Journal of Nutrition Education and Behavior
ReportHealth Communication Campaigns and Their Impact on Behavior
Introduction
One technique to change the dietary behaviors of a large number of people is to conduct communication campaigns. Communication campaigns are an organized communication activity, directed at a particular population for a particular period of time, to achieve a particular goal.1, 2 The term campaign includes organized, communication-based interventions aimed at large groups of people and social marketing efforts that include communication activities. Campaigns have promoted a wide variety of health behaviors, including seat belt use, dietary change, medication use, exercise, dental care, social support, substance use prevention and cessation, family planning, use of health services, and testing and screening for diseases. Health communication campaigns have been used to address many of the most common causes of death in the United States—poor diet, physical inactivity, tobacco use, alcohol consumption, microbial agents, and toxic agents.3 Campaigns vary widely in the particular communication activities they use, including posters, handouts, public service announcements, discussion groups, workplace or clinic-based counseling, and in-school presentations. Campaigns that count at least one form of media among their communication channels are termed “mediated campaigns.”
This narrative review describes some of the most important lessons learned from prior health campaigns that may be applicable to nutrition campaigns. It is intended for people in the field of nutrition education who have limited experience with campaigns beyond more traditional counseling and education. The first question addressed is how well media campaigns work. After reviewing the overall effectiveness of campaigns, the lessons are organized around 3 critical elements of campaign planning: goals, strategy, and research.
The review draws on the conclusions of the meta-analyses and research syntheses that have been conducted to date that examine the effectiveness of communication campaigns, conclusions from evaluations of recent prominent national campaigns (the VERB Campaign on youth physical activity sponsored by the Centers for Disease Control,4 the Legacy Foundation’s truth campaign against youth smoking,5 and the National Youth Anti-Drug Media Campaign sponsored by the Office of National Drug Control Policy6), 2 studies that have collected original data comparing campaigns,7, 8 and the scientific literature on health campaigns.
Meta-analysis can be particularly helpful in drawing generalizations from a literature that has seemingly conflicting conclusions, such as early assessments of the value of communication campaigns. Meta-analysis provides a way to estimate the average effect of campaigns and to test for contingent conditions that may be responsible for differential results.9 It is important to note that the meta-analyses vary in the criteria they use to select which campaigns to analyze, including by health topics (such as all inclusive or just nutrition), population addressed by the campaigns (such as adults or youth), and channels and settings used in the campaigns (for example, using at least one mass medium, such as television or billboards, or only examining school-based interventions). The meta-analyses and systematic reviews used in the present review are listed in the accompanying Table.
Section snippets
How effective are campaigns?
Although it may be tempting to answer the simple question, “Are campaigns effective?” it is more valuable to know the magnitude of campaign effects. Knowing the average effect size for campaigns can establish a benchmark against which to compare the effects of specific campaigns, help establish realistic goals for a new campaign, and provide guidance when designing evaluations.9
The meta-analytic results are useful in establishing average effect sizes for media campaigns. The effects reported
Campaign Goals
Campaign goals specify what the campaign is designed to accomplish within a period of time. The goals state the desired outcomes, such as the specific behavior that the campaign is promoting. The goals should be clear about the target population. Campaign objectives, which are more detailed versions of goals, should also specify the target level of change, such as: After two years, girls 14-20 years old will have increased their daily calcium consumption by 10 percentage points. The objectives
Communication strategies
Campaigns may use a variety of communication strategies to try to change the behavior of the target populations, including strategies that attempt to change the political and economic context in which people are making decisions, those aimed directly at the populations, and those aimed at people who may have influence with the target population.41, 42 Selecting which strategy or strategies to use depends on careful analysis of the context surrounding individual decision making, including
Research and evaluation
Campaigns use research at different stages in their development and implementation. Formative research, as already mentioned, serves to improve the design of the campaign. Monitoring research is critical to the implementation stage of the campaign. Summative evaluation is critical to assessing campaign effects and disseminating the findings.
It is important to monitor implementation of the campaign to make sure that the plan is being followed and that the campaign has the ability to respond
Implications for research and practice
In sum, campaigns can successfully change a wide variety of health behaviors, including dietary behaviors. It would be valuable to know average effect sizes for a wider variety of nutritional behaviors than have been reported to date. Given that effect sizes vary across health topics, it is possible that some effect sizes also differ between nutritional behaviors, and preliminary data from one study19 lend some support for that idea. There may be nutritional behaviors that lend themselves more
Acknowledgment
Thanks to Amy Yaroch and Wendy Johnson-Taylor for organizing the workshop and encouraging the article, and to Matt Lapierre for timely preliminary analysis on the nutrition meta-analysis.
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