Education, Trust, and Taboo: How Sociocultural Barriers and Professional Backgrounds Shape Engagement with Digital Breast Cancer Messaging in Islamabad and Rawalpindi

Abstract

This study examines how sociocultural barriers and professional backgrounds influence engagement with digital breast cancer awareness messaging among urban populations in Islamabad and Rawalpindi, Pakistan. Despite the proliferation of digital health campaigns, significant gaps persist between message exposure and meaningful health behavior change, particularly in contexts where stigma, educational disparities, and trust deficits intersect. Drawing on in-depth qualitative interviews with 40 participants from diverse educational and professional backgrounds ranging from undergraduate students to PhD candidates and healthcare professionals alongside content analysis of digital campaigns from 2022 to 2025, this research investigates how educational attainment, professional expertise, and cultural taboos mediate the reception, interpretation, and credibility assessment of breast cancer awareness messages. Findings reveal that while higher education and medical training facilitate critical engagement with campaign content, cultural taboos and gendered communication norms persistently constrain open dialogue, particularly in family settings. Trust in campaign messages is heavily contingent on institutional credibility, with government-affiliated and established NGO campaigns perceived as more reliable than influencer-driven content. However, even among highly educated groups, stigma and embarrassment create significant barriers to translating awareness into screening behavior. The study further identifies critical gaps in campaign inclusivity, including limited regional language accessibility, absence of male engagement, and lack of year-round visibility. These findings underscore the necessity of culturally attuned, multi-platform, and educationally differentiated health communication strategies that address both knowledge deficits and sociocultural constraints to foster meaningful public health engagement.

KEYWORDS: Breast Cancer Awareness, Digital Health Communication, Socio-Cultural Barriers, Education, Trust, Stigma, Pakistan, Health Engagement