Mass Media Health Campaigns Research Articles

A call to action for undertaking and sharing formative evaluations of public health campaigns.

Mass media campaigns are common interventions used in public health, but publicly available evaluations of such campaigns are few and far between, and particularly so for formative evaluations. In 2019, the Heart Foundation released a new campaign called 'Heartless Words', including a major advertisement that sparked instant controversy. In the backlash that followed, very little was said about the importance of rigorous pre-campaign formative evaluations and sharing these evaluations for the benefit of other researchers, practitioners and policy makers. We argue the takeaway points of such controversial campaigns are not only whether they provoke certain emotions or discussion, but also whether they are supported by robust formative evaluations that are publicly available. Formative evaluations are crucial in public health so that we can share and learn what works, for whom, and why. We call on researchers and practitioners to develop, implement and, crucially, disseminate formative evaluations for public health mass media campaigns.

Comparing the Cost-Effectiveness of Campaigns Delivered via Various Combinations of Television and Online Media

Reflecting the increasing prevalence of online media, many mass media health campaigns are now delivered using both television (TV) and online media formats. The aim of this study was to evaluate a smoking cessation mass media campaign according to the cost-effectiveness of the various combinations of TV and online media formats to inform future media buying decisions. A quasi-experimental interrupted time series approach was employed. The campaign was delivered in seven 1-week bursts using TV, online video (OV), or online display (OD) (e.g., banner ads) formats in isolation and in various combinations over a 13-week period. Campaign bursts were separated by "off-weeks" in which no campaign materials were delivered. Assessed outcomes were the number of campaign response "events" recorded (campaign web page views, calls to a smoking cessation telephone service, and registrations for smoking cessation services). The cost-effectiveness of each individual and combined media format condition in terms of these outcome variables was calculated using attributed production and broadcasting costs. Overall, OD alone was found to be the most cost-effective means of achieving the nominated campaign outcomes, followed by a combination of OV and OD and a combination of TV and OV. The use of TV in isolation was the least cost-effective. The results of this evaluation indicate that online media constitute a promising means of enhancing the cost-effectiveness of smoking cessation campaigns. Future research assessing a broader range of outcomes, especially smoking cessation, is needed to provide a more comprehensive account of the cost-effectiveness of various campaign media.

The Effect of Branding to Promote Healthy Behavior: Reducing Tobacco Use among Youth and Young Adults.

Policy interventions such as public health mass media campaigns disseminate messages in order to improve health-related knowledge, attitudes, beliefs and behaviors at the population level. Only more recently have campaigns that promote health-related behaviors adopted branding, a well-established marketing strategy, to influence how consumers think and feel about a message. This study examines whether positive brand equity for the national truth® campaign is associated with lower likelihood of cigarette use over time using the nationally representative Truth Longitudinal Cohort of youth and young adults, aged 15–21. Logistic regression models were used to examine the relationship between brand equity and the likelihood of reporting past 30-day smoking over a 12-month period. Respondents who reported positive brand equity were significantly less likely to report past 30-day smoking 12 months later (OR = 0.66, p < 0.05), controlling for covariates known to influence tobacco use behavior. Findings also translate the effect size difference to a population estimate of more than 300,000 youth and young adults having been prevented from current smoking over the course of a year. Building brand equity is a strategic process for health promotion campaigns, not only to improve message recall and salience but also to influence behavioral outcomes.

Alcohol harm reduction advertisements: a content analysis of topic, objective, emotional tone, execution and target audience

BackgroundPublic health mass media campaigns may contribute to reducing the health and social burden attributed to alcohol consumption, but little is known about which advertising characteristics have been used, or have been effective, in alcohol harm reduction campaigns to date. As a first step towards encouraging further research to identify the impact of various advertising characteristics, this study aimed to systematically identify and examine the content of alcohol harm reduction advertisements (ads).MethodAds were identified through an exhaustive internet search of Google, YouTube, Vimeo, and relevant government and health agency websites. Eligible ads were: English language, produced between 2006 and 2014, not primarily focused on drink-driving or alcohol in pregnancy, and not alcohol industry funded. Systematic content analysis of all ads was performed; each ad was double-coded.ResultsIn total, 110 individual ads from 72 different alcohol harm reduction campaigns were identified, with the main source countries being Australia (40%) and the United Kingdom (26%). The dominant topic for 52% of ads was short-term harms, while 10% addressed long-term harms, 18% addressed underage drinking, 17% communicated a how-to-change message, and 3% advocated for policy change. The behavioural objective of most ads was to motivate audiences to reduce their alcohol consumption (38%) or to behave responsibly and/or not get drunk when drinking (33%). Only 10% of all ads mentioned low-risk drinking guidelines. Eighty-seven percent of ads used a dramatisation execution style and 74% had a negative emotional tone. Ninety percent of ads contained messages or content that appeared to target adults, and 36% specifically targeted young adults.ConclusionsSome message attributes have been employed more frequently than others, suggesting several promising avenues for future audience or population-based research to compare the relative effectiveness of different characteristics of alcohol harm reduction ads. Given most alcohol-attributable harm is due to long-term disease, these findings suggest future campaigns may fill a potentially important gap if they were to focus on long-term harms. There is scope for such long-term harm campaigns to place greater emphasis on encouraging reduced personal consumption of alcohol, potentially through more frequent communication of low-risk drinking guidelines.

Combination of mass media health campaigns and health-related product distribution is recommended to improve healthy behaviors.

Combination of mass media health campaigns and health-related product distribution is recommended to improve healthy behaviors.

The effectiveness of mass media campaigns in reducing smoking in England: an observational study

BackgroundLittle evidence exists for the effectiveness of mass media campaigns in the UK despite campaigns running regularly since 1999. In 2010, the UK Government ceased spending on national public health mass media campaigns in England. Tobacco control (TC) campaigns were reintroduced in 2011, but at a lower level of funding. We need to know whether campaigns are effective to ensure continued funding. We aimed to assess the effect of government-funded televised campaigns for TC shown in England during the 2000s on adult smoking behaviours. MethodsWe measured exposure to government-funded television advertisements for TC using television ratings (TVRs) and coded the advertisements for emotional content using a theoretically based framework. Recall of advertisements from 2005 to 2009 was ascertained from participants of the International Tobacco Four Country Survey and analysed with generalised estimating equations, comparing recall between advertisements with positive and negative emotional content. Data for smoking prevalence and cigarette consumption from 2002 to 2010 were obtained from Opinions and Lifestyle surveys. Measures of smoking cessation behaviour (calls to the NHS quitline 2005–11, text requests for quit support packs 2007–10, smoking cessation website hits 2009–11, attendance and 4-week quitters at NHS Stop Smoking Services [SSS] 2001–11) were obtained from the Department of Health and NHS Information Centre. Data were analysed with generalised additive models with adjustments for seasonality, time trends, and other tobacco policies. FindingsBetween 2002 and April, 2010, 35 282 TVRs for TC were broadcast (mean 42 advertisements per year). An increase in TVRs was associated with a significant increase in recall and a reduction in mean cigarette consumption in the following month and smoking prevalence 2 months later (appendix). 45% of advertisements screened between 2004 and 2010 were coded as having positive emotional content. Negative, but not positive, emotive campaigns resulted in significantly increased and longer durations of recall (appendix). There was a significant decrease in text requests for quit support packs, quitline calls, and web hits after April, 2010, but no effect on the use of the NHS SSS (appendix). We studied recall and tobacco use at the individual level; however, TVRs measure mean potential exposure, and individual-level exposure can vary dependent on frequency of television viewing and attention to advertisements. We cannot completely rule out that other unmeasured variables confound the association with TVRs or the timing of the freeze. InterpretationTelevised campaigns are effective in changing smoking behaviours in adults. We are now exploring whether the stronger effect of negative emotive campaigns on recall translates to effects on quitting behaviour. FundingUniversities of Bath, Nottingham, and King's College London, received funding from the National Prevention Research Initiative (www.mrc.ac.uk/npr). Funding partners relevant to this award are: Alzheimer's Research Trust; Alzheimer's Society; Biotechnology and Biological Sciences Research Council; British Heart Foundation (BHF); Cancer Research UK (CRUK); Chief Scientist Office, Scottish Government Health Directorate; Department of Health; Diabetes UK; Economic and Social Research Council (ESRC); Health and Social Care Research and Development Division of the Public Health Agency; MRC; The Stroke Association; Wellcome Trust; and Welsh Assembly Government. All authors are members of the UK Centre for TC Studies. Funding from the BHF, CRUK, ESRC, MRC, and the NIHR, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. TC-4 was supported by the US National Cancer Institute; Canadian Institutes of Health Research; National Health and Medical Research Council of Australia; CRUK; Ontario Institute for Cancer Research; and Canadian Cancer Society Research Institute through awards to Geoffrey T Fong.

The 2010 freeze on mass media campaigns in England: A natural experiment of the impact of tobacco control campaigns

Background In England, until 2010, tobacco control mass media campaigns were run regularly. In April of that year the government ceased spending on public health mass media campaigns. We investigated the impact of the 18-month suspension of tobacco control mass media campaigns on a range of measures of smoking cessation behaviour. Methods We used quarterly data on attendance and 4-week quitters at National Health Service (NHS) Smoking Cessation Services (SSS) from 2001 to …

"Prismas de percepção": múltiplas leituras das campanhas em saúde no Nordeste brasileiro

This anthropological study from February 2009 to November 2010 revealed the comprehension and cultural critique of three mass media health campaigns in Northeast Brazil. Twenty-four ethnographic interviews were conducted, exploring the iconographic and semantic content of the campaigns in the Dendê community in Fortaleza, Ceará State, Brazil. The authors used Content Analysis; Systems of Signs, Significance, and Actions; and Contextualized Semantic Interpretation. There is a gap between the elaboration and reception of messages. Multiple interpretations occur (proximal reading, kaleidoscope of comprehension, and distant reading), depending on the reader's cognitive proximity to (or detachment from) the message. This "perceptual plasticity" arises from the creativity of popular imagination. Health professionals who hear rather than dismiss the "recipient's" subjective voice, which re-signifies authoritative messages, can penetrate the perception of the recipient's "visual world". In the context of poverty, this re-framing is essential for people to comprehend and proactively defend their own health.

Using Message Form to Stimulate Conversations: The Case of Tropes

The use of tropes (e.g., metaphors, ellipsis) in messages from health mass media campaigns may spark conversations. Tropes require additional cognitive elaboration to arrive at the intended interpretation, thereby providing the audience with ‘‘the pleasure of text.’’ This characteristic makes them useful for conversations in which ads are used to demonstrate one’s interpretation abilities or to strengthen group identity through a shared appreciation of ads. Tropes can thus stimulate people to think and talk about information they might otherwise ignore. As a result, this information is primed, increasing the chance that it will influence relevant behavior. At the same time, the use of tropes may have undesirable side effects, such as yielding incomprehension or misunderstanding of the message’s meaning. doi:10.1111/j.1468-2885.2008.01332.x Since 1999, an organization called loveLife has been running large-scale campaigns in South Africa aiming to reduce the rate of HIV infection among adolescents. The campaign’s tagline, ‘‘talk about it,’’ refers to the campaign’s goal to stimulate conversations among teenagers on issues pertaining to sexual health. A prominent part of the campaign is constituted by billboards that are used all over the country, displaying slogans such as ‘‘No until we know’’ and ‘‘If it’s not just me, you’re not for me.’’ These slogans present beliefs that the target audience is already familiar with, respectively, ‘‘sexual partners should know each other’s HIV status’’ and ‘‘polygamy increases the chances of HIV infection,’’ in a nonobvious way. One of loveLife’s campaign managers explained this strategy of using elliptical messages by stating that ‘‘we want people to think about our posters’’ and ‘‘we will get people to wonder. This creates conversation between parents and children, dialogue between peers. That is exactly what we want to achieve, that people talk about HIV/AIDS and sex’’ (Hollemans, 2005). Apparently, the

Turning negative into positive: public health mass media campaigns and negative advertising

Literature suggests that 'negative advertising' is an effective way to encourage behavioral changes, but it has enjoyed limited use in public health media campaigns. However, as public health increasingly focuses on non-communicable disease prevention, negative advertising could be more widely applied. This analysis considers an illustrative case from tobacco control. Relying on internal tobacco industry documents, surveys and experimental data and drawing from political advocacy literature, we describe tobacco industry and public health research on the American Legacy Foundation's "truth" campaign, an example of effective negative advertising in the service of public health. The tobacco industry determined that the most effective advertisements run by Legacy's "truth" campaign were negative advertisements. Although the tobacco industry's own research suggested that these negative ads identified and effectively reframed the cigarette as a harmful consumer product rather than focusing solely on tobacco companies, Philip Morris accused Legacy of 'vilifying' it. Public health researchers have demonstrated the effectiveness of the "truth" campaign in reducing smoking initiation. Research on political advocacy demonstrating the value of negative advertising has rarely been used in the development of public health media campaigns, but negative advertising can effectively communicate certain public health messages and serve to counter corporate disease promotion.

Sensation Seeking, the Activation Model, and Mass Media Health Campaigns: Current Findings and Future Directions for Cancer Communication

The Activation Model of Information Exposure highlights the potential for individual differences in arousal in response to information, as well as the consequences of these patterns for information processing and seeking. Over the past 2 decades, the theoretical approach has generated considerable research in health communication. Most applications, however, have focused on substance use among adolescents and young adults. In this article, we assess the relevance of the activation approach for cancer communication. Although a wide range of communication efforts related to cancer prevention and treatment stand to benefit from acknowledgement of individual differences in optimal levels of arousal, we also acknowledge issues and challenges that remain for work on the Activation Model and sensation seeking. In reaching this conclusion, we explore some limitations of the Activation Model in its current form and point to new directions for future research.

A 10-Year Retrospective of Research in Health Mass Media Campaigns: Where Do We Go From Here?

Mass media campaigns have long been a tool for promoting public health. How effective are such campaigns in changing health-related attitudes and behaviors, however, and how has the literature in this area progressed over the past decade? The purpose of the current article is threefold. First, I discuss the importance of health mass media campaigns and raise the question of whether they are capable of effectively impacting public health. Second, I review the literature and discuss what we have learned about the effectiveness of campaigns over the past 10 years. Finally, I conclude with a discussion of possible avenues for the health campaign literature over the next 10 years. The overriding conclusion is the following: The literature is beginning to amass evidence that targeted, well-executed health mass media campaigns can have small-to-moderate effects not only on health knowledge, beliefs, and attitudes, but on behaviors as well, which can translate into major public health impact given the wide reach of mass media. Such impact can only be achieved, however, if principles of effective campaign design are carefully followed.

Lessons learned from public health mass media campaigns: marketing health in a crowded media world.

Every year, new public health mass media campaigns are launched attempting to change health behavior and improve health outcomes. These campaigns enter a crowded media environment filled with messages from competing sources. Public health practitioners have to capture not only the attention of the public amid such competition, but also motivate them to change health behaviors that are often entrenched or to initiate habits that may be new or difficult. In what ways are public health mass media campaigns now attempting to succeed in a world crowded with media messages from a myriad of sources? What are the conditions that are necessary for a media campaign to successfully alter health behaviors and alter outcomes in the long term? To what extent can the successes and failures of previous campaigns be useful in teaching important lessons to those planning campaigns in the future? In this chapter we attempt to answer these questions, drawing from recent literature on public health mass media campaigns.

Insights and imperatives: Towards culling lessons from state‐of‐the‐art health communication research

INTRODUCTION Welcome to this Special Issue of Communication Studies! The purposes of this introduction are five-fold: (1) provide a precis of Communication to better situate the current issue; (2) express my deep gratitude to CSCA's Comm Interest Group Leaders and members for enabling me to serve as Guest Editor; (3) acknowledge the expertise, diligence, and commitment of a remarkable Editorial Board, Editorial Assistants, and Website developer; (4) to profusely thank several individuals who contributed to the crafting of this Special Issue behind the scenes and (5) highlight the contributions of the featured articles. It is my ardent aspiration that this SI will become a must read and standard citation for present and prospective health communication scholars, practitioners, and students. And if this volume does ascend such lofty heights, then, all those involved, from editorial assistants to aspiring authors, should be greatly commended. BACKGROUND As Kreps and Query (1990) report, Health communication emerged in the 1970s and 1980s as an active and exciting area of social scientific inquiry concerned with the central role of human interaction in the provision of health care and health promotion (p. 293). It can influence, integrate, bridge, and be shaped by several disciplines such as medicine, nursing, health psychology, medical sociology and anthropology, health education and promotion, epidemiology, social work, dentistry, optometry, law, health services administration, occupational and physical therapy, as well as pharmacy. Notwithstanding its rich, interdisciplinary nature, health communication is distinct from the preceding areas in that it focuses on the role of message behavior-verbal and nonverbal-through a variety of channels and across multiple contexts. Representative foci initially included: doctor-patient interaction, patient compliance /satisfaction, social support, health care team interaction, health care organizational communication, and mass media health campaigns (see Kreps, 1988; Thompson, 1994, 1984; Pettegrew & Logan, 1987). While much of the early health communication research was atheoretical and unsophisticated (Pettegrew & Logan, 1987; Thompson, 1984), that is no longer the case today (Kreps, 2000; Thompson, 1994). communication scholars are conducting NIH, CDC, and/or NIOSH-funded projects focusing on public health campaigns in the areas of substance abuse (Burgoon et al., 2002), HIV/AIDS prevention (Glik, Nowak, Valente, Sapsis, & Martin, 2002), and skin cancer (Parrott, Monahan, Ainsworth, & Steiner, 1998). communication scholars are taking the lead in examining the role of computer-mediated social support (Braithwaite, Waldron, Finn, 1999), and the use of the Internet across a variety of health contexts (Rice & Katz, 2001). As Kreps, Query, and Bonaguro (in press) indicate, there are multiple signs that further reinforce the vitality of Communication inquiry. In 1989, Lawrence Erlbaum and Associates launched Communication with the Founding Editor being Teresa L. Thompson, Ph.D. In 1996, Taylor and Francis launched The Journal of Communication: International Perspectives, with the Founding Editor being Scott S. Ratzan, M. D. In 2003, this latter journal will disseminate six issues, an increase from the previous quarterly releases. Approximately three years ago, the National Cancer Institute established a Communication and Informatics Research Branch, with its Chief being a Communication scholar, Gary L. Kreps, Ph.D. Circa 1998, created by' Marifran Mattson, Ph.D., and underwritten by Purdue University, an award- winning, website centering on health communication research, pedagogy, and application goes online [http://www.sla.purdue.edu/healthcomm]. Beginning in 1991 through 1996, two special issues of the American Behavioral Scientist and one special issue of The Journal of Psychology were devoted to Communication (see Kreps, Bonaguro, & Query, 1998). …

Street Theater as a Tool to Reduce Family Planning Misinformation

Mass media campaigns can be effective at communicating health information to a mass audience rather inexpensively. Critics of mass media health campaigns often contend, however, that interpersonal communication is more effective at changing behavior. Conversely, interpersonal communication activities to promote health can be effective at changing behavior, but critics have argued that they have certain limitations such as being expensive and personal (perhaps intrusive), and that they provide nonstandardized information. The present study is an evaluation of a street theater format in Peru that combined the advantages of mass and interpersonal communication to improve family planning knowledge and attitudes. The street theater was effective in decreasing misinformation concerning modern contraceptive methods.

Beyond Fear Appeals: Negative and Positive Persuasive Appeals to Health and Self‐Esteem

The present research was designed to extend our knowledge of fear appeals and attitude change in two directions. The first purpose was to compare a traditional negative, or fear, appeal to its counterpart, an appeal emphasizing the positive consequences of accepting a communicator's recommendation. The second purpose was to test the assumption of the theory of protection motivation that people are motivated to protect themselves from psychological and social, as well as physical, threats. The results disclosed that, compared to a no‐message control condition, the traditional negative appeal to health was more persuasive than the positive appeal. A positive appeal to self‐esteem, however, was superior to a negative appeal to self‐esteem. Several implications for health psychology were discussed. First, the traditional negative appeals to health may be more persuasive than positive appeals. Second, people may be persuaded to adopt healthy lifestyles for reasons other than health per se (i.e., to enhance self‐esteem). The following tentative conclusions were based on unexpected findings and should be interpreted with caution. The decision to use a positive or negative appeal should consider the number of available adaptive responses. Finally, the data suggested that mass media health campaigns should use both negative and positive appeals.