Mass Media Effectiveness

Strategic Social Marketing [email protected]

MASS MEDIABEHAVIOUR CHANGE STRATEGIES

There is clear evidence that targeted, well-executed health mass media campaigns can impact not only on health knowledge, beliefs, attitudes, and behaviours. Whilst effect sizes may appear modest compared with the impact of some clinical interventions on individual patients, these campaign effects 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.

A meta analysis of campaigns in the United States has been published. Media based campaigns have been shown to have small measurable effects in the short-term. Campaign effect sizes vary by the type of behaviour: r=.15 for seat belt use, r=.13 for oral health, r=.09 for alcohol use reduction, r=.05 for heart disease prevention, r=.05 for smoking, r=.04 for mammography and cervical cancer screening, and r=.04 for sexual behaviours. Campaigns with an enforcement (regulatory) component are more effective than those without. (Snyder Et al (2004)

To predict campaign effect sizes for topics other than those listed above, planners and researchers can take into account whether the behaviour in a cessation campaign is addictive, and whether the campaign promotes the commencement of a new behaviour, versus cessation of an old behaviour, or prevention of a new undesirable behaviour. Given campaign effect sizes in terms of behaviour change, campaign planners should set realistically modest goals for future campaigns. The results can also be useful to evaluators as a benchmark for campaign effects and to help estimate necessary sample size.

The “average” campaign affects the intervention community by about 5 percentage points, and nutrition campaigns for fruit and vegetable consumption, fat intake, and breastfeeding, have been slightly more successful on average than for other health issues.

A review focussing on physical activity campaigns concluded that they should focus more on influencing short term features such as social norms, to bring about long-term behaviour change. This should be seen as part of a broader strategy, including policy and environmental change. Evaluation designs that measure the full range of

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variables are preferred to an over-concentration on behaviour alone. Cavill et al (2004)

Campaigns that are carefully developed using formative research (both qualitative and quantitative), pay attention to the specific behavioural goals of the intervention, target populations, communication activities and channels, message content and presentation, and techniques for feedback and summative evaluation should be able to change health behaviours. Cohort (longitudinal) evaluation designs should be incorporated where possible because of the stronger evidence on cause and effect relationships they provide.

A Cochrane Systematic review assessing the effects of mass media on the utilisation of health services concluded that there is evidence that these strategies may have an important role in influencing the use of health care interventions; they should be considered as one of the tools that may encourage the use of effective services and discourage those of unproven effectiveness. Grilli et al (2002)

There is evidence of a dose-response relationship between campaign weight (dose) and impact (behaviour change). Hylan et al (2006), Craig et al (2006), Schade et al (2005) , Jorm et al (2005), MMWR (2004)

Components of successful media Campaigns

A number of researchers, both in health promotion and communication have attempted to identify the conditions under which media are most effective in promoting health. A detailed analysis of the components of successful and unsuccessful campaigns has been made by McGuire (1986), who concluded that the impact of media-even in studies that claim significant effects-may be only slight, but that the reasons for a null effect are often based on insufficient programming or analysis.

Douglas Solomon, who has been extensively involved in health media Campaigns, including the Stanford Heart Disease Prevention Project, analysed good and bad media campaigns and concluded that campaigns that have been successful owe much of their success to:

1. the extensive use of formative research regarding audience and message variables

2. the supplementation of media with interpersonal communication within small groups that provide social support and modelling of appropriate behaviours (Solomon 1982; 1984)

Solomon proposes a framework for success consisting of four main factors:

1. Adequate problem analysis including the setting of detailed objectives (ie. Specific, measurable and reasonable), and audience segmentation.

2. Appropriate media selection and use including formative research to provide information about media-use patterns.



3. Effective message design determined by specific objective setting, the generation of alternative message approaches, pre-testing and revision of campaign messages.

4. Evaluation including the study of both outcome and process evaluation.

The above attempts by McGuire(1986) and Solomon (1982;1984) and a perusal of other research (Medehlson 1973; National Institute of Health 1982; Rogers & Storey 1987; Elliot 1988) suggest a number of practical proposals for designing a successful campaign. These include the following:

1. Carry out formative research. Intuition is not sufficient for devising campaigns. Materials should be developed from skilled formative research (ie. focus groups, surveys), pre-tested, and evaluated during exposure

2. Fully understand the topic being communicated. Some topics are difficult and complex to teach (e.g. the nature of drugs and their effects), while others may be easily communicated (e.g. hygiene). Similarly, certain well-established behaviours are difficult to change (e.g.smoking), while others require only a minor effort (e.g.not littering).

3. Use skilled creative personnel. Determining a message is simple. Executing that message in a way that is optimally received and acted upon by a target audience is a highly skilled process

4. Understand the audience. The extent to which a message is attended to, comprehended and used by an audience is largely determined by the extent to which the messenger understands the audience. Detailed profiles of an audience need to be established as a preliminary to media development if a message is to be optimally received

5. Target the message. Different sub-groups have different needs, interests, beliefs and attitudes. Hence, different messages – or at least different message executions – should be tailored for different groups

6. Take account of interpersonal and peer influences. Campaigns should attempt to stimulate interpersonal contact such as the promotion of group and community activities, and the activation of interpersonal communication networks

7. Maximise contact with the message. This does not mean total bombardment. Research indicates that concentrated bursts of spot messages often work better then the same quantity of messages strung out over a long period. Maximising contact also means optimising media within the constraints of a limited

8. Set a realistic duration for the study. Many campaigns have not matched the duration of the study with the desired outcome. Longer campaigns are required to achieve behavioural change, whereas shorter campaigns may be sufficient for changes in awareness. Also, ongoing campaigns are necessary to maintain awareness and to reinforce attitude behaviour change

9. Use multiple channels. Multiple communication channels (ie. different media and media vehicles plus various non-media channels) tend to have a synergistic effect, and can carry different types of information

10. Use a credible source or spokesperson. Source credibility is a major factor affecting message acceptance. Spokespersons are selected on the



assumption that they will be credible to the target audience. For example, the use of celebrities and sport stars in anti-drug promotions to youth is common practice. Yet research suggests that youth only identify with certain aspects of an idealised role model, such as his or her ability to play music or sport. If other aspects (e.g. his/her attitude to drugs) conflict with overwhelming peer pressure, the model will be discarded rather then the anti-social habit . Pre-testing for credibility is essential in the message pre-testing.

11. Do not confuse logic and emotion. A basic distinction can be drawn between rational and emotional messages in health. The former are less stimulating, better for intelligent audiences and are best represented in long copy print. The latter suited for the electronic media. In common parlance, the difference is between a message with ‘light’ versus a message with ‘heat’

12. Set realistic goals. Major shifts in behaviour are not common in large populations over short periods. Hence it is important that intermediate goals, for example, knowledge and attitudinal goals, are set rather than behavioural goals. Furthermore, many campaigns set large, unrealistic changes as their criteria for success (e.g. reducing alcoholism), rather than more realistic immediate changes (e.g. reducing the incidence of driving while drunk). Small changes (knowledge, attitudes and behaviour) in large groups are often more possible and can result in a greater degree of success throughout the population than can be achieved by large changes in small groups.

13. Provide environmental supports for change. Research has shown consistently that most media campaigns require ‘on-the-ground’ back-up support for optimum effect. To accomplish this, media should be accompanied by strategies associated with community organisation.

14. Confirm that a mass media campaign is really justifiable. Although listed last, whether a mass media campaign is both viable and justifiable should be determined early on following the formative research phase. Mass media should be looked at in terms of costs and benefits and these should be compared with other strategies. If an alternative strategy is projected to be slightly less successful but at much less cost, the goals of a campaign may need to be re-examined. Often, a subsidiary aim of a campaign is to increase public awareness, or get more acceptance from funding bodies. In these cases a decision may still be taken to use the less cost-effective media approach.

Findings Concerning media use in health promotionA precise of a number of research studies and implications for mass media use in drug and alchol area (Miller & Ware 1989) suggests that:

Media may stimulate learning and generate often dramatic changes in behaviour where a level of pre-motivation exists. In many cases, however, mass media alone are insufficient for behaviour change and the mass media should be combined with personalised health education.

The ‘agenda setting’ role of the media produces its most pervasive impact. In the short term the influence of the mass media on its own tends to e in the

direction of reinforcing existing beliefs and opinions and helping crystallise attitudes, rather than changing them.

Mass media bestows ‘prestige’; interpersonal communication bestows ‘faith’; when both are combined, the chances of action are increased.

Community development and interpersonal contact will be important components reinforcing, and being reinforced by, rigorously developed mass media messages and supporting printed materials.



Through repetition, the mass media may produce long-term benefits by creating a climate of opinion or setting the agenda for public discussion.

The simple persuasive model of mass media influences has now been replaced by a more socially oriented approach, in which the mass media are viewed as one of many possible sources of information in society. Mass media sources cannot be discussed in isolation from personal information sources – families, friends and so on – which may support or contradict their messages.

The impact of a media message can no longer be determined by its content alone. Members of the audience are now regarded as active participants in the communication process and pr-existing beliefs, attitudes, experiences and knowledge affect attending to, interpretation and acceptance of messages.

Changes in public acceptanceHealth promotion can have similarities to fashion design. Public acceptance is changeable and what may be acceptable (and effective) at one time may not be so at another.

Summing up: When to use the mediaIn conclusion, it is apparent that the media can be an effective tool in health promotion, given the appropriate circumstances and conditions. Some of the situations in which media have been found to be most appropriate are:

1. When wide exposure is desired. Mass media offer the widest possible exposure, although this may be at some cost. Cost-benefit considerations therefore are at the core of media selection.

2. When the time frame is urgent. Mass media offer the best opportunity for reaching either large numbers of people or specific target groups within a short time frame.

3. When public discussion is likely to facilitate the educational process. Media messages can be emotional and thought provoking. Because of the possible breadth of coverage, intrusion can occur at many different levels, stimulating discussion and thereby expanding the impct of a message.

4. When awareness is a main goal. By their very nature, the media are awareness- creating tools. Where awareness of a health issue is important tot eh resolution of that issue, the mass media can increase awareness quickly and effectively.

5. When media authorities are ‘on-side’. Where journalists, editors and programmers are ‘on-side’ with a particular health issue, this often guarantees greater support in terms of space and editorial content.

6. When accompanying on-the-ground back-up can be provided. Regardless of whether media alone are sufficient to influence health behaviour, it is clear that the success of media is improved with the support o back-up programs and services.

7. When long term follow up is possible. Most health behaviour changes require constant reinforcement. Media programs are most effective where the opportunity exists for long-term follow up. This can take the form of short



bursts of media activity over an extended period, or follow up activities unrelated to media.

8. When a sufficient budget exists. Paid advertising, especially via television, can be very expensive. Even limited reach media such as pamphlets and posters can be expensive, depending quality and quantity. For media to be considered as a strategy in health promotion, careful consideration of costs and benefits needs to be undertaken.

9. When the behavioural goal is simple. Although complex behaviour change such as smoking cessation or exercise adoption may be initiated through media programs, the nature of media is such that simple behaviour changes such as immunisation or cholesterol testing are more easily stimulated through the media. In general, the more complex the behaviour change, the more non media back up is required to supplement a media health program.

10. When the ‘agenda’ includes public relations. Whether we acknowledge it or not, many, if not most health promotion programs have an ‘agenda’ which is not always explicit. Such an agenda may be to gain public support or acknowledgement, to solicit political favour or to get funds for further programs. Where public relations are either an explicit or implicit goal of a program, mass media are effective because of their wide-ranging exposure.

References

Cavill, N., Bauman, A. 2004.Changing the way people think about health-enhancing physical activity: do mass media campaigns have a role? J Sports Sci.

Craig, C. L., Cragg, S. E.,Tudor-Locke, C. Bauman, A. 2006 Proximal impact of Canada on the Move: the relationship of campaign awareness to pedometer ownership and use. Can J Public Health.

Elliot, B. 1988, ‘the development and assessment of successful campaigns’. Education co-ordinators’ workship on media skills, Brisbane.

Grilli R, R. C. M. S. 2002 Mass media interventions: effects on health services utilisation. Cochrane Database of Systematic .Reviews: Reviews 2002 Issue 1.

Hyland, A. M., Wakefield, M., Higbee, C., Szczypka, G., Cummings, K. M. 2006 Anti-tobacco television advertising and indicators of smoking cessation in adults: a cohort study. Health Educ Res

Jorm, A. F., Christensen, H., Griffiths, K. M. 2005 The impact of beyondblue: the national depression initiative on the Australian public's recognition of depression and beliefs about treatments. Aust N Z J Psychiatry

Public Opinion Quarterly, vol.37, pp.50-61.

Mc Guire WJ 1986 The myth of massive media impact: savings and salvagings’ Public communications and behaviour , vol 1 pp173-220.

Miller, M. & Ware, J. 1989, Mass media alcohol and drug campaigns; consideration of relevant issues, Monograph Series No. 9, AGPS, Canberra

MMWR Effect of ending an antitobacco youth campaign on adolescent susceptibility to cigarette smoking--Minnesota, 2002-2003. 2004.MMWR Morb Mortal Wkly Rep

Progress and Implications for the Eighties, Government Printing Office, Washington, DC.

Rogers, E.M. & Storey, J.D. 1987, ‘Communication campaigns’, in Berget, C.R. & Chattee, S.H. (eds), Handbook of Communication Science, Sage Publications, San Francisco.

Schade, C. P., McCombs, M. 2005. Do mass media affect Medicare beneficiaries' use of diabetes services? Am J Prev Med.



Snyder, L. B., Hamilton, M. A., Mitchell, E. W., Kiwanuka-Tondo, J., Fleming-Milici, F., Proctor, D. 2004. A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States. J Health Communication.

Solomon, D.S. 1982, ‘Mass media campaigns in health promotion’, Prevention in Human Services, vol. 2, nos 1 and 2, pp. 115-23.

Solomon, D.S. 1984, ‘Social marketing and community health promotion: the Stanford heart disease prevention program’. In Frederiksen, L.W., Solomon, L.J. & Brehony, K.A. (eds), Marketing Health Behaviour, Plennum Press, New York.


Mass Media Effectiveness

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