Factors Affecting the “Locus of Responsibility” in Cancer News: Focusing on the Role of Health Journalists’ Medical Expertise in South Korea

Abstract

This study is to investigate the ways news articles portray the “locus of responsibility” (LOR) for cancer causes and solutions and to identify factors associated with the different LOR frames in cancer news. This study specifically focused on health journalists’ medical expertise. There were more cancer news with personal LOR frames; professional medical journalists were more likely than general journalists to write cancer stories with personal LOR frames in both cause and solution cancer news; and, however, news organizations without professional medical journalists used more personal LOR frames than those with professional medical journalists, particularly in cause-related cancer news.

Keywords

cancer news news frame locus of responsibility Korea health journalism content analysis

Many social theorists have claimed that today’s world, variously described as a “risk society” (Beck, 1992; Giddens, 1991), “liquid modernity” (Bauman, 2000), or “second modernity” (Beck, 1999), is characterized by the fact that many important decisions are up to individuals (Bauman, 2000; Beck, 1992, 1999; Giddens, 1991). This trend is particularly manifest in the case of various health issues, including cancer. Even if the existing research has not yet fully clarified the ways news media contents influence audiences’ attribution of responsibility (Boiarsky, Rouner, & Long, 2013; Major, 2009), it is nonetheless evident that news media play a critical role in shaping public perceptions and opinions of who is responsible for causing or solving social problems (Iyengar & Kinder, 1987; Semetko & Valkenburg, 2000). Most previous studies have found more news stories emphasizing personal-level responsibility than society-level responsibility for various health issues, including cancer (S. H. Kim & Willis, 2007; Seale, 2002; Wright, Sparks, & O’Hair, 2008). Media scholars have pointed out the ways in which the media talk about health has important social implications—For example, it influences the way our society makes decisions about the allocation of resources toward health issues, and the way we conduct public discussions about the optimal balance between individual responsibility and societal responsibility (Wallington, Blake, Taylor-Clark, & Viswanath, 2010). Thus, systematic research about the ways news media frame the locus of responsibility (LOR) in their health stories not only holds scholarly significance, but also has public health implications.

The current article examines the ways Korean news media storytell about cancer, with a particular focus on the way they frame the LOR with regard to what causes cancer and who should be responsible for solving cancer problems in their news stories. Cancer is a leading cause of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer-related deaths in 2012 (Wild & Stewart, 2014). The number of new cases is expected to rise by about 70% over the next two decades (de Souza, Hunt, Asirwa, Adebamowo, & Lopes, 2016). Cancer has been the first cause of death in Korea as well since 1983 (Statistics Korea, 2014). The incidence rate of cancer in Korea also has been increasing due to rapidly aging population and lifestyle changes (Oh et al., 2016). Controlling modifiable cancer risk factors through effective health communication has become more important issue than before in Korea as well as worldwide.

As the number of cancer patients in Korea is growing (National Cancer Center, 2011), it has become more critical for news media to report on cancer news with better understanding about the potential impacts of the ways their stories are framed. Past research in South Korea suggests that people have inaccurate perceptions about the situations related to cancer, because cancer-related information such as incidence rates or mortality rates are not properly reported in the news media. For example, several studies have reported significant discrepancies from the actual cancer epidemiological data in the amount of news coverage of different cancer types (Kye et al., 2015) and in the threat portrayal of news coverage about cancer (Shim, Kim, Kye, & Park, 2016). Which news frames, especially which responsibility frames, are more prevalent is often a social construction (Liang, Tsai, Mattis, Konieczna, & Dunwoody, 2014): Therefore, different patterns of cancer responsibility frames may be found in different countries and cultures. However, there have been few systematic studies of the ways cancer news stories are framed in Korea.

The aims of the current study are twofold: (a) to assess the primary LOR in cancer news in Korea and (b) to identify the various factors affecting the different types of LOR frames in Korean cancer news. Our study will be one of the first systematic studies to evaluate which frames (personal vs. social) are prevalent in cancer news stories of the Korean news media and what factors influence the frame building process. The findings of this study will be critical to understand media storytelling about cancer in Korea and develop cancer communication strategies.

In this study, we are particularly interested in the ways the medical expertise of health news storytellers affects the LOR in cancer news stories. A recent phenomenon in Korea has been the hiring of medical professionals as full-time health reporters (hereafter called “professional medical journalists”) by many Korean news media. It would be interesting to see whether this new type of health news storytellers frames the LOR in a particular direction—whether more individual- or society-oriented—as compared with nonprofessional medical journalists. In addition to the effects of health reporters’ medical expertise on the LOR in news stories, this study also considers a range of other factors related to organizational characteristics, news media outlets (TV vs. newspaper), and news types (straight news vs. analytic news). A quantitative content analysis method was adopted with an ecological approach for this study: We analyzed the news contents published over 5 years by 24 news media outlets representing an almost comprehensive list of the news media channels delivering cancer news in Korea, including TV networks, general newspapers, medical newspapers, and online news media.

Social and Personal Frames for Cancer News

Previous news framing studies have proposed that any event (e.g., cancer) has multiple attributes in it, and news media tend to show their bias when reporting about it by selecting only a certain sample of attributes in the event while excluding others (Entman, 1993; Gitlin, 1980; Iyengar, 1991). Framing research calls this process of selecting and excluding attributes in an event as framing and explains that biases in framing processes would have significant effects on individuals and society (Gitlin, 1980). Generally speaking, framing studies have focused on two research agenda: (a) categorizing news frames and identifying factors that influence the process of news framing (i.e., frame building) and (b) assessing the effects of news framing on the public perception, attitudes, and opinions on a certain event, issue, or object (i.e., frame setting) (Scheufele, 1999). The current study limits its scope to the issues related to frame building rather than frame setting as this study attempts to examine how cancer news are framed in the Korean news media.

Many framing studies about health topics have paid attention to an issue about whether health issues are presented in the news media either as personal or social ones. In fact, health issues, including cancer, are mostly both personal and social. The causes of breast cancer, for example, can be attributed either to the patient herself (e.g., nulliparity, breast-feeding, alcohol consumption, physical activity, body fatness, or reproductive factors such as early menarche and late menopause) or to social issues such as environmental problems, changes in economic structures, structural opportunities for marriage and childbirth, insurance policies, the availability of/access to medical facilities for screening or treatment, or governmental policies, rules, and regulations. The ways health news stories are framed—either personally or socially—may have different effects on individuals and society (Cookson, 2000; Ellingsen, Johannesson, Mollerstrom, & Munkhammar, 2012; Rege & Telle, 2004).

Previous studies have noted that health news stories tend to show a bias toward personal frames rather than social frames, that is, they focus on individual-level causes/solutions to health problems, while downplaying socially determined health issues (Seale, 2002; Wright et al., 2008). This has been a general pattern in the news stories about different health issues, including general diseases (Peng & Tang, 2010), obesity (Barry, Jarlenski, Grob, Schlesinger, & Gollust, 2011; Bonfiglioli, Smith, King, Chapman, & Holding, 2007; Hawkins & Linvill, 2010; S. H. Kim & Willis, 2007; Lawrence, 2004; Saguy & Almeling, 2008), women’s health (Roy, 2008), and heart diseases (Clarke & Van Amerom, 2008). This pattern has also been found in news stories about cancer in general (Clarke & Van Amerom, 2008) and about some specific cancer sites, such as breast cancer (Brown, Zavestoski, McCormick, Mandelbaum, & Luebke, 2001). Clarke and Van Amerom (2008) found that cancer stories reported by news media often did not clearly address the issues related to social determinants, such as food accessibility and quality, housing, social services, social exclusion, unemployment, or employment security.

Cancer news may focus on different aspects of cancer issues. Following previous studies about news frames (Iyengar, 1990, 1991), we can divide those into news about what/who causes cancer, and about what/who is responsible for solving cancer problems (Hilton, Patterson, & Teyhan, 2012; A. E. Kim, Kumanyika, Shive, Igweatu, & Kim, 2010; S. H. Kim & Willis, 2007). In their study of obesity news, S. H. Kim and Willis (2007) found that there were significant differences in the ways news stories were framed depending on whether they focused on causes or solutions. The authors found that the emphasis was more likely to be on personal responsibility (rather than social responsibility) in the stories focusing on how to solve the problem than in those discussing its causes. Building on S. H. Kim and Willis’s study, we ask whether a similar pattern can be observed in cancer news in Korea. To address this issue, we formulate two research questions as follows. In these research questions, we compare personal LOR frame (e.g., personal history, experiences, lifestyle, or demographic, physical, or biological characteristics as causes for cancer or individuals’ own efforts to make decisions, pay costs, or change their attitudes, lifestyles, habits, or behaviors as solutions to cancer problems) and social LOR frame (government-level, corporate-level, or community-level perspectives; decisions; activities; or environments as causes or solutions for cancer). The first research question (RQ1-1) is about cancer news addressing causes, whereas the second one (RQ1-2) is about those dealing with solutions:

RQ1-1: Which of the personal or social LOR frame is more prevalent in cancer news about what or who causes cancer?

RQ1-2: Which of the personal or social LOR frame is more prevalent in cancer news about who or what is responsible for solving cancer problems?

Professional Medical Journalists and Health Storytelling

Writing a good health-related news story is not an easy job: It requires both medical knowledge and journalistic training. Journalists often cite their lack of background knowledge or their difficulties gaining access to medical experts as barriers to effective reporting on medical issues (Larsson, Oxman, Carling, & Herrin, 2003). Considering these barriers, many have suggested building significant collaborations between journalists—particularly those who write health stories—and health professionals (Leask, Hooker, & King, 2010), public health experts (Friedman, Tanner, & Rose, 2014), or governmental public health organizations (Avery, Lariscy, & Sohn, 2009). One effective (but not necessarily easy or efficient) way for news media organizations to realize these collaborations may be to hire health professionals and train them to become health reporters themselves. An increasing number of professional medical journalists, such as CNN correspondent Sanjay Gupta, have been hired by traditional news organizations. This has been a noticeable trend in the Korean news media environment as well. As of today, about 10 major Korean news organizations (both newspapers and TV networks) have hired professional medical journalists.

One can think of many positive contributions that can be made by professional medical journalists to news organizations and their audiences. Several recent studies have found that professional medical journalists write better quality health stories than nonprofessional medical journalists (Wilson, Robertson, McElduff, Jones, & Henry, 2010). This may be an outcome of their capacity to build a positive mix of medical expertise, their easier access to medical experts, and their newly adopted journalistic skills.

However, managing two identities and roles at the same time—as a former physician and current journalist—does not always produce positive outcomes. Professional medical journalists often mention internal conflicts and a heightened uncertainty in their understanding of their new role (Linden, 2010). They seem to know that they are expected to write stories using their medical expertise; for this reason, they often tend to be less critical about problems arising from the social structure, while focusing on their specialized knowledge (S.-S. Kim, 2004).

How does this affect the way professional medical journalists frame their cancer stories in comparison with nonprofessional medical journalists? Previous framing studies have explained that journalist-level factors (e.g., political orientation) could influence frame building in news stories (Scheufele, 1999). However, there has been little systematic research specifically identifying the ways in which journalists contribute to the frames in the news (Brüggemann, 2014). One study based on interviews with health journalists in New Zealand reported that health journalists tended to favor biomedical stories involving lifestyle and individual responsibility but were less likely to use social frames to present stories involving sociopolitical concerns (Hodgetts, Chamberlain, Scammell, Karapu, & Waimarie, 2008). Based on this limited number of previous studies only, it is not possible to predict that professional medical journalists in Korea use personal LOR frames more frequently than social LOR frames. We therefore consider the following two research questions in this study:

RQ2-1: Which of the personal or social LOR frame is more prevalent in the news stories about cancer causes written by professional medical journalists, as compared with those written by nonprofessional medical journalists?

RQ2-2: Which of the personal or social LOR frame is more prevalent in the news stories about cancer solutions written by professional medical journalists, as compared with those written by nonprofessional medical journalists?

The aforementioned issue—that is, the role of professional medical journalists in the ways cancer news stories are framed—can also be considered at the organizational level. The question therefore shifts to whether having (or not having) a professional medical journalist in-house makes a significant difference to the ways cancer news stories are framed in news organizations as a whole. At least two scenarios can be suggested: a diffusion scenario and a division-of-labor scenario. Nonprofessional health journalists writing cancer news may be influenced by their professional medical journalist colleagues to write cancer news “professionally,” so that there may be no significant differences between the frames adopted by professional medical journalists and other journalists (diffusion scenario); alternatively, the presence of a professional medical journalist in a news organization may give other reporters room to take different angles, perspectives, or frames, so that there may be different patterns between the news frames adopted by professional medical journalists and those adopted by others in their news organization (division of labor scenario).

RQ3-1: Which of the personal or social LOR frame is more prevalent in news stories about cancer causes written by news organizations with in-house professional medical journalists, compared with those without?

RQ3-2: Which of the personal or social LOR frame is more prevalent in news stories about cancer solutions written by news organizations with in-house professional medical journalists, compared with those without?

Other Factors Affecting the LOR

We examine two other factors that may influence the LOR in cancer news: the type of news media outlet (TV vs. print media) and the news type (straight news vs. analytic stories). Previous studies of news framing have demonstrated that TV news delivered more individual than social LOR frames in both political or public affairs news (Pan & Kosicki, 1996; Semetko & Valkenburg, 2000; Sotirovic, 2003) and health news (S. H. Kim & Willis, 2007). Based on these studies, we introduce research questions considering whether there may be differences between the LOR frames used in TV news and in print media news. In his 1991 seminal work, Iyengar linked thematic TV news to social responsibility frames, and episodic news to individual responsibility frames. Semetko and Valkenburg (2000) reported that the use of news frames was often related to the news type (serious news vs. sensational news); they found that serious news used more LOR (both personal and social) frames, whereas sensationalist outlets used more human interest frames. However, they did not push their study further into observing the ways personal and social frames are differently influenced by the news type and media outlet. Building primarily on Iyengar’s work, this study compares two types of cancer news: straight news (i.e., cancer news stories designed to deliver facts or events without further explanations or subjective evaluations) versus analytic stories (i.e., cancer news stories containing detailed explanations, perspectives, interpretations, or opinions).

RQ4-1: Which of the personal or social LOR frame is more prevalent in news stories about cancer causes delivered by television media, as compared with print media?

RQ4-2: Which of the personal or social LOR frame is more prevalent in news stories about cancer solutions delivered by television media, as compared with print media?

RQ5-1: Which of the personal or social LOR frame is more prevalent in news stories about cancer causes delivered as straight news, rather than as analytic news?

RQ5-2: Which of the personal or social LOR frame is more prevalent in news stories about cancer solutions delivered as straight news, rather than as analytic news?

Method

Data

We analyzed 24 news media outlets, including three TV networks (KBS, MBC, and SBS), 16 general print media (Chosun Ilbo, Joongang Ilbo, Dong-a Ilbo, Hankyoreh-Shinmun, Kyonghyang-Shinmun, Hankuk-Ilbo, Kukmin-Ilbo, Munhwa-Ilbo, Seoul-Shinmun, Segye-Ilbo, MK Business News, Seoul Economy News, The Asia Economy Daily, Aju business Daily, Money Today, and Financial News), three medical newspapers (Dailymedi, Medical Times, and Yeihyub-Shinmun), one online medical news site (The Korea Doctor’s Weekly), and one news agency website (Yonhap News). Among this almost comprehensive list of Korean news outlets, we searched for the news items published between January 1, 2008, and December 31, 2012, which contained the Korean word for cancer (“ahm”), along with any one or more of the Korean words for “cause,” “incidence,” “carcinogen,” and “engenderment.” These keywords were chosen via consultations with health reporters who had significant experience of writing about cancer. The search was conducted on Eyesurfer (Version 3.0), an online database news scrapping service system used in Korea. After excluding all overlapping articles, a total of 13,583 news stories were collected through the search. Using a systematic stratified sampling method that took into account the proportion of articles in each of the three types of media outlets, we randomly selected about 11% (n = 1,500) of the news articles as our study sample: 890 from general newspapers, 291 from network television news, and 319 from medical news media. The unit of analysis was the individual article.

Variables

LOR for cancer causes

Cause-related cancer news stories were assigned a value on a nominal scale for each of the following five categories: personal, social, technology, nature, and none. If an article mentioned multiple causes for cancer, it was assigned more than one value. Therefore, the total number of frames analyzed in this study can be more than the number of news stories included in the sample. Although our research focused on comparing the personal and social LOR frames, we included other frame categories often used in cancer news, whether independently or in conjunction with personal and social LOR frames. If a story did not mention any cancer cause, it was categorized as “none.” Stories were considered to have a personal LOR frame if they mentioned personal history, experiences, lifestyle, or demographic, physical, or biological characteristics (e.g., gender, age, weight, etc.) as causes for cancer (e.g., “being obese increases renal cancer by 61%,” or “overnutrition makes people more vulnerable to colorectal cancer”). Any story pointing to government-level, corporate-level, or community-level perspectives; decisions; activities; or environments—or the lack thereof—as causes for cancer (e.g., “government health agencies pay little attention to the hazards from asbestos,” or “because of government officials’ mistakes, it is possible that cooking oils contain lots of benzopyrene”) was considered to have a social LOR. Cancer news were assessed as having a technology LOR when they cited everyday technologies (e.g., hair dryers, microwaves, cell phones, etc.), medical equipment (e.g., X-rays or computed tomography [CT]), or pharmaceutical products as potential causes of cancer without directly mentioning the responsibilities of individuals, corporations, or governments (e.g., “long-term use of the acetaminophen contained in Tylenol may lead to non-Hodgkin’s lymphoma,” or “CT may cause cancer in children”). The nature LOR frame was attributed to news stories that presented natural processes or outcomes as causes of cancer without directly mentioning the responsibilities of individuals, corporations, or governments (e.g., “humans can develop lung cancer if they are exposed to radon-tainted air,” or “the RET fusion gene causes lung adenocarcinoma”).

LOR for cancer solutions

As above, solution-related cancer news stories were assigned nominal scale values for the following five LOR categories: personal, social, technology, nature, and none. If an article mentioned multiple LORs for cancer solutions, it was assigned more than one value. If a story did not mention any cancer solution, it was categorized as “none.” Stories were considered to have a personal LOR frame if they emphasized individuals’ own efforts to make decisions, pay costs, or change their attitudes, lifestyles, habits, or behaviors as solutions to cancer problems (e.g., “one has to quit smoking,” or “people must get colorectal cancer screening”). Stories were considered to have a social LOR frame if they mentioned governments’, corporations’, health agencies’, health organizations’, communities’, or any other collective-level efforts to solve cancer-related problems (e.g., “the Korean Ministry of Health and Welfare should launch a new campaign against heavy drinking” or “a Korean company has been planning to reduce the amount of polluted water discharged from its factories”). Cancer news were assessed as having a technology LOR when they mentioned new technologies, new equipment, new technical programs and processes, or new products based on novel technological developments as solutions to cancer problems without directly mentioning the responsibilities of individuals, corporations, or governments (e.g., “new materials have been developed to cure colorectal cancer” or “a new study found that aspirin could increase the survival rate for colorectal cancer”). The nature LOR frame was attributed to news stories that mentioned natural materials or processes as solutions without directly mentioning the responsibilities of individuals, corporations, or governments (e.g., “eating red tomatoes may prevent cancer,” or “vegetables and fruit cellulose reduce the risk of getting colorectal cancer”).

Professional medical journalists

Cancer news writers were regarded as professional medical journalists if they satisfied one of the following conditions: (a) they had an MD degree or (b) they had acquired an official “professional medical journalist” or equivalent title from their news organization. Almost all of the reporters with an MD degree were officially recognized by their news organization as professional medical journalists in Korea. However, some reporters who had written about health issues substantially for many years had also been given an official medical journalist title. Out of the total sample (n = 1,500), 101 articles were categorized as news stories written by professional medical journalists. When a story was cowritten by a professional medical journalist and other general journalists, it was considered as having been written by professional medical journalists.

News organizations with professional medical journalists

The 24 news organizations included in our analysis were divided into two groups: those with professional medical journalists as defined in the previous paragraph (n = 10), and those without (n = 14).

Media outlets

We categorized the news media outlets into either print media (n = 16) or television (n = 3). For our analysis of the effects of different media outlets, we excluded online media, news agencies, and medical newspapers as their number was too small.

News types

The cancer stories about causes and solutions were categorized into two groups: straight news and analytic stories. We defined straight news as news stories that were mainly designed to deliver facts or events, without further explanations or subjective evaluations. Analytic stories were defined as stories containing detailed explanations, perspectives, interpretations, and opinions no matter whether they appear as headline news, special section news, columns, or editorials.

Intercoder Reliability

The data were coded by six graduate students with a major in communication. Before the coding started, the coders attended a couple of workshops led by one of the authors to acquire a full understanding of the coding schemes. Several follow-up ad hoc meetings between the coders and the researchers were conducted whenever necessary throughout the coding period. Before the main coding phase started, a pilot coding session was conducted on 100 randomly selected articles. Krippendorff’s alpha scores were calculated to verify the intercoder reliability, as follows: .91 for cancer causes, and .91 for cancer solutions.

Results

Our first research question considered which frame (social LOR or personal LOR) was more prevalent in cancer news, especially those about cancer causes or cancer solutions. We found that around 90% of cancer news talked about cancer causes, and most of them adopted a personal LOR frame (38.7%), followed by a social LOR frame (26.5%), a nature LOR frame (17.8%), and a technology LOR frame (17.8%) (see Table 1). About 11.4% of the cancer news stories did not include any word related to cancer causes. About 80% of cancer news mentioned what to do about cancer (cancer solutions); 49.4% of all solution-related cancer news stories used a personal LOR frame, whereas 36.9% were based on a social frame. Only a small number of cancer news mentioned nature (0.7%) or technology (1.2%) in relation to cancer solutions. For cancer news about either causes or solutions, stories based on a personal LOR frame were more prevalent than those based on a social LOR frame: The gap was about 10% for both cause- and solution-related cancer stories.

Table 1.

Locus of Responsibility Frames in Cause-Related and Solution-Related Cancer News (Multiple Counts).

Frame	Cause		Solution
Frame	Frequency	%	Frequency	%
Personal	580	38.7	741	49.4
Social	397	26.5	553	36.9
Technology	267	17.8	18	1.2
Nature	267	17.8	10	0.7
None	171	11.4	319	21.3
Total number of news stories	1,500	100	1,500	100

Note. The frequency values are based on multiple counts. Therefore, the summation of the percentage values in the table can exceed 100.

The second set of research questions (RQ2-1 and RQ2-2) considered whether the prevalence of specific LOR frames was dependent on who wrote the stories. More specifically, the study aimed to compare the ways professional medical journalists and general journalists wrote cancer stories, and the different LOR frames they adopted. We found that professional medical journalists relied heavily on the personal LOR frame for cancer causes (58.7%), and little on the social frame (6.3%) (Table 2). Professional medical journalists’ bias toward the personal LOR frame was even stronger in the case of solution-related cancer news stories, as follows: personal frame (77.8%), and social frame (15.9%). By contrast, general journalists demonstrated a relatively better balance between the social and personal LOR frames: 35.7% versus 29.3% in cause-related cancer news, and 45.5% versus 39.8% in solution-related cancer news.

Table 2.

Locus of Responsibility in Cancer News Stories Written by Professional Medical Journalists and by General Journalists (Multiple Counts).

Frame	Cause				Total	Solution				Total
	Professional health journalist		Nonprofessional health journalist			Professional health journalist		Nonprofessional health journalist
	n	%	n	%		n	%	n	%
Personal	111	58.7	472	35.7	580	147	77.8	601	45.5	741
Social	12	6.3	387	29.3	397	30	15.9	526	39.8	553
Technology	31	16.4	241	18.2	267	0	0.0	18	1.4	18
Nature	57	30.2	211	16.0	267	2	1.1	8	0.6	10
None	21	11.1	153	11.6	171	24	12.7	297	22.5	319
Total number of news stories	189		1,321		1,500	189		1,321		1,500
	χ² = 217.44*, df = 10, p = .000					χ² = 245.04*, df = 10, p = .000

Note. The frequency values are based on multiple counts. Therefore, the summation of the percentage values in the table can exceed 100.

p < .05.

RQ3-1 and RQ3-2 were formulated to compare the cancer news stories published by two groups of news media organizations (those with professional medical journalists and those without) in terms of the prevalence of personal LOR or social LOR frames in their cancer stories (Table 3). In the cancer news about causes, news organizations with professional medical journalists generally showed a more balanced use of different frames than those without professional medical journalists. We found that media organizations without professional medical journalists demonstrated a greater reliance on the personal frame (43.1%) than those with professional medical journalists (32.5%). There was not much difference between the two groups of news organizations in their use of LOR frames in solution-related cancer news.

Table 3.

Locus of Responsibility in Cancer News Stories Written by News Organizations With Professional Medical Journalists and Those Without (Multiple Counts).

Frame	Cause				Total	Solution				Total
	Having		Not having			Having		Not having
	n	%	n	%		n	%	n	%
Personal	202	32.5	378	43.1	580	288	46.3	453	51.6	741
Social	139	22.3	258	29.4	397	241	38.7	312	35.5	553
Technology	157	25.2	110	12.5	267	13	2.1	5	0.6	18
Nature	101	16.2	166	18.9	267	4	0.6	6	0.7	10
None	96	15.4	75	8.5	171	124	19.9	195	22.2	319
Total number of news stories	622		878		1,500	622		878		1,500
	χ² = 85.55*, df = 5, p = .000					χ² = 13.93*, df = 5, p = .016

Note. The frequency values are based on multiple counts. Therefore, the summation of the percentage values in the table can exceed 100.

p < .05.

We compared the ways cancer news stories were framed (with a personal or social LOR) by print media and TV news outlets (RQ4-1 and RQ4-2). As shown in Table 4, print media showed slightly higher percentages of cause-related cancer news stories based on a personal (38.1%) or a social LOR frame (25.5%) than television (32.8% and 23.2%, respectively), indicating that print media used more responsibility frames than TV networks in general when reporting about cancer. On the contrary, television outlets showed a significantly higher percentage of cancer stories about causes based on a technology frame (36.9%) than print media (15.3%). There was not a statistically significant difference between print media news and television news in terms of news frames for solution-related stories (χ² = 3.606, df = 5, p = ns).

Table 4.

Locus of Responsibility in Cancer News Stories Reported by Newspapers and Television Networks (Multiple Counts).

Frame	Cause				Total	Solution				Total
	Newspaper		Television			Newspaper		Television
	n	%	n	%		n	%	n	%
Personal	339	38.1	65	32.8	580	450	50.6	91	46.0	741
Social	227	25.5	46	23.2	397	324	36.4	74	37.4	553
Technology	136	15.3	73	36.9	267	15	1.7	1	0.5	18
Nature	177	19.9	35	17.7	267	2	0.2	0	0.0	10
None	111	12.5	11	5.6	171	173	19.4	41	20.7	319
Total number of news stories	890		198		1,500	890		198		1,500
	χ² = 59.29*, df = 5, p = .000					χ² = 3.61*, df = 5, p = ns

Note. The frequency values are based on multiple counts. Therefore, the summation of the percentage values in the table can exceed 100.

p < .05.

We also examined the difference between straight news and analytic stories with regard to the prevalence of personal or social LOR frames (RQ5-1 and RQ5-2). We found that more than half of the analytic stories about cancer (58.7%) used a personal LOR frame to address cancer causes, as compared with 31.7% of straight news (Table 5). Straight news about cancer causes used more social (30.2%) and technology frames (20.1%) than analytic stories (15.6% and 11.2%, respectively). This pattern was especially striking in the case of solution-related cancer news: A little less than three quarters of the analytic stories about cancer solutions (72.5%) used a personal frame, compared with 41.4% of straight news. Straight news (40.4%) about cancer solutions used more social frames than analytic stories (26.5%).

Table 5.

Locus of Responsibility in Cancer News Stories Written as Straight News and as Analytic Stories (Multiple Counts).

Frame	Cause				Total	Solution				Total
	Straight		Analytic			Straight		Analytic
	n	%	n	%		n	%	n	%
Personal	354	31.7	226	58.7	580	462	41.4	279	72.5	741
Social	337	30.2	60	15.6	397	451	40.4	102	26.5	553
Technology	224	20.1	43	11.2	267	10	0.9	8	2.1	18
Nature	184	16.5	83	21.6	267	7	0.6	3	0.8	10
None	123	11.0	48	12.5	171	286	25.7	33	8.6	319
Total number of news stories	1,115		385		1,500	1,115		385		1,500
	χ² = 140.33*, df = 5, p = .000					χ² = 187.52*, df = 5, p = .000

Note. The frequency values are based on multiple counts. Therefore, the summation of the percentage values in the table can exceed 100.

p < .05.

Discussion

The current study set out to assess the primary LOR and to identify the factors influencing the different LORs in Korean cancer news. We found that, in general, there were more cancer news stories based on personal LOR news frames than on social LOR news frames in the Korean media. We found that cancer news writers’ medical expertise was more related to personal LOR news frames than to social ones in both cause- and solution-related stories. Professional medical journalists were more likely than general journalists to write cancer stories about causes or solutions based on a personal LOR frame. This tendency was especially striking in solution-related cancer news. However, the picture was different at the media organizational level. News organizations without professional medical journalists used more personal LOR frames than those with professional medical journalists, particularly in their cause-related cancer news. Both the personal and social LOR frames were more prevalent in newspaper stories about cancer causes than in TV news stories about cancer causes. In TV news stories, the technology LOR frame appeared more frequently than other frames. The personal LOR frame was much more prevalent in analytic stories than in straight news about both causes and solutions.

Several points linked to the findings of this study require further discussion. First, consistently with previous studies (Barry et al., 2011; Brown et al., 2001; Clarke & Van Amerom, 2008; S. H. Kim & Willis, 2007; Peng & Tang, 2010; Roy, 2008), the current study found a bias toward the personal LOR frame in the Korean news media content about cancer issues. In the cancer news about either causes or solutions, the personal LOR was more prevalent than the social LOR, suggesting that more efforts should be made by Korean news organizations to balance the LOR frames in the cancer news delivered to their audiences, so that individuals may gain a multifaceted perspective on cancer causes and solutions.

Second, the current study showed that professional medical journalists could give a biased view of cancer issues by making their audience see them primarily as individual-level problems, while ignoring their social aspects. Professional medical journalists can help audiences understand complex health issues, including cancer. Thanks to these health reporters with MD degrees, audiences can gain in-depth knowledge of what measures to follow for prevention and treatment. These professional medical journalists can play the role of family doctors for their audience, telling them what to do and what to avoid to lead a better, healthier life. This is obviously a positive contribution that professional medical journalists can make toward their news organization and their audience. However, the results of the current study indicate that professional medical journalists should reflect on what they write and make greater efforts to build a balance between the personal and social frames in their news stories about cancer.

Third, interestingly and in contrast with the findings about the biased effects of professional medical journalists on the ways cancer news are framed, we found that news organizations with professional medical journalists (as opposed to without) adopted more balanced LOR frames in their cancer stories. These results seemed to confirm that, with regard to the impact of professional medical journalists at the organizational level, what we called earlier as the division-of-labor scenario (which states that the presence of a professional medical journalist in a news organization may give other reporters room to take different angles, perspectives, or frames) is more likely than the diffusion scenario (which states that nonprofessional health journalists writing cancer news may be influenced by their professional medical journalist colleagues).

Only those media organizations equipped with financial and other resources are able to hire medical doctors as full-time reporters. When a news organization has one or more medical professional journalists, this leaves more room for other general reporters to write different kinds of stories—that is, stories other than those focusing on conventional health tips and recommendations for prevention or treatment, which are now covered by their colleagues who used to be medical doctors. It is possible that, thanks to the presence of professional medical journalists, general journalists have more freedom to focus on the social aspects of cancer issues. However, we do not believe that this should give professional medical journalists an excuse to focus solely on individual LOR-framed stories. They should develop journalistic ways to deal with health issues by addressing both personal-level and social-level responsibilities for prevention and treatment.

Fourth, straight news used more social frames than analytic stories, whereas analytic stories used more personal frames than straight news. This may be related to the fact that analytic stories are mostly written by professional medical journalists to be published in health sections, whereas straight news are likely to be written by general journalists to appear in non-health-related sections.

The present study does not provide any data about the potential causal links influencing whether—and how—the LOR frames used in cancer news affect audiences’ attribution of responsibility and their behavioral approaches to prevention and treatment. However, recent studies have demonstrated that the ways situations are framed by mediated or nonmediated storytelling affect the ways individuals interpret situations and the ways they behave in those situations. For example, Ellingsen et al. (2012) conducted a prisoner’s dilemma game experiment: They found that whether they called the game a community game or a stock market game made a significant difference on the degree to which individuals were willing to cooperate with one another. Malle (2004) reported that framings around specific incidents and individuals were more likely to result in audiences’ perceptions of attributions of responsibilities focusing on the characteristics of individuals. Boiarsky et al. (2013) found that personal LOR stories significantly increased the public’s perception that individuals are responsible for given issues, whereas social LOR stories do not have the same effect. Major (2009) reported that thematic stories about lung cancer and obesity increased individuals’ attribution of social responsibility. Although more empirical studies are needed to confirm the causal link between media LOR frames and audience LOR frames (and the ways individuals talk about health issues as well as the ways they act according to those frames; Lundell, Niederdeppe, & Clarke, 2013), the existing studies have consistently stressed the importance of writing balanced news stories about health issues, including cancer.

Last, our results indicate what we need to consider for improving cancer prevention. First, our results suggest that there should be more education about public health, social determinants of health, and health communication in the medical curriculum in South Korea. Second, we also need to develop journalism education and training programs that emphasize the importance of balanced cancer news frames that contain both personal and social responsibilities for cancer incidences and treatment. Third, in addition to the changes in medical education curriculum and journalism education and training programs, we may also need to consider expanding health literacy and medical literacy education for the public to help them understand clinical and public health aspects of cancer issues with expectation that these education programs work as a buffer to the biased cancer news frames.

We believe that our suggestion for using balanced news frames for cancer issues should be applied not only in Korea but also in other countries. However, we need to consider contextual factors in developing specific cancer prevention programs. In particular, we need to pay attention to the differences among different countries in terms of cancer incidence rates and survival rates, popularity of professional medical journalists, conditions of media markets, level of media literacy and health literacy among the general public, and cultural differences in attribution. Due to these contextual factors, we may expect to get different levels of bias toward LOR in different countries and will need to develop different strategies in different places to make sure of building balanced frames in news stories about cancer as one important health communication goal of cancer prevention.

There are some potential future research topics based on the findings of the current study. First, in our future research, we may want to analyze the changes over time. For example, we may ask whether the reliance on personal or social LOR frames in Korea has increased or decreased over time or whether it fluctuates depending on certain situational changes. In future studies, the dataset should be extended to include years prior to the period analyzed in this study to gain a better view of the trends over time. Second, we did not analyze the contents by cancer type. However, there might be some variances among the different types of cancers regarding the prevalence of either social or personal LOR frames. This may be an interesting area for future research. Third, we would attempt to take into account the journalists’ varying levels of experience, particularly among professional medical journalists in future studies. Professional medical journalists may have different writing patterns and attitudes depending on their length of experience as a journalist.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Yong-Chan Kim (PhD, University of Southern California) is professor at the College of Communication at Yonsei University, South Korea. He is the director of Urban Socio-Spatial Informatics Center (USSI) and the principal investigator of the Urban Communication Lab (UCL) at Yonsei. His research has focused on urban communication, new communication technologies, and health/risk communication.

Minsun Shim (PhD, University of Pennsylvania) is associate professor of communication at Inha University, South Korea. Her research interests include health and risk communication, media effects on health, and cognitive and affective processes in online communication and social media.

Jee Hyun Kim (MA, Yonsei University) is a doctoral candidate at the Graduate School of Communication and Arts at Yonsei University.

Keeho Park (MD, PhD, Yonsei University) is associate professor at the Graduate School of Cancer Science and Policy at National Cancer Center, South Korea. He is also the director of Cancer Policy at National Cancer Center. His research has focused on community health, subjective well-being, positive psychology, and health communication.

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