Social Norm Messages Research Articles

Cleaning up our acts: Psychological interventions to reduce engine idling and improve air quality

A large-scale field experiment tested psychological interventions to reduce engine idling at long-wait stops. Messages based on theories of normative influence, outcome efficacy, and self-regulation were displayed approaching railway crossing on street poles. Observers coded whether drivers (N = 6049) turned off their engine while waiting at the railway crossings (only 27.2% did so at baseline). Automatic air quality monitors recorded levels of pollutants during barrier down times. To different degrees, the social norm and outcome efficacy messages successfully increased the proportion of drivers who turned off their engines (by 42% and 25%, respectively) and significantly reduced concentrations of atmospheric particulate matter (PM2.5) 2 m above ground level. Thus, the environment was improved through behavior change. Moreover, of both practical and theoretical significance, there was an ‘accelerator effect’, in line with theories of normative influence whereby the social norm message was increasingly effective as the volume of traffic increased.

A randomised experiment of health, cost and social norm message frames to encourage acceptance of swaps in a simulation online supermarket.

Offering lower-energy food swaps to customers of online supermarkets could help to decrease energy (kcal) purchased and consumed. However, acceptance rates of such food swaps tend to be low. This study aimed to see whether framing lower-energy food swaps in terms of cost savings or social norms could improve likelihood of acceptance relative to framing swaps in terms of health benefits. Participants (n = 900) were asked to shop from a 12-item shopping list in a simulation online supermarket. When a target high-energy food was identified in the shopping basket at check-out, one or two lower-energy foods would be suggested as an alternative (a "swap"). Participants were randomised to only see messages emphasising health benefits (fewer calories), cost benefits (lower price) or social norms (others preferred this product). Data were analysed for 713 participants after exclusions. Participants were offered a mean of 3.17 swaps (SD = 1.50), and 12.91% of swaps were accepted (health = 14.31%, cost = 11.49%, social norms = 13.18%). Swap acceptance was not influenced by the specific swap frame used (all p > .170). Age was significantly and positively associated with swap acceptance (b = 0.02, SE = 0.00, p < .001), but was also associated with smaller decreases in energy change (b = 0.46, SE = .19, p = .014). Overall, offering swaps reduced both energy (kcal) per product (b = -9.69, SE = 4.07, p = .017) and energy (kcal) per shopping basket (t712 = 11.09, p < .001) from pre- to post-intervention. Offering lower-energy food swaps could be a successful strategy for reducing energy purchased by customers of online supermarkets. Future research should explore alternative solutions for increasing acceptance rates of such swaps.

The Effectiveness of Social Norms in Fighting Fake News on Social Media

ABSTRACT Fake news poses a substantial threat to society, with serious negative consequences. Therefore, we investigate how people can be encouraged to report fake news and support social media platform providers in their actions against misinformation. Based on social psychology, we hypothesize that social norms encourage social media users to report fake news. In two experiments, we present participants a news feed which contains multiple real and fake news stories while at the same time exposing them to injunctive and descriptive social norm messages. Injunctive social norms describe what behavior most people approve or disapprove. Descriptive social norms refer to what other people do in certain situations. The results reveal, among other things, that highlighting the socially desired behavior of reporting fake news using an injunctive social norm leads to higher reporting rates for fake news. In contrast, descriptive social norms do not have such an effect. Additionally, we observe that the combined application of injunctive and descriptive social norms results in the most substantial reporting behavior improvement. Thus, social norms are a promising socio-technical remedy against fake news.

Flying in the Face of Climate Change: Quantitative psychological approach examining the social drivers of individual air travel

Aviation contributes substantially to anthropogenic climate change. This paper situates individual behaviour changes alongside technological efficiency gains and policy processes in the search for significant emission reduction in the aviation sector. Using online survey methodology (N = 393) and expanding upon existing psychological perspectives on individual attitudes and behaviours, this study focuses on the social influence on air travel. Considering social identity and global social networks, two new instruments, the Cosmopolitan Identity Scale (CIS) and the Global Social Interconnectedness Score (GSIS), were introduced to capture the social drivers of air travel within standardized questionnaires. Different subgroups of travellers were clustered and compared along external and psychological variables, to allow the construction of more effective policies in the aviation sector. Overall, the awareness of environmental problems caused by flying led to a perceived dilemma between environmental attitudes and travel, which resulted in the engagement with carbon offsets. The global social interconnectedness, built through international experience, led to increased travel to visit friends and family, and an overall increase in flight kilometres. The social identification as a cosmopolitan was related to social media use and predicted flight kilometres directly, implying a particular sensitivity to social norm messages in online campaigns.

Sustained Reductions in Children's Risk Taking from Peer-Communicated Behavioral Safety Norms.

This research examined whether the positive effects of a peer-communicated social norm that reduces risk-taking behaviors persist over time and if a reminder of this peer-communicated safety message has any impact on this outcome. Positive mood in 7- to 9-year olds was induced experimentally and risk taking intentions and behaviors were measured when the child was in a positive and neutral mood state and after they had been exposed to either a safety or neutral peer-communicated social norm message. A few weeks later, half of the participants who experienced the safety social norm message were exposed to a reminder of this message via a slogan and risk-taking measures were taken again when in a heightened positive mood state. Exposure to a safety norm successfully counteracted the increase in risk taking associated with a positive mood state. These effects persisted for several weeks regardless of whether the children were exposed to a reminder. Manipulating peer social norms holds promise as an approach to produce reductions in children's risk taking and these effects persist at least over several weeks.

Youth Experiences with Social Norms Feedback: Qualitative Findings from The Drug Prevention Trial the GOOD Life.

Background: Normative feedback is an intervention strategy commonly used in drug prevention programmes. This study collected process evaluation data about how programme recipients engage with social norms (SN) feedback in The GOOD Life intervention and how they experience it. Methods: Eight focus group interviews were conducted with a total of 44 adolescents (pupils aged 14–16 years) who have participated in the social-norms-based intervention The GOOD Life. The interviews focused on three topics: (1) interest in and impact of the intervention; (2) perception of the intervention elements; and (3) suggestions for improvement of The GOOD Life. They were transcribed and analysed with content analysis. Results: The analysis revealed that The GOOD Life motivated pupils to re-evaluate their own drug use behaviour and overall met their interest regarding receiving engaging and non-moral forms of drug prevention programmes. While pupils perceived the normative feedback session in the classroom and the posters with SN messages as positive, stimulating and surprising, the web-based application with SN feedback was rarely used and less positively evaluated. Anonymity and confidentiality were regarded as essential to provide honest answers in the poll. The pupils suggested even more variety in ways to engage them and to use more gaming elements. Conclusions: SN feedback was well perceived by adolescents. The intervention met their interest and needs and was able to achieve the intended impact of challenging norm perceptions. Anonymity and confidentiality are key in order to build trust and engage adolescents in the intervention.

Social norm nudges in shopping trolleys to promote vegetable purchases: A quasi-experimental study in a supermarket in a deprived urban area in the Netherlands

BackgroundSupermarkets are a key point of purchase for groceries and can therefore have a considerable influence on eating behaviours. Evidence suggests that descriptive social norm nudges in shopping trolleys can be effective in stimulating vegetable purchases in supermarkets. ObjectiveWe investigated the effect of a combination of two nudging strategies in shopping trolleys – a social norm about vegetable purchases and a designated place to put vegetables – on the amount of vegetables purchased in a supermarket in a deprived urban area in the Netherlands. DesignA quasi-experimental study was conducted with two conditions: 1) intervention days on which the shopping trolleys in the supermarket had a green nudge inlay indicating a place for vegetables and a social norm message and 2) control days on which the regular shopping trolleys (no inlay or social norm) were used in the supermarket. During both the intervention and control days, vegetable purchases were measured by means of the cash receipts collected from customers at the checkouts. In addition, individual and purchase characteristics were assessed by means of short surveys. ResultsIn total, 244 customers participated in the study. Ordinal logistic regression analyses showed that customers on the intervention days (n = 123) were in a higher tertile for grams of vegetables purchased compared to the customers on the control days (OR: 1.66, 95% CI: 1.03–2.69, p = 0.03), especially those who bought groceries for less than three days (OR: 3.24, 95% CI: 1.43–7.35, p = 0.003). Sensitivity analyses also showed that intervention customers who noticed the green inlay were even more likely to purchase more vegetables (OR: 1.86, 95% CI: 1.06–3.25, p = 0.02). ConclusionsThis quasi-experimental study showed that a nudge inlay in shopping trolleys communicating a social norm on vegetable purchases and indicating a distinct place to put vegetables in the trolley increased vegetable purchases among supermarket customers.

Do perceived norms of social media users’ eating habits and preferences predict our own food consumption and BMI?

In laboratory studies, exposure to social norm messages conveying the typical eating behaviour of others has influenced participants' own consumption of food. Given the widespread use of social media, it is plausible that we are implicitly exposed to norms in our wider social circles, and that these influence our eating behaviour, and potentially, Body Mass Index (BMI). This study examined whether four perceived norms (perceived descriptive, injunctive, liking and frequency norms) about Facebook users' eating habits and preferences predicted participants' own food consumption and BMI. In a cross-sectional survey, men and women university students (n = 369; mean age = 22.1 years; mean BMI = 23.7) were asked to report their perceptions of Facebook users' consumption of, and preferences for, fruit, vegetables, energy-dense snacks and sugar sweetened beverages (SSBs), their own consumption of and preferences for these foods, and their BMI. Multiple linear regression revealed that perceived descriptive norms and perceived frequency norms about Facebook users' fruit and vegetable consumption were significant positive predictors of participants' own fruit and vegetable consumption (both ps < .01). Conversely, perceived injunctive norms about Facebook users' energy-dense snack and SSB consumption were significant positive predictors of participants’ own snack and SSB consumption (both ps < .05). However, perceived norms did not significantly predict BMI (all ps > .05). These findings suggest that perceived norms concerning actual consumption (descriptive and frequency) and norms related to approval (injunctive) may guide consumption of low and high energy-dense foods and beverages differently. Further work is required to establish whether these perceived norms also affect dietary behaviour over time.

Evaluation of a university’s smart partying social norms campaign including emoji-style messaging

ABSTRACT Background: Given the media saturated world today’s college students occupy, novel messaging needs to be utilized to cut through the noise to influence their perceptions of a perennial issue facing their population – problematic drinking behaviors. Method: The current study developed and implemented a year-long, multi-channel campaign effort by using the well-worn social norms framework in combination with a messaging tool all students are aware of – emojis – to produce messages seen by about half of the student body. Results: Campaign exposure was related to increased perceptions of the prevalence of safe partying behaviors, as well as the number of students who reported being more aware of what gets put into their drinks while partying. A non-social norms message – one with a percentage less than 50% of the population – also was related to increased perceptions, indicating that buttressing numerous social norms messages with one that is not may lead to a halo effect. Conclusions: Future research should strive to isolate emojis’ efficacy within health campaign messaging to determine if they can be used as a useful strategy to engage with college students, or just a passing fad.

Unraveling the “Social” in Social Norms: The Conditioning Effect of User Connectivity

Operating on the basic principle of “telling people about what lots of other people do,” social norms interventions have demonstrated efficacy in inducing behavior change in diverse settings. However, very few studies examine how the effect of social norms is differentially manifest across individuals, especially in the contemporary socially connected digital world. We provide new empirical evidence from a randomized field experiment that included more than 7,000 individuals on an online physical activity community observed for a two-month period. We find that connectivity plays an important role in moderating the effectiveness of social norms: individuals with higher levels of social connectivity are more susceptible to a social norms message. Additional analysis reveals that individuals who engage in information sharing (high followers and low followees) are the most susceptible to the social norms message. This study has important implications for the effective and safe use of social norms in nudging people’s behavior. Our finding that social norms do not affect all users equally should help optimize interventions by focusing on users with high susceptibility based on easily observable measures.

Crafting messages to fight dishonesty: A field investigation of the effects of social norms and watching eye cues on fare evasion

The impact of watching eyes cues and descriptive social norm messages on fare evasion was studied in two experiments that were conducted in two railway stations in France. In Study 1, a natural field experiment, passengers were exposed for a two-week period to either a control eye-cues poster or to an experimental eye-cues with a social norm messaging campaign. In Study 2, an artefactual experiment in the field, participants in the experimental train station were asked to participate in a lying task before and after they were exposed to the messaging campaign. The results from both studies suggest that although watching eye cues alone are not effective in a crowded train station, exposing passengers to watching eye cues together with a descriptive social norm messaging campaign reduced the fare evasion rates observed by standard inspection operations, and eliminated lying behavior measured by the die-under-cup paradigm. These results strengthen the external validity of laboratory experiments that have documented small scale cheating behavior and highlight the potential benefits of internal enforcement techniques to fight dishonesty in the field. In addition, they stress the advantage of combining visibility cues and social norms when orienting people toward more moral behavior.

Social norms and free-riding in influenza vaccine decisions in the UK: an online experiment

BackgroundNudge-based social norm messages conveying high influenza vaccination coverage levels signal a strong social norm, encouraging vaccination, but also a low risk of infection, discouraging vaccination and promoting free-riding. The complex interplay between these two signals can result in ambiguous vaccination decision-making at varying coverage levels. We aimed to measure different vaccination coverage levels’ (VCLs) effect on influenza vaccination intention through an online experiment. MethodsUK residents aged 18 years or older were eligible to participate in this online experiment and recruited via Prolific. They were stratified by gender and randomly assigned to a control group with no message (n=202) or one of seven treatment groups (n=1 163) with different messages of VCLs (ie, proportion of vaccinated people [10%, 25%, 50%, 65%, 75%, 85%, or 95%]) in the respondents’ environment. Effect on respondents’ vaccination intention was measured with self-reported intention and three elicited behaviour measures: opening an online map locating nearby private flu jab providers; time looking at this map; and downloading a calendar reminder to vaccinate. Linear regressions, probit, logistic, and double hurdle models were used, controlling for population behaviour perceptions, risk attitudes, and behavioural and socioeconomic characteristics collected through individual questionnaires. FindingsBetween May 3 and August 20, 2018, 1365 participants were eligible to participate. Those treated with coverage levels at 65% or higher reported significantly greater stated vaccination intention (greater intention 13·2% [95% CI 6·32–20·08], p<0·0001 if VCL=65%; 15·82% [8·65–23], p<0·0001 if VCL=75%; 18·12% [10·45–25·79], p <0·0001 if VCL=85%; 20·22% [11·98–28·45], p<0·0001 if VCL=95%) than the control group. These participants were also more likely to look at the map of vaccination locations (increased likelihood 14·6 percentage points [3·65–25·55], p=0·0090; 20·81 percentage points [9·73–31·88], p<0·0001; 18·4 percentage points [6·57–30·23], p=0·0023; 14·12 percentage points [1·27–26·96], p=0·031), and spent longer looking at the map (longer viewing 0·52 s [0·13–0·91], p=0·0094; 0·74 s [0·34–1·14], p<0·0001; 0·65 s [0·23–1·08], p=0·0025; 0·5 s [0·04–0·96], p=0·032) than the control group. Coverage lower than 65% did not lead to any significant differences between treatment and control groups for any of these measures. There was no significant effect of any treatment VCL on calendar download intention. InterpretationAverage vaccination intention was higher at lower coverage levels (potential social norm compliance) but lower at higher coverage levels (possible free-riding). Because this study examines vaccination intention rather than uptake and uses an online experimental design that might dampen generalisability, further research should be done. Still, policy makers should consider this curvilinear effect when designing vaccination interventions as using lower social norm messages might nudge vaccination better than extremely high messages. FundingImperial College Business School, National Institute for Health Research Health Protection Research Unit, UK Medical Research Council, Department for International Development, Medical Research Council Centre for Global Infectious Disease Analysis.

Using an egalitarian social norms message to improve attitudes toward diversity in an academic context: examining intended and unintended effects of source and recipient gender

Social psychologists have leveraged social norms messaging about prejudice to improve social climates. Less research, however, has explored how social identities of message sources and recipients (e.g., gender) influence receptivity to these messages. Testing for the effects of source and recipient social identity on message receptivity is not just of theoretical importance, but also has practical implications for who can effectively deliver such messages and whether such messages have unintended negative consequences for disadvantaged group members. In the present research, an experimental design explored whether the effectiveness of an egalitarian social norms message (compared to a control message) depended on source gender, recipient gender, and their interaction, as well as whether the egalitarian social norms message had unintended negative consequences for participants. Results of an experiment with undergraduate participants (N = 434) showed that receiving an egalitarian social norms message (compared to a control message) resulted in more positive diversity attitudes and stronger intentions to confront prejudice, and these effects did not depend on source gender. The egalitarian social norms message, compared to the control message, did not have detrimental effects on members of socially disadvantaged groups, and was evaluated as more beneficial for social climate. Implications for intervention are discussed.

The effect of nudges aligned with the renewed Flemish Food Triangle on the purchase of fresh fruits: An on-campus restaurant experiment

ObjectiveThis study examined the effect of nudges, inspired by the recently renewed Flemish Food Triangle, on fruit sales in a Belgian on-campus university restaurant. MethodsIn this mixed-method real-life experiment, nudges were added weekly over a period of four consecutive weeks: placement of (1) Food Triangle posters in the restaurant, (2) ‘green heart’ icons above the fruit stands, and (3) substitution and (4) social norm messages at the fruit stands. During baseline (no intervention) and all intervention weeks, dessert sales were registered. Short interviews were used to ask customers about their perceptions regarding the intervention. Follow-up measurements (7 and 30 weeks later) evaluated the longer-term effectiveness, while all nudges remained in place. Dessert sales were analyzed separately for both sexes, students and staff categories (based on academic degree). ResultsCompared to baseline, the combination of the Food Triangle and the green heart intervention materials in week 2 resulted in significant increases in fruit consumption across almost all subgroups. The other intervention materials used in the current study had rather limited effects in the short term. After 7 weeks of follow-up, significant fruit sale increases were established for all subgroups compared to baseline. At 30 weeks follow-up, the effect for staff B (Bachelor's degree) disappeared. The majority of the respondents (66.4%) had noticed at least one of the nudges, while only 3.4% indicated to have adjusted their dessert choice as a result of the nudges. ConclusionsThe combination of nudges was effective in the long term and increased fruit purchase in nearly all subgroups. Short interviews show that a more active approach may be needed to increase effect sizes.

Does Level of Received Intervention Dose Have an Impact on the Effectiveness of the Social Norms Alcohol Prevention Program The GOOD Life?

Background: Few studies have assessed how social norms messages are perceived and understood by adolescents in secondary school. We examined whether the self-reported level of exposure, satisfaction and recall of a social norms intervention had an impact on the preventive effect of the intervention The GOOD Life. Furthermore, we explored which factors were associated with high recall of the intervention.Methods: Data from pupils aged 13–17 years enrolled in a cluster-randomized controlled trial with 18 intervention schools (n = 641) and 20 control schools (n = 714) were analyzed using multilevel regressions. The intervention provided social norms messages through three different communication elements: classroom feedback session, posters, and web-application. At 3-months follow-up, pupils from the intervention schools were asked about their participation in, their satisfaction with and recall of the intervention. The effects were examined on: overestimation of peer drinking, binge drinking (5 or more drinks on one occasion) and alcohol-related harms.Results: Regards the outcome overestimation of peer drinking higher preventive effect sizes were observed for higher levels of exposure, satisfaction, and recall. Regards the outcome alcohol-related harms preventive intervention effects were observed for medium exposure and higher satisfaction. For binge drinking we found no significant effects for any level of exposure, satisfaction, or recall. Higher levels of satisfaction and exposure, and female sex were associated with better recall of the intervention.Conclusion: For higher levels of self-reported exposure, satisfaction, and retention regarding the social norms messages we observed stronger intervention effects regards several outcomes suggesting that these implementation parameters are important for intervention effectiveness.Trial registration: The trial is registered at Current Controlled Trials with study ID ISRCTN27491960.

Pre-notification and reminder SMS text messages with behaviourally informed invitation letters to improve uptake of NHS Health Checks: a factorial randomised controlled trial

BackgroundThe NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. Public Health England (PHE) wants to increase uptake.MethodsWe explored the impact of behaviourally informed invitation letters and pre-notification and reminder SMS on uptake of NHS HCs. Patients at 28 General Practices in the London Borough of Southwark who were eligible to receive an NHS HC between 1st November 2013 and 31st December 2014 were included. A double-blind randomised controlled trial with a mixed 2 (pre-notification SMS – yes or no) × 4 (letter – national template control, open-ended, time-limited, social norm) × 2 (reminder SMS – yes or no) factorial design was used. The open-ended letter used simplification, behavioural instruction and a personalised planning prompt for patients to record the date and time of their NHS HC. The time-limited letter was similar but stated the NHS HC was due in a named forthcoming month. The social norms letter was similar to the open-ended letter but included a descriptive social norms message and testimonials from local residents and no planning prompt. The outcome measure was attendance at an NHS HC.ResultsData for 12, 244 invites were analysed. Uptake increased in almost all letter and SMS combinations compared to the control letter without SMS (Uptake 18%), with increases of up to 12 percentage points for the time-limited letter with pre-notification and reminder (Uptake 30%; Adjusted Odds Ratio AOR 1.86; 95% CI 1.45–2.83; p < 0.00); 10 percentage points for the open-ended letter with reminder (Uptake 27%; AOR 1.68; 95% CI 1.31–2.17; p < 0.00) and a 9 percentage point increase using the time-limited letter with reminder (Uptake 27%; AOR 1.61; 95% CI 1.25–2.10; p < 0.00). The reminder SMS increased uptake for all intervention letters. The pre-notification did not add to this effect.ConclusionsThis large randomised controlled trial adds support to the evidence that small, low cost behaviourally informed changes to letter-based invitations can increase uptake of NHS HCs. It also provides novel evidence on the effect of SMS reminders and pre-notification on NHS HC attendance.Trial registrationRetrospectively Registered (24/01/2014) ISRCTN36027094.

A panacea for improving citizen behaviors? Introduction to the symposium on the use of social norms in public administration

Recent years have seen a growth in the use of social norm messages by local and national governments across the world. These messages have primarily been used to induce desired behaviors among the non-compliant minority by pointing to the compliance of the majority. As well as being of considerable theoretical interest, these messages have a high level of empirical and experimental support in government settings as well as a few null and negative findings. In this introduction to the symposium, we offer an overview of research to date using social norms in public administration, reviewing what ‘stylized facts’ emerge, then introduce the articles included in the symposium.

Testing verbal quantifiers for social norms messages in cancer screening: evidence from an online experiment

BackgroundStudies have shown that presenting correct information about group norms to correct misperceptions of norms can influence health behaviours. In two online studies we investigated how different ways of communicating the current uptake of 43% of the English Bowel Scope Screening (BSS) programme affects intention among disinclined men and women.MethodsIn the first study, 202 participants were asked to interpret eight quantifiers for 43% uptake (‘few’, ‘many’, ‘a considerable number’, ‘a large number’, ‘a great number’, ‘a lot’, ‘numerous’ and ‘nearly half’) and to indicate how misleading they perceived each of them to be. In the second study, with 1245 participants, we compared the motivational impact of two quantifiers (‘a large number’ and ‘nearly half’ which were associated with the highest perceived uptake (48.9%) and considered least misleading in study 1 respectively) with a control message that did not contain any information on uptake, and a message which communicated actual uptake as a proportion (43%).ResultsWhile we found that both verbal quantifiers increased screening intentions compared with the control group (from 7.8 to 12.5%, aOR 1.72; 95%CI 1.00–2.96 in the case of ‘a large number’ and 14.3%, aOR 2.02; 95%CI 1.20–3.38 for ‘nearly half’), simply communicating that 43% do the test, however, had no impact on intentions (9.9% vs. 7.8% aOR 1.25; 95%CI 0.73–2.16).ConclusionVerbal quantifiers can be used to improve the perception of low uptake figures and avoid a demotivating effect.

The effect of eye images and a social norms message on healthcare provider hand hygiene adherence.

Depictions of eye images and messages encouraging compliance with social norms have successfully motivated behavioral change in a variety of experimental and applied settings. We studied the effect of these 2 visual cues on hand hygiene adherence in a cohort of hospital-based healthcare providers participating in an electronic monitoring and feedback program. Prospective, quasi-experimental study utilizing an interrupted time-series design. Intervention placards depicting an image of eyes, a social norms message, or a control placard were placed near soap and alcohol-based hand-rub dispensers on 2 hospital units. Placards were alternated every 10 days. Hand hygiene opportunities and adherence rates were assessed electronically via the CenTrak Hand Hygiene Compliance Solution. A total of 166 nurses and certified nursing assistants (74 on a medical-surgical unit and 92 on a progressive care unit) were monitored electronically over the 4-month study period. In total, 184,172 electronic observations were collected (110,903 on a medical-surgical unit and 73,269 on a progressive care unit). The median daily number of electronic observations was 1,471 (interquartile range, 1,337-1,584). The preintervention baseline hand hygiene adherence rate was 70%. No statistically significant increase in hand hygiene adherence was observed as a result of either intervention. Displaying eye images or a social norms message in the hospital environment did not result in measurable improvements in HH adherence in a cohort of healthcare providers participating in an electronic monitoring and feedback program.

Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence

BackgroundMass media campaigns can be used to communicate public health messages at the population level. Although previous research has shown that they can influence health behaviours in some contexts, there have been few attempts to synthesise evidence across multiple health behaviours.ObjectivesTo (1) review evidence on the effective use of mass media in six health topic areas (alcohol, diet, illicit drugs, physical activity, sexual and reproductive health and tobacco), (2) examine whether or not effectiveness varies with different target populations, (3) identify characteristics of mass media campaigns associated with effectiveness and (4) identify key research gaps.DesignThe study comprised (1) a systematic review of reviews, (2) a review of primary studies examining alcohol mass media campaigns, (3) a review of cost-effectiveness evidence and (4) a review of recent primary studies of mass media campaigns conducted in the UK. A logic model was developed to inform the reviews. Public engagement activities were conducted with policy, practitioner and academic stakeholders and with young people.ResultsThe amount and strength of evidence varies across the six topics, and there was little evidence regarding diet campaigns. There was moderate evidence that mass media campaigns can reduce sedentary behaviour and influence sexual health-related behaviours and treatment-seeking behaviours (e.g. use of smoking quitlines and sexual health services). The impact on tobacco use and physical activity was mixed, there was limited evidence of impact on alcohol use and there was no impact on illicit drug behaviours. Mass media campaigns were found to increase knowledge and awareness across several topics, and to influence intentions regarding physical activity and smoking. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. The evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.LimitationsStatistical synthesis was not possible owing to considerable heterogeneity across reviews and studies. The focus on review-level evidence limited our ability to examine intervention characteristics in detail.ConclusionsOverall, the evidence is mixed but suggests that (1) campaigns can reduce sedentary behaviour, improve sexual health and contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective.Future workFuture work could fill evidence gaps regarding diet mass media campaigns and new-media campaigns, examine cost-effectiveness in areas other than tobacco and explore the specific contribution of mass media campaigns to multicomponent interventions and how local, regional and national campaigns can work together.Study registrationThis study is registered as PROSPERO CRD42015029205 and PROSPERO CRD42017054999.FundingThe National Institute for Health Research Public Health Research programme.