This scoping review was conducted in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) [21] and guided by the scoping review framework by Arksey and O’Malley [22]. The review focused on the use of social marketing interventions for promoting breast cancer screening and positive behavioral changes in vulnerable populations. The review was designed to address the following research questions: (1) What are the characteristics of social marketing interventions that aim to promote cancer screening? (2) What methodological approaches have been used to evaluate the interventions? (3) What are the outcomes used to measure the impact of interventions? and (4) What are the impacts of social marketing interventions in promoting breast cancer screening?

A comprehensive literature search was conducted in 6 electronic databases: Web of Science, PubMed, EBSCOhost (via CINAHL), MEDLINE, PsycINFO, and Scopus. The search included studies using quantitative, qualitative, and mixed methods designs to ensure a broad retrieval of relevant literature. To focus on recent advancements and growing research on social marketing strategies for breast cancer screening uptake and preventive behaviors, the search was limited to articles published between 2010 and 2025.

The literature search was performed from August 2025 to October 2025. In addition to the database search, snowballing techniques were applied, including backward reference checking (screening reference lists of selected articles) and forward reference searching using the “cited by” function in Google Scholar. These manual searches were performed to retrieve possible articles that might be missed from the electronic databases. Aligning with the research objectives, the following 6 key search components were identified: (1) breast cancer; (2) screening or testing; (3) SMC, promotional activities, or advertisement; (4) social media, mass media, or mass communication; (5) intention to screen or test; and (6) behavior change or preventive behavior.

Alternative keywords were used for each component and combined using the Boolean operators “OR” within categories and “AND” between categories. Boolean operators were not applied in Google Scholar. Additionally, a truncation symbol (*) was used where applicable to capture word variations, as detailed in Tables 1 and 2.

The study included patients with breast cancer and those at risk who had participated in interventions involving any type of social marketing strategy, such as health promotion activities and community awareness programs. Titles, abstracts, and full-text articles were screened using PDF content to ensure alignment with the study objectives. Selected articles were subsequently stored in a Zotero database for reference management.

Articles were included if they met the specific criteria outlined in Table 3, which included the language and publication period, study design, intervention and outcomes, and target population. Meanwhile, studies not fulfilling the criteria listed in Table 3, not published in English, not focusing on breast cancer patients, or not involving cancer survivors or health professionals were excluded. Review articles, online materials, conference proceedings, nonoriginal articles, and articles that evaluated static internet pages, such as blog posts, were also excluded.

Title and abstract screening were conducted by 2 researchers, followed by full-text assessment for eligibility. Disagreements were resolved through consensus, with a third reviewer serving as a mediator. An interrater reliability analysis was performed for title and abstract screening, and an acceptable level of agreement was achieved (Cohen α=0.72). Data extraction was conducted independently by 2 research assistants to ensure accuracy and consistency. The lead researcher predefined the key data points to be recorded. A structured data extraction form was used, capturing the following details: authors’ names, research objectives, study location and design, population of interest, interventions applied, and main findings. Any discrepancies during data extraction were resolved using the same consensus approach described in the screening process, with a third reviewer providing mediation when necessary.

Although quality appraisal is not always required in scoping reviews due to the diversity of study designs [23], this review used a risk of bias assessment given its specific focus on social marketing strategies or programs for women with breast cancer and high-risk groups. The methodological quality of each study was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions [24]. The assessment considered 5 key domains: sequence generation, allocation concealment, adjustment for confounders, blinding, completeness of data, and selective reporting.

The extracted data and outcomes from the reviewed studies are shown in Table 3. We categorized the outcomes using an adapted version of key performance indicators and metrics related to social media use in health promotion [25]. The main aspects include insights, exposure and reach, and various levels of engagement. Information on the design, theoretical foundation, and delivery methods of interventions was also extracted from the reviewed studies. Furthermore, information regarding the potential mechanisms by which social marketing interventions shape behavior change was gathered by using the behavior change technique (BCT) taxonomy described by Michie et al [26].

The extracted data were analyzed using a narrative approach and thematic analysis, as recommended for scoping reviews. An inductive approach was used to identify and synthesize key themes based on the main findings from each study. The data synthesis process involved familiarization and coding, performed independently by 2 research assistants. The next step entailed developing the themes, whereby systematic coding was used to generate overarching themes. The last stage was validation and consensus, in which all the themes were reviewed by the authors to ensure consistency with the extracted data. Discrepancies were also resolved through discussion. All data management and analysis procedures were conducted using Excel (Microsoft Corp).

The literature search retrieved 724 articles from 6 databases. More than one-half (572/724, 79%) of the results were removed before screening, as 450 were identified as duplicates and 122 records were marked as ineligible. Upon title and abstract screening, 69 records were excluded. In the final stage, 15 of the 58 articles were eligible and included in the qualitative and thematic analysis. The reasons for excluding 43 full-text articles are outlined in Figure 1.

Table 4 outlines the characteristics of the reviewed studies. All the articles were original studies published in peer-reviewed journals. Most of the studies were conducted in the United Kingdom (n=4), and 1 each was conducted in Greece, Malaysia, Romania, Saudi Arabia, the United Arab Emirates, India, the United States, Israel, Turkey, China, and South Korea. In terms of study design, 4 studies were either single or multicenter randomized controlled trials (RCTs), 4 were quasi-experimental designs, 4 comprised a combination of cross-sectional surveys and pre- and posttest designs, 2 were case studies, and 1 article involved content analysis and in-depth interviews.

The sample size of participants in the studies ranged from 32 to 1945 with a total of 10,287 women enrolled in the intervention groups and 1164 in the control groups accross the 15 studies. The participants’ ages were presented in 8 studies, with a minimum age of ≥20 years to a maximum age of 70 years old. Most studies used >40 years old as the eligibility criterion.

This section presents findings regarding the first objective, focusing on the characteristics of social marketing interventions in the context of breast cancer screening. Specifically, the results are described based on intervention source and types; underpinning theories; insights, exposure, and reach; and outcome measures.

The factors influencing breast cancer screening awareness were investigated by 4 articles. Alomairy et al [14] found that cultural backgrounds shaped younger and older women’s attitudes toward breast cancer screening services. Abdulla et al [32] and Sinha and Sharma [33] reported that younger age, higher education, occupation, and being single improved the likelihood of attending breast cancer awareness programs, with knowledge gaps, cost concerns, and the lack of physician recommendations constituting the major barriers. The performance of breast awareness practices and clinical breast examinations was associated with having a lower level of religious beliefs and better understanding of the importance of screenings [36]. In contrast, none of the demographic variables influenced improvement in symptom awareness scores among Malaysian women who were exposed to a culturally adapted and mass media campaign (TV, radio, print media, and social media) [30]. These findings reflect the multifactorial nature of breast cancer screening behaviors and the need for tailored social marketing interventions.

Most articles on social marketing interventions assessed breast cancer awareness and screening intentions using a mixture of experimental and observational study designs to measure exposure, reach, and impacts on investigated outcomes. A few studies revealed that national and regional breast cancer awareness campaigns and targeted interventions might improve cancer awareness, screening intentions, and uptake. The available evidence also suggests that exposure, reach, and engagement attained by these interventions differed by age, gender, educational level, and users’ ethnicity.

Although several reviews have been published on interventions to address cancer screening and prompt diagnosis, to the best of our knowledge, this scoping review is the first attempt to focus on social marketing interventions to improve breast cancer screening, awareness, early diagnosis, and presentation to care. The findings add to the existing knowledge pool by reflecting the data paucity and robust clinical trials exploring the level of engagement, mechanisms of behavior change, and attendance at screenings specifically designed for women with breast cancer and high-risk groups. It is difficult to attain high engagement levels given the challenge with accessing timely observational data on breast cancer screening attendance [40,41]. This is further complicated by the fact that social marketing interventions are usually designed without provision for evaluation and impact metrics [42]. A similar situation was observed in the scoping review conducted by Plackett et al [5], whereby the authors commented, based on expert validation of emerging themes, that campaigns are designed rapidly without room for evaluation.

Immediate changes are difficult to measure since cancer screening and early diagnosis are long-term goals, which is in sharp contrast to the primary design of SMCs. More comprehensive evaluations that reflect outcomes of behavior change and engagement could be achieved by developing an evaluation framework that integrates components of behavior change theories [43]. Nevertheless, it is difficult to equivocally demonstrate that a specific campaign is primarily responsible for a change in behavior or outcome, in addition to the organizations’ limited resources and time to perform evaluations. Such assessments could, however, be conducted in campaigns involving collaboration with public health and institutional bodies.

In this review, we attempted to use the BCT taxonomy to delineate the various BCTs used in social marketing interventions to shape participants’ health behaviors, including social support, incentives, and equipping vulnerable populations with health information. The health belief theory was the framework predominantly used to develop the investigated interventions. According to BCTs, providing actionable health information about breast cancer symptoms and risk factors could have stronger and direct positive effects on behavior change. The BCTs used in breast cancer campaigns, such as sharing personal stories, could help create social support and influence public opinion, thereby encouraging help-seeking behaviors, increasing screening uptake, and improving health outcomes. Future interventions could explore these assumptions, particularly how national and regional social marketing strategies might facilitate positive behavior change and the most important messages required in such interventions.

This scoping review revealed the degree to which social marketing interventions addressed inequalities in breast cancer screening, awareness, and early diagnosis. The available evidence suggests a low reach and engagement with ethnic minorities [1,30], which is mainly associated with limited access to breast cancer screening, stigma, and low engagement with social media and SMCs [44,45]. This inequality is further exacerbated when the information is not culturally adapted [46]. The low uptake of screening and awareness may also stem from the lack of campaign role models that are highly respected and resonate with ethnic minorities [18].

Inequalities in the use and impacts of SMCs were also identified in terms of age, educational level, marital status, and occupation. Younger age, higher education, being employed, and being single improved the odds of exposure to breast cancer awareness programs and perceived benefits toward screening services [14]. These results align with recent data on social marketing and media use in the United Kingdom and high-income countries by age and gender [47]. The finding underscores the need for specific campaign strategies preferred by target users and those more likely to facilitate broad engagement.

Future interventions involving social marketing approaches should assess inequalities in exposure, reach, and engagement, as well as consider the effectiveness directly in relation to the target groups. Designing interventions toward populations with a disproportionate disease burden could address health inequalities observed in breast cancer screening and early diagnosis. This could be achieved by shifting from broad, “one-size-fits-all” approaches to audience-segmented interventions that effectively tackle systemic barriers. Social marketing strategies involving mass and social media can shift the “product” from fear-inducing to capacity-building, relatable, and manageable actions [48]. Educational-related barriers could be addressed by incorporating language and cultural nuances, partnering with community leaders, and designing messages that align with cultural beliefs and mitigating local cancer myths [49].

Meanwhile, inequities introduced by unemployment could be tackling systemic and hidden costs. Examples include campaigns that promote screenings related to tangible solutions, such as free and accessible mammography centers in local communities. These marginalized groups could also be further reached by expanding distribution channels beyond digital spaces, focusing on physical and trusted touchpoints [48]. Other possible channels to address the aforementioned inequities include leveraging trusted intermediaries to deliver face-to-face messaging and engaging the support ecosystem while considering the role of family structures in health care decisions [5].

Based on the syntheses of the 15 articles, most SMCs and interventions had significant impacts on breast cancer screening awareness and preventive behaviors. Overall, the findings are consistent with previous reviews on the use of social marketing strategies in HIV testing and related outcomes [49], whereby a consistent pattern of positive results were observed. Nevertheless, effectiveness seems to differ depending on specific elements used in the intervention, such as mass media, social media, and recognizable figures. Methodological limitations also need to be considered when interpreting the findings.

For instance, 2 RCTs [27,28] incorporating SMCs and health promotional activities led to significant improvement in upscaling breast cancer awareness, with a large effect size. These promising results may stem from the efficacy of such campaigns at enabling the transition from mere information to behavioral change. By integrating health promotional activities such as culturally tailored education, the intervention directly addresses psychosocial barriers, strengthens self-efficacy, and encourages proactive health actions [50]. Moreover, a comprehensive marketing mix is established by collaborating with stakeholders to tackle barriers such as accessibility and cost [14].

Social media or mass media and community outreach campaigns [39] were also instrumental at enhancing breast cancer awareness. These campaigns combined broad reach and localized, culturally tailored messaging as well as mitigated specific barriers to care such as stigma and fear. As a result, women were empowered to identify symptoms early and encouraged to visit screening centers [30,39]. However, the actual effect size of changes in breast cancer awareness could not be ascertained given the low-quality research designs. Promising results were also reported in a few qualitative interventional studies involving social media or mass media campaigns [29,37]. Positive advertisements capturing reliable data on breast cancer and endorsements from highly respected celebrities were perceived more positively, leading to proactive health actions. Celebrities can upscale breast cancer awareness and promote positive attitudes toward screening by leveraging their massive reach to destigmatize the cancer, break obstacles, and act as crucial relatable models for early diagnosis [51]. Involving recognizable figures bridge gaps between the general public and complex medical information, translating awareness into life-saving actions [52].

Video-based marketing was primarily used as the source of intervention in 2 studies [18,33], with both reporting greater awareness and improved knowledge and attitudes toward breast cancer screening postintervention. This approach was effective at bypassing literacy barriers, capturing attention, and directly inspiring proactive health behaviors because they rapidly translate complex health information into accessible, emotionally resonant and culturally adaptable formats [53].

Nevertheless, the evidence from the studies needs a deeper assessment and to be interpreted cautiously. Direct comparisons between the interventions was challenging given the different study designs and interventional approaches. However, the large effect sizes reported for SMCs incorporating health promotional activities suggest that these elements are effective at upscaling breast cancer awareness and positive screening decisions. This is further supported by the robust research designs used in the reviewed studies [14]. Community outreach and mass media campaigns also showed promising results in terms of breast cancer awareness and preventive behaviors, with the inclusion of recognizable figures providing additional benefits [54]. Meanwhile, evidence from video-based marketing approaches is weak, and the incorporation of other proven marketing elements may be required to optimize their effects.

Overall, the reviewed studies depict the importance of identifying SMCs and delivery methods that strongly resonate with the target audience [55]. Significant efforts are required to achieve audience segmentation and formative research with the target market for planning and branding the campaign. A catchy slogan and name are critical components of effective SMCs, but the information was lacking in most studies. As a result, it is unclear whether these important elements contributed to the promising outcomes reported in the reviewed studies.

Quality appraisal also revealed that only 2 clinical trials (RCTs) had a robust design. Based on the weak study designs, it is difficult to conclusively infer that the SMCs led to improved breast cancer awareness, screening uptake, and early diagnosis or presentation into care. Although the use of different approaches and evaluation methods provided a clear picture of the population’s exposure to the SMC and the participants’ awareness levels, a standardized approach is required to facilitate robust comparisons between campaigns in terms of effectiveness and economic benefits. We acknowledge the diverse nature of target populations when conducting SMCs, but a standardized reporting of exposure and impact is crucial for significant progress to be achieved in this unique field of public health.

Research into social marketing in public health interventions is rapidly growing, and this scoping review presents only the current and available evidence for social marketing interventions. Only articles written in English were included in our review, thereby neglecting information from relevant interventions either conducted in non-English speaking countries or not written in English. This limitation affects the generalizability of the review findings. Many of the SMCs used combined interventional approaches and sources, possibly contributing to the positive outcomes in terms of breast cancer awareness and screening participation.

Given the lack of a standardized protocol for report evaluations of social marketing interventions, the data synthesis was based on the outcomes measured and reported in the reviewed studies. In other words, some degree of reporting bias might be present in the included studies. The exclusion of gray literature may also introduce some bias, as only articles retrieved from selected databases and peer-reviewed journals were analyzed. The quality appraisal highlighted moderate to weak study designs in 13 of the 15 articles. We did not perform a meta-analysis due to the heterogeneity between the studies, particularly in terms of study designs, delivery methods, type of social marketing interventions, and diverse outcomes. Developing a reporting protocol based on available frameworks for evaluating social marketing research should be considered in future research endeavors.

This scoping review revealed that behavior change outcomes were sparingly assessed in most evaluations of social marketing interventions to improve breast cancer awareness, screening, and early diagnosis. The limited evidence reflects various types of social marketing interventions, ranging from community outreach to health professional and educational strategies, social media or mass media campaigns, and video-based marketing, which may improve breast cancer awareness and intended and actual screening uptake. Robust evaluations of these interventions could be performed in future research by using well-established evaluation frameworks and reporting guidelines. This will assist with capturing behavior change outcomes and elucidating their underlying mechanisms. Specific users or engaged individuals should be identified, and measures should be used to ascertain whether some health inequalities could be addressed by social marketing interventions. Developers and funders of these campaigns should also consider using an evaluation plan before conducting the actual campaign. Such evaluation plans may consider using feasible mixed methods and quasi-experimental designs. This is crucial to ensuring that campaign exposure and impact are measured adequately, as well as identifying the specific elements responsible for the observed behavioral change.