Region 6 also conducted outreach. Those working on the program met with family doctors. Also, public forums were held on the topic in community centres and general women's health issue meetings were held in co-ordination with local women's groups, with good turnouts.

Both regions took some time to develop outreach efforts. The lack of stronger definition of these efforts and a focus on them in the "Standards" document required the regions to work to define the opportunities and develop a program. A better-developed and perhaps centrally controlled program of outreach would have made outreach a focus from the beginning.

3. Characteristics of source or medium. Credibility of the source can influence the outcome of the campaign.

The source of the information in the first instance was the local regional hospital corporation. As covered in the case, the suggested letter was text-heavy. The exact format was up to the region. In the case of regions 2 and 6 it was sent on corporation stationery (Appendix D).

One characteristic of the source, in the case of the letter, is that it is official. The suggested text was also fairly complicated. Although the source was credible, the appearance of the letter could be off-putting. To someone who was unable to read the letter could easily be intimidating and useless.

This intimidation factor is lessened when the source is a person speaking directly to another person, in the case of outreach. This is particularly true if the source is a health professional, whose characteristics are generally accepted as credibility and compassion.

The "Standards" document does not take into consideration the perspective of the audience in recommending the letter as the first approach. The planning here fails to recognise that communicating first through a text-heavy, official letter may not open the receiver up to the message.

4. Formative evaluation. The campaign message must be tested against the viability of it in reality. The means to achieve the message being promoted must exist.

The message in the case is viable. The means to achieve the goal of the message - have women make a breast cancer screening appointment - exist. It is not apparent in the "Standards" document or during the author's experience working on the case, that formative evaluation was undertaken. At the least, the planners would have benefited from a thorough examination of the various available means that could have been employed to meet the goal.