Rethinking the message on alcohol and breast cancer with UK women: a Delphi study

Alcohol consumption is a well-established, yet, under-recognized risk factor for breast cancer (BCa) in women. Low public awareness of this link limits informed decision-making and undermines support for evidence-based alcohol policy. Existing communication strategies often neglect the socioemotional context in which such messages are received. This study offers a novel, participant-informed approach to message development, grounded in rigorous qualitative methods and public involvement. A Delphi study engaged 260 women aged 40-65-drinkers, ex-drinkers, and those with BCa-via an open-ended survey. Responses were explored in greater depth through seven online focus groups (n = 33) and a workshop (n = 7), to review themes and findings. Reflexive thematic analysis identified two overarching themes: (i) barriers to effective communication, including social norms, mistrust of public health messaging, psychological defence mechanisms, and fear of stigma and (ii) messaging strategies for overcoming these barriers, with narrative-based approaches (e.g. personal stories) identified as a promising alternative to hard-hitting or fear-based messaging. These findings extend existing literature by offering a framework for constructing public health messages that resonate with diverse audiences while avoiding unintended harms. By foregrounding the emotional and cultural dynamics of risk perception, this research contributes significant and timely evidence to inform cancer prevention campaigns and alcohol policy advocacy.