بازاریابی سلامت و نقش حساس نظریه سیگنالینگ در آگاهی از سرطان پستان
Abstract
1- Introduction
2- India's healthcare sector: an emerging economy context
3- Theoretical grounding: signaling theory
4- Literature review: challenges facing the healthcare sector of an emerging economy
5- Research design
6- Discussion and conclusions
References
Abstract
In India, breast cancer is the most commonly diagnosed type of cancer among women in cities and urban areas, yet women seek medical care extremely late due to lack of awareness about self-examination. This study explores the health marketing literature via signaling theory, to uncover the unique social, economic, cultural and institutional challenges and opportunities faced by health marketers and consumers in breast cancer awareness (BCA) in an emerging economy – India. An interpretive-inductive method, alongside a grounded theory approach via focus groups with medical professionals and interviews with women is employed. Findings reveal complex challenges at national, state and community levels which impact negatively on the reputation of India's health sector. Social marketing strategies could be leveraged to raise BCA via community health activists. Propositions are suggested and a conceptual framework is developed to assist health marketers to manage BCA in an emerging economy.
Introduction
Breast cancer is the most common cancer in most cities in India, including Mumbai, Delhi, Bengaluru, Bhopal, Kolkata, Chennai and Ahmedabad, accounting for 25% to 32% of all female cancers (Breast Cancer India, 2016). In India, breast cancer is the most commonly diagnosed type of cancer for urban Indian women (Bawa, 2012; Murthy, Agarwal, Chaudhry, & Saxena, 2007). Statistics show that 70,218 Indian women died of breast cancer in 2012 and by 2020 breast cancer is set to overtake cervical cancer as the most common type of cancer among all women in India (Shetty, 2012). In Western countries, breast cancer incidence rates increase with age, unlike India, where the rate of incidence is reversed, with the highest female mortality rate occurring in those aged between 30 and 50 (Khokhar, 2012). Studies show women seek medical care extremely late due to a lack of awareness about self-examination and India's unique socio-cultural complexity (Rath & Gandhi, 2014; Shetty, 2012). Thus, women's breast healthcare in India is neglected (Khokhar, 2012). The problem appears to manifest first, from insufficient government investment in developing an effective breast cancer awareness (BCA) strategy and second, the consequences of India's rapid economic development. Globally, “…most developing countries have pursued formal health care system strategies which give primacy to government roles in financing and delivering health services” (Berman, 1998, p. 1463). However, for India, the task of delivering healthcare to over a billion people has proven a challenging and complex task, especially with the growing middle classes demanding higher quality healthcare services (Brosius, 2012). Healthcare in India is, at present, predominantly the responsibility of the central and state governments, each of the 29 respective states having control over delivering its own health services. However, overall control is held by the Ministry of Health and Family Welfare (hereafter MoHFW). Previous research has documented several challenges within the healthcare industry in India, including remuneration, motivation, commitment, quality, productivity, retention and training (e.g., Astor et al., 2005; Martinez & Martineau, 1998; O'Donnell et al., 2008; Sengupta & Nundy, 2005; Vujicic, Zurn, Diallo, Adams, & Dal Poz, 2004). India is also witnessing a growth in the private healthcare sector and evidence indicates that this industry will impact greatly on the economy, similar to the boom in the Information Technology-Business Process Outsourcing (IT–BPO) industry (NASSCOM, 2010). The federal budgets of 2011–16, showed on average a 10–20% rise in the health budget (federal budget speeches 2011–2016). For example, the funds from 2010 to 2011 for health rose to $5.9bn or £3.7bn (BBC, 2011) and in 2017–18 the health budget is expected to get a $1.5 billion, or 27%, increase in funding to around $7 billion (Kalra, 2016). However, there is no strategic focus on women's breast healthcare (Gangane, Manvatkar, Ng, Hurtig, & San Sebastián, 2016).