. In Twitter, with the United Kingdom in the lead, differences are much less noticeable. In YouTube, Canada stands out considerably in terms of views (table 3).
Regarding followers and subscribers, YouTube’s numbers are very modest, and Instagram shows very significant data considering that it is much more recent. The U.S. organization, once again, records the highest average number of followers per day both on Facebook and on Instagram, while the United Kingdom reaches the highest average number of followers on Twitter, and Canada, the highest average number of subscribers on YouTube. The minimum values correspond to Uganda on Facebook, the Philippines on Twitter, Tunisia on YouTube, and Kenya on Instagram (table 3).
As usual, the correlation between the average number of likes and followers per day is very high in the case of Facebook (r = 0.999) and positive in the case of Twitter (r = 0.724). The correlation between views and subscribers on YouTube is also very high (r = 0.934). The correlation data between the number of active social network users in each country and the reception data are only significant in the cases of Facebook likes and followers (r= 0.653 and r= 0.657) and Instagram followers (r = 0.667).
On the other hand, the correlation between the incidence rate and the reception indicators is positive in all cases (from r = 0.46 in the case of the average number of views on YouTube to r = 0.616 in the case of the subscribers to that same network). There is no correlation, however, between these indicators and the mortality rate.
Transmission-reception ratio
Overall, analyzing the medians of the comparable data (since means are not significant), Facebook generates more likes than Twitter. However, when it comes to followers, Instagram is the most productive network (table 4).
|
Country |
|
|
YOUTUBE |
|
|||
|
Likes / posts |
Followers / posts |
Likes / posts |
Followers / posts |
Views / posts |
Subscribers / posts |
Followers / posts |
|
|
Australia |
28.377 |
28.582 |
0.966 |
2.018 |
11875.882 |
9.588 |
7.292 |
|
Brazil |
17.106 |
17.261 |
0.008 |
0.281 |
2244.966 |
7.310 |
31.582 |
|
Canada |
5.424 |
5.432 |
0.330 |
0.535 |
45248.230 |
17.213 |
14.780 |
|
China |
11.335 |
11.352 |
n |
n |
n |
n |
n |
|
Costa Rica |
4.010 |
4.074 |
n |
n |
n |
n |
n |
|
Ghana |
2.720 |
2.886 |
n |
n |
n |
n |
n |
|
Indonesia |
1.693 |
1.777 |
0.005 |
1.056 |
109.149 |
3.149 |
8.413 |
|
Kenya |
5.969 |
6.115 |
0.591 |
0.508 |
n |
n |
11.885 |
|
Malaysia |
4.125 |
4.175 |
n |
n |
n |
n |
n |
|
Malta |
3.981 |
4.074 |
n |
n |
n |
n |
n |
|
Mauritius |
24.254 |
24.535 |
n |
n |
n |
n |
n |
|
Mexico |
0.728 |
0.745 |
0.202 |
0.268 |
55.456 |
0.176 |
n |
|
Nigeria |
4.848 |
4.904 |
n |
n |
n |
n |
n |
|
Peru |
n |
n |
n |
n |
3217.800 |
12.900 |
n |
|
Philippines |
3.520 |
3.565 |
0.124 |
0.244 |
n |
n |
2.028 |
|
Saudi Arabia |
n |
n |
0.123 |
0.450 |
n |
n |
n |
|
Senegal |
10.955 |
11.136 |
n |
n |
n |
n |
n |
|
Sierra Leone |
8.143 |
8.169 |
n |
n |
n |
n |
n |
|
South Africa |
1.948 |
1.997 |
0.129 |
2.701 |
123.672 |
0.281 |
n |
|
Spain |
3.857 |
4.198 |
0.111 |
0.716 |
n |
n |
n |
|
Tunisia |
13.626 |
13.788 |
n |
n |
42.543 |
0.286 |
n |
|
Uganda |
1.230 |
1.254 |
0.183 |
0.343 |
n |
n |
n |
|
United Kingdom |
1051.172 |
983.872 |
0.563 |
3.922 |
3079.762 |
2.415 |
50.093 |
|
United States |
399.752 |
386.397 |
0.086 |
8.449 |
3354.168 |
4.861 |
59.383 |
|
Mean |
73.126 |
69.559 |
0.263 |
1.653 |
6935.163 |
5.818 |
23.182 |
|
Median |
5.136 |
5.168 |
0.129 |
0.535 |
2662.364 |
4.005 |
13.332 |
* Data calculated taking into account the average number of posts per day during a year on Facebook and from the beginning of their activity on the other networks, as well as the average of likes, followers, views and subscribers per day on each network.
Source: author’s elaboration
National data indicate that, in the case of Facebook, United Kingdom and the United States achieve the best like-to-post and follower-to-post ratios, far above the others, whereas Mexico, Uganda, Indonesia and South Africa are at the bottom of that list. On Twitter, the differences between countries are much less noticeable, and while the Australian organization achieves the best ratio of likes per tweet, the United States, the United Kingdom and South Africa are way ahead in terms of number of followers; the worst results correspond to Indonesia when it comes to likes, and to the Philippines and Mexico when it comes to followers. The United States and the United Kingdom are the countries recording the best performance results on Instagram, whereas the Philippines records the worst results (table 4).
Overall, there is no significant correlation between the average number of posts per day and the average number of likes, followers or subscribers, except in the case of Twitter, where this correlation is high (r = 0.858 in the case of likes and r = 0.802 in the case of followers).
CONCLUSSIONS
The present study is based on a sample of organizations from countries on all continents, with different economic development and Internet penetration levels and highly variable breast cancer incidence and mortality rates. Even though there is a certain correlation between social media penetration and network presence, and the organizations from the more developed countries seem to have, in general, an earlier and more varied presence on the online world, case studies are diverse enough to assume that other factors have an influence on these organizations’ decision whether to be present or not on social networks.
One of these factors is the disease’s incidence, which also seems to correlate to a certain extent with the presence of these organizations on more or less social networks and with their reception results in terms of likes, views, followers or subscribers, although not with the posting frequency. Thus, Australia, the United Kingdom, the United States and Canada, which are four of the five countries with the highest disease incidence, were pioneers in joining social networks and are present on all four most relevant networks, with positive reception results.
The fact remains that, as noted above, breast cancer is mainly a “first-world” disease, and the countries with the highest incidence are also the most technologically developed. Therefore, it is little wonder that mortality rate does not relate to diversity regarding online presence, nor to activity or reception levels. Indeed, the countries with the highest mortality rates are not those in which the disease has the highest incidence, but others in which, with a few exceptions, early detection and cure processes may be more complex.
With specific regard to the use of each social network, Facebook, with the highest worldwide penetration, is chosen by most organizations to develop their online activities. Moreover, its performance in terms of transmission-reception ratio, with a median of more than 5 likes per post, is quite positive when compared, for instance, with the study by Corbacho-Valencia et al. (2018), in which an average of 2,2 reactions per post is calculated for the most engaging posts published during 2017 Breast Cancer Awareness Month by 21 organizations from the United States, the United Kingdom, Canada and Australia. This implies that, even in the case of organizations with low posting frequency and few followers, these followers are quite loyal and respond positively to the content posted by the organizations, probably due to their high level of involvement.
As for Twitter, despite the fact that its penetration is much lower than that of YouTube or Instagram, half of the organizations remain on it because they created their accounts between 2008 and 2012, during Twitter’s boom years; only Uganda joined late, in 2017. However, most organizations, in line with usage trends, have reduced their activity on Twitter and it can be expected that some may eventually close their accounts.
Although YouTube is the second most relevant social network worldwide, its penetration is uneven across countries, which affects the organizations’ presence on the video channel. In addition, the activity level of several organizations is quite limited, and so are their reception results.
Regarding Instagram, there are already a few organizations from very different latitudes that have decided to join this network. Instagram is proving to yield good performance results, with an average follower-to-post ratio that doubles that of Facebook; therefore, considering that it is already the third social network in terms of penetration, Instagram seems a good alternative for those organizations wishing to start or increase their online activities.
In view of these results, it would be recommended that organizations focus their efforts on Facebook and Instagram, also using them as a platform for the dissemination of possible audiovisual material that barely reaches views on YouTube.
As a limitation to this study, it should be noted that the reported trends are not particularly significant and that, in some cases, the presence on social networks may depend more on the organizations’ will and interest to be active on the online world than on objective factors recommending their presence on networks. For instance, the organizations of Uganda, Sierra Leone and Nigeria are present on Facebook even though Internet penetration rates in these countries reach only 6%, 8% and 12% respectively.
It is true that, in these cases, the posting frequency is low, and the reception results are limited. However, in a continent where the percentage of network users rose from 4% to 17% within a year, and with an upward trend that is expected to continue in the coming years, it is relevant and a very good new that organizations fighting breast cancer, especially in countries with high mortality rates, make such efforts to maintain their online presence.
Although the findings of this descriptive study are not surprising, their importance lies in its broad perspective. Cancer has often been assumed to be a disease that mainly affects the first world, but the mortality rate from breast cancer in underdeveloped or developing countries is high and the incidence rate is increasing. It is therefore relevant to analyze from the field of study of communication the mechanisms and tools that can contribute to the prevention and early detection of the disease, the fund raising for its research and the accompaniment of patients, also in these contexts and not only in countries that already have a high level of communication development.
The expansion of the use of social networks in developing countries makes it possible to rely on their potential as disseminators of information in the short and medium term. For this reason, the mere verification of the efforts that some organizations are already making in this area, as well as the comparison of their activity with entities in developed countries in order to identify their shortcomings and opportunities, is valuable in opening up new avenues of research.
In this sense, a future line of research would be the content analysis of the publications with the greatest impact in these contexts, to detect the possible existence of patterns related to the subject, format or language, similar or different from those usual in the developed countries, that help organizations improve their publications to achieve a greater impact in view of their specificities.