In the case, there were attempts to ensure the language of the standard brochure was simple. However, this approach was not taken with the letter of invitation. If the presence of a significant percentage of illiterate people in the target population had been a focus at the beginning of the planning, the disadvantage of illiteracy in the target group could have been targeted.

The question of channels is very important. Choosing channels that target the underprivileged in the case means adopting channels other than those that rely on written communication. Those who planned the communication in the case stressed two channels as the most effective: physician referral and letters of invitation. The focus of the support of the central body, the DHCS, however, is the letters of invitation, to be accompanied by a standard brochure. The "Standards" document includes a suggested letter of invitation.

As stated in the case description, in the promotion section the "Standards" document states, "The Department of Health and Community Services shall implement general provincial efforts to promote breast cancer screening services, including the development of a standard brochure aimed at encouraging participation of the target group and the mailing of introductory explanatory letters to health professionals and provincial associations/organisations requesting their support" (Breast Cancer...1994:3).

The "Standards" document also states, "Region Health Corporations should promote breast cancer screening services through regional and local initiatives directed at health professionals and the target women" (Breast Cancer...1994:3).

So, the DHCS developed both the promotional brochure and a standard letter to support the suggested activity of direct mailing of letters of invitation. In support of the physician referral, DHCS planned an introductory letter and suggested the regions carry out other activities. Providing support to the suggestion of mailing personal letters of invitation but providing only one letter to the physicians focused activities on the letters of invitation idea and not on physician referral. The channel of letters of invitation, effective in reaching the privileged, the literate group, is given preference over the channel of physician referral which would be more effective in reaching the underprivileged, the illiterate group. There was an opportunity here that might have been taken if the planners had been aware of the characteristics of the group, to encourage personal contact with members of the target public.