Health Communication Campaigns and Their Impact on Behavior

Abstract

The objective is to review the evidence for the effectiveness of health communication campaigns to inform future nutrition campaigns. The review drew on existing meta-analyses and other literature. The average health 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 topics. The factors affecting success rates are discussed. The conclusion is that nutrition campaigns that pay attention to the specific behavioral goals of the intervention, target populations, communication activities and channels, message content and presentation, and techniques for feedback and evaluation should be able to change nutrition behaviors.

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.