The difficulty that this point exposes is with the channels used. The initial recruitment effort was the mailing of the letter of invitation and the standard brochure. As noted earlier, a significant percentage of the target audience for this message was illiterate. The channel of direct mailing of written communication was inappropriate and not available to a significant percentage of the population. Region 2 and Region 6 efforts both concentrated their efforts initially behind the mailings, as suggested by DHCS (Henderson and Novaczek, 1996 and Bosca, 1997). This is a major failing of the program.

Campaign goals

A case like this should also be evaluated in strictly tangible terms. As stated earlier, the "Standards" document set a goal of 70% of women aged 50-69 years participating in breast cancer screening once every two years.

As noted earlier, the program in Region 2 began in August, 1995, and at the first meeting for this dissertation, held on April 24, 1996, the participation rate was 40%. By the second meeting, November, 1997, two years and three months after the program began, the rate was 55%.

In Region 6 the program began in November, 1995 and on December 1, 1997, two years and one month later, the estimated participation rate was 36%.

Additionally, on September 29, 1997, Chris Heissner characterised the response rate to the program overall as "low" (1997).

Clearly, neither region reached the goal and their communications campaigns could not be judged to be successes.

As pointed out earlier, Rice and Aitkin (1989) assert that campaigns must set reachable goals, and that public communication campaigns often set higher standards for success than commercial campaigns.

This is an important point, but there is a certain logic to public campaigns setting high goals, particularly if the campaign is on a health message. If reaching an individual through a health message campaign can save that person's life, then it is difficult to set a target of 35%, for example.

Given this perspective, the 70% participation rate set for the breast cancer screening campaign is perhaps optimistic, but it would not appear unachievable, given the progress of Region 2.