PUBLIC HEALTH CAMPAIGNS

Promoting public health and preventing the spread of dangerous health risks is an integral communication function in modern society. Whether the focus is on the prevention and control of acquired immunodeficiency syndrome (AIDS), cancer, heart disease, or community violence, a fusion of theory and practice in communication is urgently needed to guide effective promotion efforts. Public health campaigns involve a broad set of communication strategies and activities that specialists in health promotion engage in to disseminate relevant and persuasive health information to groups of people who need such information to help them lead healthy lives.

Public health campaigns involve the strategic dissemination of information to the public in order to help groups of people resist imminent health threats and adopt behaviors that promote good health. Typically, these campaigns are designed to raise public consciousness about important health issues by educating specific groups (i.e., target audiences) about imminent health threats and risky behaviors that might harm them. Health campaigns are generally designed both to increase awareness of health threats and to move target audiences to action in support of public health. For example, public health campaigns often encourage target audience members to engage in healthy behaviors that provide resistance to serious health threats. These behaviors can include adopting healthy lifestyles that include exercise, nutrition, and stress-reduction; avoiding dangerous substances such as poisons, carcinogens, or other toxic materials; seeking opportunities for early screening and diagnosis for serious health problems; and availing themselves of the best available health-care services, when appropriate, to minimize harm.

Frailty of Messages that Promote Health

Campaigns are designed to influence public knowledge, attitudes, and behaviors, yet achieving these goals and influencing the public is no simple matter. There is not a direct relationship between the messages that are sent to people and the reactions these people have to the messages. In addition to interpreting messages in very unique ways, people respond differently to the messages that they receive. For example, having drivers use their seatbelts when they drive might seem like a very straightforward public health goal. A very simple campaign might develop the message, "Wear your seatbelt when you drive!" For this message to influence the beliefs, attitudes, and values of all drivers, the campaign planner must take many different communication variables into account. Is this message clear and compelling for its intended audience? How are audience members likely to respond to this message? Will they pay attention to it? Will they adjust their behaviors in response to it? Campaign planners must do quite a bit of background research and planning to answer these questions. Effective communication campaigns must be strategically designed and implemented. In other words, they must use carefully designed messages that match the interests and abilities of the audience for which they are designed, and they must convey the messages via the communication channels that the target audience trusts and can easily access.

A primary goal of the campaign is to influence the way the audience thinks about the health threat. If the target audience already believes this issue is very serious and of great relevance to their lives, this will lead the campaign planner to craft messages that will support these preconceptions. If, on the other hand, members of the target audience barely recognize the health threat and are not at all concerned about it, the campaign planner must design communication strategies that will raise the audience's consciousness and concern about the topic.

Generally, campaign planners want to convince target audiences to recognize and take the identified health threat seriously. They want to influence the audience's beliefs, values, and attitudes about the issue to support the goals of the campaign. Only after a communication campaign raises audience consciousness and concern about the threat can it begin to influence (or persuade) the target audience to adopt specific recommendations for resisting and treating the identified health threat. The communication strategies used to raise consciousness and the strategies used to motivate action may be quite different.

Message Strategies and Communication Channels

Effective public health campaigns often employ a wide range of message strategies and communication channels to target high-risk populations with information designed to educate, motivate, and empower risk reduction behaviors. For this reason, modern campaigns have become increasingly dependent on integrating interpersonal, group, organizational, and mediated communication to disseminate the relevant health information effectively to specific high-risk populations.

Most campaigns use mass media (i.e., newspapers, radio, television, etc.) to convey their messages to large, and sometimes diverse, audiences. These channels for communication often have the ability to reach many people over vast geographic distances. In recognition of the multidimensional nature of health communication, the most effective public health campaigns develop information dissemination strategies that incorporate multiple levels and channels of human communication. To have the greatest potential influence on the health behaviors of the target audience, public health campaigns often employ a wide range of communication channels (e.g., interpersonal counseling, support groups, lectures, workshops, newspaper and magazine articles, pamphlets, self-help programs, computer-based information systems, formal educational programs, billboards, posters, radio and television programs, and public service announcements). The use of these different media is most effective when the campaign is designed so that the different communication channels complement one another in presenting the same public health messages to different targeted audiences.

Because effective use of communication channels is so important to the success of public health campaigns, research related to health communication can perform a central role in the development of an effective campaign. Such research helps campaign planners to identify consumer needs and orientations; target specific audiences; evaluate audience message behaviors; field test messages; guide message conceptualization and development; identify communication channels that have high audience reach, specificity, and influence; monitor the progress of campaign messages; and evaluate the overall effects of the campaign on target audiences and public health.

Strategic Public Health Campaign Model

Developing and implementing effective public health campaigns is a complex enterprise. Campaign planners must recognize that mere exposure to relevant health information will rarely lead directly to desired changes in health-related behavior. Edward Maibach, Gary Kreps, and Ellen Bonaguro (1993) address the complex relationship between communication efforts and campaign outcomes in their strategic health communication campaign model. This model identifies five major stages and twelve key issues that planners of public health campaigns should consider in developing and implementing their strategic campaigns. The major elements of the model are (1) campaign planning, (2) theories for guiding efforts at health promotion, (3) communication analysis, (4) campaign implementation, and (5) campaign evaluation and reorientation.

Campaign Planning

Campaign planning addresses two major issues, setting clear and realistic campaign objectives and establishing a clear consumer orientation to make sure that the campaign reflects the specific concerns and cultural perspectives of the target audiences. Realistic campaign objectives refer to the purposes of the campaign. Identifying an important public health threat or issue that can be effectively addressed by a campaign is a crucial first step. There must be an important health issue to address, and it must be a problem that poses significant risks for groups of people.

Is the identified health threat likely to be reduced through the implementation of a public health campaign? Are there clearly identified and proven strategies for addressing the threat that can be promoted by the campaign? Are members of the campaign audience likely to adopt the health strategies that will be promoted in the campaign? These questions must be answered before a public health campaign is started, or the planners risk wasting time and money on a campaign that will have a minimal effect on public health.

Adopting a consumer orientation means that the whole campaign is designed from the unique cultural perspective of the target audience and that members of the audience are involved as much as possible in the planning and implementation of the campaign. It is imperative that the campaign planners clearly understand the orientation and predisposition of the target audience in order to craft the most appropriate and effective campaign for that audience. Campaign planners must identify specific (well-segmented) target populations who are most at-risk for the identified health threats that will be addressed in the campaign. These populations of individuals become the primary audiences to receive strategic campaign messages.

Research related to public health campaigns focuses on the effective dissemination of relevant health information to promote public health. To develop and design persuasive campaign messages that will be influential with the specific target audiences, campaign planners must conduct audience analysis research to gather relevant information about the health behaviors and orientations of the target audiences. Audience analysis also helps campaign planners learn about the communication characteristics and predisposition of target audiences.

Theories for Guiding Efforts at Health Promotion

Once the basic campaign planning has been completed, it must be determined which established behavioral and social science theories will be used as guides for developing overall campaign strategies and materials. The best theories have been tested in many different contexts (with different populations) and provide the campaign planners with good advice in directing campaign efforts. Too often campaign planners are in such a rush to provide people with health-related messages that they do not carefully design their communication strategies.

Theory provides campaign planners with strategies for designing, implementing, and evaluating communication campaigns. There are a wide range of behavioral theories of communication, persuasion, and social influence that can be effectively used to guide public health campaigns. The theories that are adopted will direct the campaign planners' use of message strategies to influence key public audiences. For example, Albert Bandura (1989) developed an insightful theory concerning self-efficacy as a key variable in behavior change, which would lead campaign planners to develop message strategies that build the confidence of members of the target audience to implement and institutionalize campaign recommendations into their lives. Campaign planners who apply exchange theories to their efforts are likely to craft messages that identify the personal detriments of health risks and the benefits of adopting proposed behavioral changes. These theories direct the persuasive communication strategies used in public health campaigns.

Communication Analysis

Communication analysis identifies three critical issues in designing public health campaigns: (1) audience analysis and segmentation, (2) formative research, and (3) channel analysis and selection. Audience segmentation involves breaking down large culturally diverse populations into smaller more manageable and more homogenous target audiences for health promotion campaigns. The greater the cultural homogeneity (i.e., the more they share cultural attributes and backgrounds) of a target audience, the better able campaign planners are to design messages specifically for them. With a diverse target audience, the campaign planner is hard pressed to develop message strategies that will appeal to all parts of the population. It is far more effective to target an audience that shares important cultural traits and is likely to respond similarly to campaign message strategies.

After segmenting the target audience into the most culturally homogenous group possible, the campaign planners should, in order to guide the design of the campaign, gather as much information about the group's relevant cultural norms, beliefs, values, and attitudes. The more complete the audience analysis process, the more prepared the campaign planners are to tailor the messages to the specific needs and predilections of the target audience. Audience analysis can take the form of surveys, focus group discussions, or consultation of existing research results that are available and describe key aspects of the population of interest.

Formative research is the process used to guide the design and development of the campaign by gathering relevant information about the ways in which representatives of the target audience react to campaign messages. In essence, it is an early method of testing the effect of the developing campaign when changes, updates, and other refinements can still be made to reflect audience responses. Formative research can also help campaign planners make knowledgeable choices about which communication channels to use in the campaign because those channels are most likely to reach and influence the specific target audiences.

Campaign Implementation

Implementation involves the long-term administration and operation of the campaign. Campaign planners must carefully establish an effective marketing mix, which originates from the field of marketing and is indicative of the growth of social applications of marketing principles (i.e., social marketing) in public health campaigns. The marketing mix is based on product, price, placement, and promotion. In other words, campaign planners try to establish clear sets of campaign activities (products) to promote objectives that audience members can adopt with minimal economic or psychological costs (price). These objectives need to be presented in an attractive manner that is very likely to reach the target audience (placement), and the message must provide the members of the audience with information about how, when, and where they can access campaign information and programs (promotion).

Campaign planners should carefully evaluate the campaign process, which involves identifying macrosocial conditions that may influence accomplishment of the campaign goals and designing strategies for promoting long-term involvement and institutionalization of campaign activities with the target audience. Process evaluation is used to keep track and evaluate campaign activities in order to identify areas for fine-tuning campaign efforts. Since target audiences reside within and are interdependent with the larger society, campaign planners must attempt to involve these larger social systems, such as business organizations and government agencies, in the campaign activities. For example, planners for a campaign related to tobacco control used macrosocial factors to provide strong support for their efforts. They accomplished this by lobbying in support of government and corporate regulations that restricted smoking behaviors in public places and that corresponded nicely with their message strategies that encouraged people to not smoke. In this way, the macrosocial regulations on smoking supported the campaign goals of reducing smoking behaviors.

Furthermore, the campaign planner should design strategies for the long-term involvement of the audience with the goals and activities of the campaign in order to ensure that the audience members institutionalize the messages and make them a regular part of their daily lives. An excellent strategy for such institutionalization is to empower members of the target audience to get personally involved with implementing and managing campaign programs so they have a greater stake in achieving campaign goals and so the campaign activities become part of their normative cultural activities. For example, campaigns that support increased physical activity and fitness have benefited from efforts to establish annual activities, festivals, and sporting events to institutionalize their campaign goals.

Campaign Evaluation and Reorientation

The final process involved in the strategic communication campaign model is evaluation and reorientation. At this point, a summative evaluation (i.e., and evaluation of campaign outcomes) is conducted to determine the relative success of the campaign in achieving its goals at an acceptable cost, as well as to identify areas for future public health interventions. The information gathered through such outcome evaluations reorients campaign planners to the unmet health needs of the target audience. Such feedback is essential in leading campaign planners back to the first stage of the model (planning), where they identify new goals for health promotion. Through this evaluative feedback loop, the strategic communication campaign model illustrates the ongoing cyclical nature of efforts at health promotion.

Campaigns and Communication Research

As seen in the strategic communication campaign model, communication research performs a central role in strategic public health campaigns. Data are gathered (1) in the planning stage to identify consumer needs and orientations, (2) in the communication analysis stage to target specific audiences, evaluate audience message behaviors, field test messages to guide message conceptualization and development, and to identify communication channels with high audience reach, specificity, and influence, (3) in the implementation stage to monitor the progress of campaign messages and products and to determine the extent to which campaign objectives are being achieved, and (4) in the evaluation and reorientation stage to determine the overall effects of the campaign on target audiences and public health. The strategic communication campaign model suggests that to maximize the effectiveness of efforts at health promotion, research in the area of health communication must be used to guide the development, implementation, and evaluation of strategic public health campaigns.

See also:Health Communication.

Bibliography

Albrecht, Terrance, and Bryant, Carol. (1996). "Advances in Segmentation Modeling for Health Communication and Social Marketing Campaigns." Journal of Health Communication: International Perspectives 1(1):65-80.

Bandura, Albert. (1989). "Perceived Self-Efficacy in the Exercise of Control over AIDS Infection." In Primary Prevention of AIDS: Psychological Approaches, eds. Vickie M. Mays, George W. Albee, and Stanley F. Schneider. Newbury Park, CA: Sage Publications.

Kotler, Philip, and Roberto, Eduardo L. (1989). Social Marketing: Strategies for Changing Public Behavior. New York: Free Press.

Kreps, Gary L. (1996). "Promoting a Consumer Orientation to Health Care and Health Promotion." Journal of Health Psychology 1(1):41-48.

Lefebvre, Craig, and Flora, June. (1988). "Social Marketing and Public Health Intervention." Health Education Quarterly 15(3):299-315.

Maibach, Edward W.; Kreps, Gary L.; and Bonaguro, Ellen W. (1993). "Developing Strategic Communication Campaigns for HIV/AIDS Prevention." In AIDS: Effective Health Communication for the 90s, ed. Scott C.

Ratzan. Washington, DC: Taylor and Francis. Ratzan, Scott C. (1999). "Editorial: Strategic Health Communication and Social Marketing of Risk Issues." Journal of Health Communication: International Perspectives 4(1):1-6.

Rice, Ronald E., and Atkin, Charles K., eds. (1989). Public Communication Campaigns, 2nd ed. Newbury Park, CA: Sage Publications.

Gary L. Kreps