INTRODUCTION

Cancer is the leading cause of death in many countries, including Korea. Reflecting the public’s considerable concerns about cancer, a range of media outlets, including newspapers, provide a large volume of news regarding cancer. The news media coverage of cancer spans various topics, including carcinogenesis, prevention, screening programs, and newly developed drugs and treatments [1-3]. Importantly, this content is reproduced and transmitted in various ways by broadcasting and Internet entities, such that media consumers have easy access to it [4].

However, the coverage of cancer in the news media has been criticized for providing biased information. For instance, the media report about treatment more frequently than about prevention [5,6] and often exaggerate the benefit of technological advances [7,8]; furthermore, relatively few articles tend to be published that present in-depth information about cost, quality of evidence, potential risks, and alternative options for treatment [9,10]. By frequently highlighting certain medical providers and new drugs, the news media may deliver unrealistic expectations for a complete cure and prompt individuals to seek specific services for themselves [11-13]. Although content of this nature might be considered to be helpful for cancer care because it provides detailed information about healthcare resources, it can also cause problems. Such news articles promote an individualistic approach and excessively medicalize various cancer-related issues; furthermore, individuals in different socioeconomic status (SES) groups are disproportionately likely to recognize and accept useful information, which may lead to differential risk behaviors across SES groups [10,12,14]. Additionally, it has been claimed that cancer news coverage deflects the responsibility for cancer care onto the individual, which might worsen health inequities.

Since the health information conveyed by the media has a cumulative effect on the public’s awareness and behavior [1, 11], it is of particular importance to understand how the news media cover cancer-related issues and how their coverage affects knowledge gaps in the domestic context. In previous international studies, researchers have shown that news coverage and ways of reporting differed according to ethnicity and geographic region, suggesting that some social groups might have greater information needs than the general population [5,14-17]. In Korea, although a few reports have found discrepancies between news coverage and the actual statistics or significance of various phenomena in reality [18,19], we do not have a broad understanding of the context of cancer news coverage. Because online news articles are rapidly published and circulated in Korea, the knowledge gaps among different SES groups might depend on information accessibility and media consumers’ understanding of the content.

The influence of the news media on health awareness can be inferred from analyses of news coverage, as news coverage as a whole reflects the reporting framework of the media. The reporting framework represents the media’s views on specific issues, through which the news media affect public awareness in a particular manner [10,20]. This study provides an overview of cancer news coverage in representative national Korean newspapers. Based on an in-depth examination of relevant articles utilizing content analysis, the researchers present a discussion of the implications of current cancer coverage in the news media and the reporting framework with regard to cancer awareness.

METHODS

Data Collection

We primarily collected cancer-related news articles from the Korean Integrated News Database System (KINDS, www.kinds. or.kr) operated by the Korea Press Foundation (KPF), to obtain national newspaper articles that had been written between January 1, 2015 to December 31, 2017. Eight daily publications were included in the search results: Kyunghyang Shinmun, Kukmin Ilbo, Naeil Shinmun, Munhwa Ilbo, Seoul Shinmun, Segye Ilbo, Hankyoreh, and Hankook Ilbo. We selected one daily newspaper (Chosun Ilbo) that was not included in the KPF database but had a high domestic circulation for additional data collection, considering the quantity of data and the capabilities of the research team. ChungAng Daily and Dong-A Ilbo were excluded because their news articles have been included in the KINDS since 2018. News articles from Chosun Ilbo written during the same period were searched and selected via the Chosun Ilbo archive (http://srchdb1.chosun.com/pdf/i_archive/index.jsp).

Of the news articles from these 9 publications, we restricted our analysis to news articles dealing with cancer-related healthcare or medical information. First, we conducted a primary search with a single keyword (“cancer”) in all reporting fields to include as many articles as possible, and then we performed a secondary screening to exclude articles that did not contain cancer-related information about healthcare or medical issues; for example, name lists, obituaries, accident reports, anecdotes, previews, and sports articles. The same search method was applied in both the KINDS database and the Chosun Ilbo archive. We initially collected 13 480 articles from the primary search, and a total of 2806 news articles were included in the final analysis. Table 1 lists the number of articles from each newspaper.

Method of Analysis

In order to analyze the collected news articles, the following 4 items were coded and categorized for each article: (1) main theme, (2) type of the article, (3) overall attitudes and tone, and (4) number of sources.

We coded the themes of the news articles using an inductive method, which enabled a comprehensive categorization and understanding of a broad scope of diverse content [21]. First, the main researcher carefully read each article at least twice and then inspected and abstracted the content to form the primary coding framework. Two additional researchers read a random sample comprising 10% of the articles and classified the articles independently. Through repeated discussions, the 3 researchers jointly modified the primary coding framework and finalized the thematic categories by consensus.

The type of newspaper article was classified into 3 categories depending on the method through which information was conveyed: “informational,” “analysis,” or “opinion/review.” Informational articles were those that simply described, explained, or cited factual information without a detailed analysis or interpretation. Basic summaries and explanations of factual information were classified as informational articles. Analysis articles were those that focused on analyzing the causes or mechanisms of certain phenomena, explaining the background and history of various issues, or presenting a discussion or interpretation based on factual information. Opinion/review articles were those that mostly included judgments, claims, and commentary based on subjective values. The tone of the articles was categorized as positive, negative, or neutral. Newspaper articles that mostly highlighted positive aspects or conveyed generally optimistic attitudes were classified as positive; those that highlighted negative aspects, adopted a critical attitude, or described problems were classified as negative; and articles that contained a mix of positive and negative tones or ones that did not show any clear attitude were classified as neutral. According to the number of informational sources that were either directly or indirectly cited, articles were classified as citing a single source or multiple sources, or as having unclear sources.

The main researcher assigned the final categories for the classification of the theme, type, and tone of all articles, while another researcher independently coded a random sample comprising 10% of the articles. The two researchers then convened to compare and adjust the results. After repeated discussions and adjustments, the interrater reliability (measured using the Cohen kappa coefficient) was high (≥0.800) [22], with kappa values of 0.875 for themes, 0.843 for the article type, and 0.823 for the tone of the description.

Ethics Statement

This study are not done on human or human material, and the review of institutional review board is not required.

RESULTS

The numbers of news articles reporting cancer-related information were unevenly distributed across the source newspapers. A few newspapers, such as Kukmin Ilbo (23.7%) and Segye Ilbo (18.2%), reported far more frequently about cancer than others (Table 1).

As for the thematic classification, the top 4 categories were general healthcare information, the latest research and development (R&D), specific medical institutions/personnel, and specific technology/products, which jointly accounted for 74.8% of all articles (Table 2). General healthcare information, corresponding to articles delivering validated information or relatively established facts about cancer, was the most common theme, followed by articles on the latest R&D, which illuminated the R&D results of certain researchers or institutions. The articles on specific medical institutions/personnel and technology/products mostly highlighted the positive aspects of clinics, professionals, drug, devices, or other resources, as illustrated in Table 2. The less common categories included official cancer-related statistics, followed by national cancer policies/programs for public relations or debates on the necessity of various programs and National Health Insurance (NHI) policies (informing readers about coverage changes or arguing for the need to expand coverage). Articles dealing with private insurance, cancer and environmental factors, and occupational cancer comprised only 1-3% of all articles.

Table 3 shows the proportional distribution of article type and tone by the thematic category. Although informational articles had the highest proportion in all categories, informational articles were more common in articles dealing with the latest R&D and specific medical institutions/personnel than in other categories (97.4% and 98.7%, respectively). The category of articles on specific medical institutions/personnel had a remarkably high proportion of informational articles with a positive tone (81.1%). This pattern was directly linked with the tendency for these informational articles to introduce particular medical providers or hospitals favorably; in fact, this category had only two articles with a negative tone, which reported a medication error that occurred in one hospital and a case of failed medical equipment introduction, respectively. Similarly, the category of specific technology/products contained the second highest frequency of articles with a positive tone (67.9%) and informational articles with a positive tone (61.3%), showing a similar pattern to that of the specific medical institutions/personnel category. Additionally, the articles in the categories of the latest R&D (23.7%) and private insurance (22.4%) were more positively written than other categories.

In contrast, analysis and opinion/review type articles were more heavily concentrated in the category of articles dealing with the NHI (28.7% and 14.7%, respectively). As seen in Table 2, all of these articles dealt with coverage expansion, criticizing the limited coverage of the NHI with a negative tone or arguing for the expansion of drug coverage. The categories of cancer and environmental factors and occupational cancer showed higher proportions of analysis articles (24.6%, and 21.6%, respectively), while only a few articles in these categories belonged to the opinion/review type. The analysis articles in these categories tended to describe the perspectives of stakeholders briefly, dealing with issues such as leukemia occurring at a workplace (Table 2).

As for the number of news sources, the articles in the categories of specific medical institution/personnel and the latest R&D most frequently cited a single source (Table 4). In contrast, the articles from the categories of occupational cancer and cancer and environmental factors were more likely to cite multiple news sources.

DISCUSSION

The media actively engage in communication with the public through a certain reporting framework, both affecting and reflecting the public’s awareness and attitudes on specific issues such as cancer [20]. Thus, news coverage about cancer can provide empirical evidence regarding the messages that the media convey to the public about cancer and how Koreans cope with cancer, and it can suggest how the reporting framework of the media affects the public. In this regard, the results of this study provide a few crucial points relevant for a discussion of the media’s influence on cancer awareness.

Above all, the thematic categories of specific medical institution/personnel, specific technology/products, and the latest R&D accounted for a significant proportion of all news articles (45.7%), aside from general healthcare information about cancer care. These categories contained many news articles about certain medical providers, hospitals, facilities, new drugs and devices, and the latest medical information, on which basis people might be able to access healthcare resources on their own. However, to utilize the information presented in articles in practice, the content should be read carefully, because a large part of the information generally has yet to be verified in terms of its accuracy and adequacy [23,24]. It is also likely that some healthcare resources are not easily accessible for some people even if they wanted to do so, due to limitations of finances, time, and distance.

Thus, the reporting framework of the news articles has two implications. First, within this framework, one should sort out the relevant information and seek specific healthcare resources to cope with cancer on an individual basis, depending on one’s own financial and health literacy. However, this approach is likely to widen knowledge gaps and to exacerbate health inequities in cancer care, because it tends to highlight and expand the role of personal capabilities. Second, many of the news articles contained advertising messages for specific healthcare resources, to the point that some of them seemed to be practically advertorials, rather than news. Articles in the categories of specific medical institutions/personnel and technology/products actively introduced readers to certain medical providers, clinics, hospitals, and new drugs. These categories tended to have more informational articles with a positive tone and a single source, suggesting a lack of well-balanced information. Advertising messages were also found in the categories of general healthcare information and the latest R&D. As shown in Table 2, some news articles emphasized the name of a certain clinic with detailed information (e.g., the address of the clinic) in a corner, or they highlighted the name of medical providers with titles and affiliations [12]. These findings are consistent with the previous criticism that the mass media publicize products or services on behalf of their news sources [24,25], inducing the public to visit specific providers or medical institutions. It has also been pointed out that advertorials confuse the public, because such articles are advertisements in the form of news articles [26]. Again, only individuals with a high level of health literacy will be able to discern whether the information can be trusted and is helpful in terms of its accuracy and adequacy.

Lastly, the analysis and opinion/review articles mostly focused on the categories that reflected higher levels of social concern such as the NHI, cancer and environmental factors, and occupational cancer. However, the scope of news coverage seemed to be fairly limited, although the details should be clarified in further qualitative studies. As briefly illustrated in Table 2, all of the analysis and opinion/review type articles in the NHI category uniformly argued for the expansion of insurance coverage; however, a number of issues closely related to NHI, such as financial sustainability and the relationship of the NHI with private insurance, were not dealt with. By presenting such cursory information, these articles could not properly contextualize and present complex issues systematically; instead, the issues were simplified and reduced to ethical problems [10,20,24], and the lack of detailed information might widen knowledge gaps among different SES groups [14].

As the present study was exploratory with the goal of understanding the overall coverage of cancer news, additional studies are required to clarify the media’s influence on cancer awareness with a more specific focus. Studies of the articles published in particular newspaper sections or focusing on certain subjects are required to verify and elaborate the present results. Moreover, in-depth qualitative analyses would clarify the details of the content and its latent meaning, or could provide concrete evidence of the nature of advertising. In addition, an analysis of the comprehensibility of news content from the reader’s perspective would more directly shed light on the differential influence of the media according to SES subgroups.

To summarize, the cancer news articles in Korean daily newspapers included diverse thematic categories, and the categories markedly differed in terms of the type of articles, their tone, and the number of cited sources. The news articles provided extensive information about healthcare resources, but frequently included advertorials, and they seemed to be deficient in conveying comprehensive and in-depth information regarding complex issues such as NHI. It is therefore inferred that the availability and usefulness of the information presented in these articles depend on individuals’ capabilities, such as financial and health literacy, and the current reporting framework is likely to widen knowledge gaps across SES subgroups.

Notes

CONFLICT OF INTEREST

The authors have no conflicts of interest associated with the material presented in this paper.

FUNDING

This work was supported by the National Cancer Center (grant No.1610311).

ACKNOWLEDGEMENTS

Notes

AUTHOR CONTRIBUTIONS

Conception and design: HSM, YAK. Acquisition of data: HSM, JP. Formal analysis: HSM. Funding acquisition: YAK. Writing - original draft: HSM. Writing - review & editing: EHY, JP, YAK.

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Figure & Data

References

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