Social Media Awareness Campaigns Policy Change
Lancet. Writer manuscript; available in PMC 2014 Dec 1.
Published in final edited form every bit:
PMCID: PMC4248563
NIHMSID: NIHMS643749
Use of mass media campaigns to change health behaviour
Abstract
Mass media campaigns are widely used to expose loftier proportions of large populations to letters through routine uses of existing media, such every bit goggle box, radio, and newspapers. Exposure to such messages is, therefore, by and large passive. Such campaigns are often competing with factors, such equally pervasive product marketing, powerful social norms, and behaviours driven past addiction or habit. In this Review we hash out the outcomes of mass media campaigns in the context of various health-risk behaviours (eg, use of tobacco, alcohol, and other drugs, heart illness risk factors, sex-related behaviours, road safety, cancer screening and prevention, child survival, and organ or blood donation). We conclude that mass media campaigns tin can produce positive changes or preclude negative changes in health-related behaviours across big populations. We assess what contributes to these outcomes, such as concurrent availability of required services and products, availability of community-based programmes, and policies that support behaviour change. Finally, nosotros advise areas for improvement, such as investment in longer amend-funded campaigns to achieve adequate population exposure to media messages.
Introduction
Over the by few decades, media campaigns take been used in an attempt to bear upon various wellness behaviours in mass populations. Such campaigns have most notably been aimed at tobacco use and heart-disease prevention, only accept also addressed booze and illicit drug utilize, cancer screening and prevention, sex-related behaviours, kid survival, and many other health-related bug. Typical campaigns take placed messages in media that reach large audiences, most often via television or radio, but besides outdoor media, such as billboards and posters, and print media, such as magazines and newspapers. Exposure to such messages is mostly passive, resulting from an incidental effect of routine use of media. Some campaigns incorporate new technologies (eg, the internet, mobile phones and personal digital assistants), but recipients have so far by and large been required to actively choose to seek information, for instance by clicking on a spider web link, and give-and-take of these methods is not included in this Review.
Media campaigns can be of short elapsing or may extend over long periods. They may stand alone or be linked to other organised programme components, such as clinical or institutional outreach and easy admission to newly available or existing products or services, or may complement policy changes. Multiple methods of broadcasting might exist used if health campaigns are part of broader social marketing programmes.1
The cracking promise of mass media campaigns lies in their ability to disseminate well divers behaviourally focused messages to large audiences repeatedly, over time, in an incidental manner, and at a low cost per head. Equally nosotros talk over in this Review, however, that hope has been inconsistently realised: entrada messages can fall short and even backfire; exposure of audiences to the bulletin might not see expectations, hindered past inadequate funding, the increasingly fractured and chaotic media environment, apply of inappropriate or poorly researched format (eg, boring factual messages or historic period-inappropriate content), or a combination of these features; homogeneous messages might not be persuasive to heterogeneous audiences; and campaigns might address behaviours that audiences lack the resources to alter.
Directly and indirect methods to impact behaviour alter
Mass media campaigns can work through direct and indirect pathways to change the behaviour of whole populations.2 Many campaigns aim to direct impact individual recipients by invoking cerebral or emotional responses. Such programmes are intended to affect decision-making processes at the individual level. Anticipated outcomes include the removal or lowering of obstacles to change, helping people to adopt good for you or recognise unhealthy social norms, and to associate valued emotions with achieving change. These changes strengthen intentions to alter and increase the likelihood of achieving new behaviours.3 For case, an antismoking campaign might emphasise risks of smoking and benefits of quitting, provide a telephone number for a support line, remind smokers of positive social norms in relation to quitting, associate quitting with positive self-regard, or a combination of these features.
Behaviour change might also exist accomplished through indirect routes. First, mass media letters can set an agenda for and increment the frequency, depth, or both, of interpersonal word about a particular health issue inside an individual'south social network, which, in combination with individual exposure to messages, might reinforce (or undermine) specific changes in behaviour. 2d, since mass media messages achieve big audiences, changes in behaviour that go norms within an individual'south social network might influence that person'southward decisions without them having been direct exposed to or initially persuaded by the campaign. For case, after viewing televised antismoking entrada messages, several members of a social group might exist prompted to form a support grouping to help them stop smoking. Another individual who has non seen the television entrada could decide to join the support group and change his or her own behaviour. Finally, mass media campaigns can prompt public discussion of health bug and lead to changes in public policy, resulting in constraints on individuals' behaviour and thereby change. For example, a entrada discouraging smoking considering of its second-manus furnishings on not-smokers might not persuade smokers to quit, but information technology might increment public support for a new policy that restricts smoking in specific places, which might have the secondary effect of persuading smokers to quit.
Evidence for health behaviour change
Nosotros discuss a range of media campaigns, from constrained experimental programmes with circuitous inquiry apparatus funded specifically to test the promise of public communication, such as the Stanford Middle Affliction Prevention Program,4,5 to campaigns mounted as big-scale interventions on a regional or national scale, not operationally constrained by the demand for event assessment, merely to which assay was later practical, such as the U.s. National Youth Antidrug Media Entrada.6 These distinctions matter because the strength of the claims of causality is afflicted by the campaign design. For case, campaigns designed to maximise scale and operational success simply that do not carefully assess outcomes might be expected to make weak claims compared with those that include carefully planned experimental assessments. Big-scale media campaigns do, however, take higher population exposure and can exploit the indirect pathways that can increase overall population response to campaigns. Conscientious experimental designs are more often used to assess just the straight effects of small-scale campaigns, which might non provide the potential for maximum effectiveness.7
Tobacco, alcohol, and illicit drugs
One in three long-term tobacco users die prematurely, largely from cardiovascular and respiratory diseases and cancer. Without intervention, one billion premature deaths globally are predicted to be related to tobacco by the finish of this century.8 Tobacco use is also a major contributor to social inequalities in bloodshed in many populations worldwide.9 Far more studies have been done to assess the effects of media campaigns on tobacco use than on any other wellness-related issue and, consequently, the evidence for benefit is strong (table). Betwixt the 1970s and mid-1990s, the studies were controlled field experiments forming role of research demonstration projects, whereas from the mid-1990s onwards, large-calibration media campaigns have been assessed equally key components of state and national tobacco control programmes.
Table
Summary of reviews of mass media campaign features and furnishings on behaviour, by health topic*
| Blazon of behaviour | Competing influences | Numbers and characteristics of mass media campaigns in reviews | Summary conclusions | |
|---|---|---|---|---|
| Tobacco | Ongoing | Addiction, tobacco marketing, pricing, social norms |
| Strong evidence for benefit |
| Alcohol | Ongoing | Alcohol marketing, pricing and availability, social norms, addiction |
| Trivial bear witness for benefit |
| Physical activeness | Ongoing | Lack of ecology support (eg, walking paths), safety concerns, labour-saving products |
| Moderate evidence for do good, especially in motivated individuals and with prompts at point of decision |
| Nutrition | Ongoing | Food marketing and pricing lack of access to fresh fruit and vegetables |
| Moderate evidence for benefit when specific healthy food choices promoted |
| CVD prevention | Ongoing | As for nutrition and physical activity |
| Moderate testify for benefit |
| Nascence-rate reduction | Ongoing | Social norms for family size, lack of admission to services |
| Moderate evidence for benefit, peculiarly amidst motivated individuals |
| HIV infection prevention | Ongoing | Sexual drive, cultural reinforcement of risky behaviour, lack of access to services |
| Moderate evidence for benefit on safety utilise; footling show for do good on number of sex activity partners |
| Cervical cancer screening | Episodic | Lack of access to screening services |
| Moderate evidence or benefit when used with other programmes |
| Chest cancer screening | Episodic | Lack of admission to screening services |
| Moderate evidence for do good, but no findings for mass media simply |
| Bowel cancer screening | Episodic | Lack of access to screening services |
| No evidence for mass media just |
| Skin cancer prevention | Ongoing | Social norms for tanning |
| Insufficient bear witness for individual behaviour alter |
| Immunisation | I-off or episodic | Lack of access to vaccines |
| Moderate prove for benefit |
| Diarrhoeal illness | Episodic | Previous custom of withdrawing food and liquids |
| Moderate testify for do good |
| Breastfeeding | Ane-off or episodic | Cultural preferences, hospital practices |
| Weak testify for do good |
| Route safe | Ongoing | Alcohol marketing and pricing, drowsiness, road and vehicle design |
| Potent evidence for increased apply of safety belts and decreased drink driving when enforcement campaigns used, mixed conclusions for designated driver campaigns |
| Organ donation | One-off | Cultural and religious beliefs, family relationships |
| Moderate testify for benefit |
| Mental health, violence, and kid maltreatment | Ongoing | Social norms, access to tearing means of harm (weapons, drugs, etc) |
| Inconclusive findings for kid maltreatment; little evidence for benefit in suicide prevention |
| Prehospital response times for potential heart assault symptoms | Episodic | Rural location, failure to recognise severity |
| Moderate evidence for decreased filibuster and emergency calls |
Comprehensive reviews of controlled field experiments and population studies show that mass media campaigns were associated with a refuse in young people starting smoking10 and with an increment in the number of adults stopping.10,11 Smoking prevention in young people seems to take been more than likely when mass media efforts were combined with programmes in schools, the customs, or both.10 Many population studies have documented reductions in adult smoking prevalence when mass media campaigns have been combined with other tobacco command strategies, such as increases in tobacco taxation or smoke-free policies.10,11 In the absence of formal control groups not exposed to mass media campaigns, however, it is difficult to split the furnishings of the unlike strategies. Some studies have used fourth dimension series analyses12 or natural experiment designs that exploit variation in degree of exposure to the media entrada and conform for exposure to other tobacco control policies, and accept constitute benign contained furnishings of campaigns.13,14
The achievement of acceptable exposure to media campaigns seems important for reducing population tobacco use; withdrawal of media campaigns has been associated with a turn down in benign furnishings.x,12,15,16 This outcome is unsurprising while influences that promote tobacco employ remain (eg, marketing and the addictive nature of tobacco).
Nearly testify has been generated from studies in high-income countries because the highest number of campaigns take been done in that location and enquiry capacity is substantial there. Evidence is mixed on the ability of mass media campaigns to redress the disparities in smoking prevalence between subgroups with high and low socioeconomic condition.17 One accomplice study has suggested that loftier exposure to antitobacco campaigns that elicit negative emotions, such as fear, disgust, and sadness, promotes increased cessation rates in lower socioeconomic populations.14 This finding is consequent with show in many population subgroups of the positive effects of antitobacco campaigns that use negatively emotive advertising messages.10 For example, media campaigns that graphically link smoking to serious health damage to motivate adult smoking abeyance (figure) have also been associated with prevention of smoking uptake amid young people.10 This result might be an indirect consequence of reductions in adult (eg, parental) smoking attributable to campaigns, which exerts a protective upshot on youth uptake.18 Direct furnishings of such campaigns on young people have, all the same, also been suggested.10,19 A hereafter challenge for media campaigns related to tobacco control is to ensure their bear witness-based awarding in low-income and centre-income countries, which have infrequently received such programmes, and in groups with low socioeconomic status in high-income countries.
Images from a television advertisement in Australia'south National Tobacco Entrada
Smoking is linked graphically to arterial damage and the caption "Every Cigarette Is Doing You lot Damage" was used. The campaign was associated with a reject in developed smoking rates.12 Reproduced courtesy of the Section of Health and Ageing, National Tobacco Campaign.
During the belatedly 1990s, several tobacco companies began to broadcast mass media campaigns internationally to advocate that young people should not smoke. Studies of forced (non-incidental) exposure, in which young people had to sentinel then recall and appraise advertisements, take concluded that these messages were appraised poorly by the target audience.10 The Philip Morris tobacco company in the The states likewise circulate campaigns encouraging parents to talk with their children about tobacco use. Population-based studies plant high exposure to the manufacture'due south youth-directed campaign was associated with strengthening intention to smoke in the hereafter,xx,21 whereas high exposure to the parent-directed campaigns strengthened intentions to smoke in the futurity, lowered perception of impairment from smoking, and increased the risk of electric current smoking behaviour.21 A theory for these outcomes is that few reasons beyond only being a teenager were offered every bit to why young people should not smoke. By giving a subtle bulletin that smoking is an adult activity, tobacco tin seem like a forbidden fruit and attractiveness can increase.
Misuse of alcohol contributes to effectually 4% of the global burden of sick wellness and premature death, principally from alcohol-utilise disorders, cancer, cardiovascular disease, liver cirrhosis, and injury.22 With the exception of mass media campaigns to reduce drink driving, campaigns to lessen booze intake have had footling success.23,24 Most accept been targeted towards young people,23,25,26 but the potential effects have generally been overshadowed past widespread unrestricted alcohol marketing strategies and the view of drinking as a social norm. Prophylactic drinking campaigns sponsored past alcohol companies have been ineffective in changing drinking behaviour, because the messages are viewed as ambiguous by recipients.27,28 No assessments have been conducted of whether the publicising of alcohol drinking guidelines affects booze-related damage.25
Little peer-reviewed research is available on the effects of mass media campaigns to change behaviours related to illicit drug utilize; near all work has been undertaken in the USA. One study establish positive furnishings of a campaign that ran from 1987 to 1990 and addressed utilize of marijuana and crack cocaine by young people.29 By contrast, another study plant the effects to be overstated for a campaign that ran in Montana, USA, against methamphetamine use.thirty Between 1998 and 2004, the US Congress spent near U.s.$1 billion on a national antidrug media campaign aimed at young people aged nine–18 years, their parents, and other influential adults. The campaign used television and radio advertizement, accompanied past other media and community programmes, to provide teaching, with the goals of preventing initiation of marijuana use and persuading occasional users to cease. Letters directed at parents encouraged them to talk with their children nigh drugs and to closely supervise and monitor their behaviour. Although some localised time-limited studies showed positive furnishings among immature people who require substantial novelty and stimulation (termed high-sensation immature)31 and those who likewise received school-based drug prevention data,32 a comprehensive national assessment showed that the entrada did non positively affect attitudes towards or behaviour related to marijuana employ among young people.5 Indeed, some evidence suggested that greater exposure would take increased intention to employ marijuana, perhaps because the underlying message of the campaign was that marijuana employ was mutual place and thus normal.5 Amongst parents, the campaign had favourable effects in terms of their attitudes towards and behaviour in relation to talking with children almost drugs. No comeback was reported, even so, in attitudes towards or monitoring of their children's behaviour.33 The evidence for the success of campaigns focusing on illicit drug apply is inconsistent.
Nutrition, activity, and prevention of centre disease
Cardiovascular disease is a leading cause of death worldwide and is a major contributor to health-care costs in developed countries. In addition to tobacco use, risk factors include high claret pressure, loftier blood cholesterol concentrations, poor diet, physical inactivity, and obesity.34,35 Whereas rates of heart disease and stroke have lessened since the 1950s, those of obesity accept increased strikingly among adults and especially among children in high-income countries.35–38
In the 1970s and 1980s, large-calibration community-based public communication interventions aimed at preventing cardiovascular disease, including the North Karelia Project in Finland, and the Stanford Heart Affliction Prevention Program and the Minnesota Middle Health Program in the United states, were amidst the beginning to be formally assessed for effectiveness.39 Smaller-scale cardiovascular disease prevention programmes followed in the mid-1980s and 1990s. In aggregate, these programmes yielded loftier awareness and improvements in risk-reducing behaviours, such as changes to diet and increases in physical activity. Cantankerous-sectional independent sample outcome effects, particularly on overall risk for cardiovascular disease, however, were brusk-term, modest in size, and similar in magnitude to secular declines in communities not exposed to mass media campaigns.40 Researchers have argued convincingly, though, that large-scale, uncontrolled, national campaigns with big mass media components, such as the National High Claret Pressure level Didactics Programme and the National Cholesterol Teaching Program in the USA, contributed to these substantial secular declines in blood pressure, blood cholesterol concentrations, or both.41
Since the mid-1980s, the scale of mass media campaigns related to center health has decreased, whereas the size of those directed towards improving nutrition, increasing physical activity, or both, has increased. Before 1990, campaigns related to diet frequently focused on reducing fat intake, simply the results in terms of improving food choices seem to accept been mixed.35 Later media campaigns focused on increasing consumption of fruit, vegetables and low-fat milk, and were deemed more than successful, especially when people were provided with access to salubrious foods or had wellness disorders for which changes in diet would be beneficial.34,35,42,43 Campaigns aimed at increasing low-fatty-milk consumption have as well motivated governmental policy changes.44 The introduction of signs and labels providing nutritional information at the signal of purchase in restaurants, grocery stores, and vending machines, take too increased the likelihood of people selecting healthy food.35
Campaigns with mass media components aimed at changing physical activity behaviours have yielded curt-term increases in concrete activity, mainly in highly motivated individuals.45–47 Success has been seen with community-wide walking campaigns targeting adults, peculiarly older adults (eg, >50 years),48,49 and the United states of america Center for Illness Control and Prevention'southward VERB campaign, which targeted children aged 9–13 years.36,46 The latter entrada used commercial marketing techniques and had achieved population-level changes at year 2, with testify beingness reported for an exposure-response relation.36,46 Small-scale interventions that have used motivational posters to encourage use of stairs instead of elevators take also inverse behavior.35,47 Mass media programmes for prevention of babyhood obesity have shown encouraging results, with improvements in torso-mass index Z scores beingness associated with the exposure to the campaigns.37,38
Assessment of campaigns to promote nutrition and concrete activity, like those promoting tobacco control, shows that while short-term changes can be achieved, sustained effects are difficult to maintain after campaigns end.34,38,45,46,49,50 Competing environmental factors, such as like shooting fish in a barrel access to and marketing of energy-dumbo nutrient,51 the complexity of recommendations for nutritional and physical activity behaviour in dissimilar population subgroups,50 and changes over time in recommendations made by wellness educators are notable obstacles to achieving longer-term population-level changes.46 Sufficient exposure to entrada letters,52 including in high-hazard and underserved populations,41,46,47 is besides a business organization. Finally, almost all assessed mass media campaigns accept included multiple programme components (eg, other community, school, and worksite interventions) and, therefore, the effects of mass media campaigns are difficult to isolate.41,45,47
Nascence-charge per unit reduction and prevention of HIV infection
Reductions in birth rates and prevention of HIV infection require changes in man behaviour on a large scale. Unsurprisingly, therefore, both these problems accept been standing focuses for mass media campaigns. Those intended to encourage family unit planning have been specially of import in low-income countries,53 whereas those aimed at preventing HIV infection accept been relevant in depression-income and high-income countries.54,55
The transition from high to depression nativity rates has been argued to require a climate of opinion "supportive of modern contraceptive use and the idea of smaller family unit sizes".56 This opinion is supported past substantial evidence that the spread of data through mass media, along with efforts to promote family planning, is associated with adoption of contraception.57,58 Positive outcomes tin can be shown whether comparisons are fabricated across geographic areas, over time within geographic areas, or between individuals.57 For example, Cleland and Ali58 accept noted a sharp growth in the apply of condoms for protection confronting pregnancy amongst immature women across Africa (from five% to eighteen% between 1993 and 2001), which they attribute to HIV-related prophylactic promotion campaigns. Although these temporal or cross-exclusive associations are noteworthy and, in some cases, are contained of potential confounders, separation of the effects of exposure to modern values through ordinary media content from effects of exposure to specific procontraceptive campaign content is not e'er clear-cut.
Evidence from discrete projects complements that from population-level and aggregated studies. Effective family planning communication strategies take included the embedding of pro-family-planning letters in amusement programmes, especially in a lather opera format, social marketing with expanded distribution of family unit planning devices, and focused promotional advertising. The greatest short-term increases in need accept been reported for people who were exposed to entrada letters and were already because use; the furnishings in people who were not previously committed to use are less convincing.57
Programmes for prevention of HIV infection accept received substantial funding worldwide, and mass media campaigns have been major components of those programmes. Behavioural targets have included uptake of HIV testing, use of condoms, and lowering the number of sexual practice partners. Bertrand and colleagues54 noted mixed results for mass media interventions in low-income countries: a few studies yielded minor to moderate effects, only others accomplished no change. Wellings55 summarised a series of European AIDS campaigns with major mass media components run in the early 1990s. She establish that campaign action and trends in the proportions of people with casual sexual partners who used condoms increased linearly, specially in countries with more vigorous campaigns, only at that place was no effect on the number of sex activity partners. Noar and co-workers59 built on an earlier reviewthreescore and judged that merely ten of 34 identified campaigns had robust quality cess components, merely of these viii showed pregnant effects on behaviour.
Of the campaigns aimed at reducing nascence and HIV infection rates, reviews have shown consistently that discrete mass media programmes can affect behaviour.
Cancer screening and prevention
Screening of asymptomatic individuals for cervical, breast, and colorectal cancers is recommended for early detection.61 Mass media campaigns to encourage women to accept Papanicolaou (Pap) smears and undergo screening mammography have been run in many high-income nations since the early 1990s. Initial experience, predominantly from Australia and the U.s., suggested that mass media campaigns supported by tailored reminder messages prompted short-term increases in Pap-smear uptake, particularly when there was proficient availability of screening services.62,63 Subsequently research indicated that brusque-duration screening programmes that offered piece of cake access to screening services, used reminder letters, and specifically included television receiver circulate components were associated with short-term population-broad increases in attendance for Pap smears,64 including in indigenous minority populations65 and those of low socioeconomic status.66 Besides in the instance of mammography, apply of mass media campaigns and reminder letters in areas where screening was already organised and available led to increases in uptake.65 Snyder and colleagues42 did a meta-analysis of The states-based campaigns and the findings suggested a pocket-size merely pregnant effect. Mass media campaigns without organised screening services, even so, have produced little or no detectable increases in use of cervical cancer screening;61,62 no such studies have been done for breast or colorectal cancer screening.61
Skin cancer is caused mainly by overexposure to ultraviolet radiation in sunlight.67,68 Mass media campaigns aimed at prevention of pare cancer have full-bodied on reducing patterns of sun exposure, mainly in blanched populations. The types of behaviours virtually often recommended take been avoidance of direct exposure in high ultraviolet periods and the wearing of protective article of clothing and sunscreen products. A systematic review showed insufficient evidence of an clan between mass media campaigns—alone or accompanied by comprehensive community programmes—and changes in sun-exposure behaviours.67 A study from Australia that assessed sun protection attitudes and behaviours for 15 years in the presence of variable amounts of media entrada exposure (SunSmart), all the same, has provided convincing evidence of improvements in attitudes and behaviour in the presence of peel cancer prevention media campaigns.69 Furthermore, reductions in the incidence of melanoma accept been observed, especially amidst young people, over the decades of this media campaign.seventy The researchers of this Australian study advocate as crucial the need for sustained community-wide organised efforts that include mass media to maintain the positive preventive effects and counter competing forces that promote sunbathing and tanning, such as fashion trends and solarium marketing.70
Child survival
In many low-income countries, a substantial portion of premature mortality and associated morbidity occurs betwixt nascency and age 5 years. Major causes of poor kid survival include inadequate treatment of dehydration resulting from diarrhoea, non-vaccination for preventable diseases, and failure to breastfeed exclusively and for sufficient time.71,72 Each of these causes has been the target of mass media campaigns, with mixed bear witness for success.
One review found 4 of six childhood vaccination programmes that used mass media achieved substantial improvements in vaccine use, and the furnishings were incremental with increasing exposure to the entrada.73,74 One cost-effectiveness analysis in Bangladesh attributed increasing use of immunisation services to national campaign exposure.75 A afterwards review of vaccination interventions found no additional examples of mass media campaigns alone.76 Rather, mass media was a strategy widely used in multicomponent vaccination campaigns worldwide, and substantial improvements in childhood vaccination were repeatedly recorded. Equally with other campaigns, effects cannot be specifically attributed to the mass media campaign component.77
In a review of five diarrhoea treatment programmes that used mass media to promote home-mixed or premixed rehydration solutions, three were associated with increased adoption of rehydration solution.73
Although mass media programmes to promote breastfeeding accept been mounted, reviews from the 1990s onwards seem scarce or non-existent. Ii studies—i from Hashemite kingdom of jordan in the belatedly 1980s78 and i from Armenia79,80—show positive effects.
In countries where mortality from sudden babe decease syndrome has been monitored, expiry rates have sharply declined, attributed mainly to a change in the position in which infants are put downwards to sleep (on their backs). National campaigns with strong mass media components have been part of distribution of this message and have been aimed at members of the public and medical practitioners. Sharp reductions in prone sleeping take accompanied reductions in deaths from sudden babe expiry syndrome of well over 50%.81
A reduction in the use of children'due south aspirin, owing to this drug'due south association with Reye's syndrome, might partly indicate an indirect, not-campaign-led mass media issue. In the U.s.a. the media coverage of the public fence over risks of children'due south aspirin consumption was associated with an sharp decline in use of and in incidence of the disease. The introduction of warnings on aspirin bottle labels was associated with a further smaller but still notable drop in the disease until it near disappeared.82
Other wellness behaviours
Road rubber mass media campaigns accept promoted reductions in the frequency of road accidents and deaths through increases in uses of seat belts, booster seats for children, and helmets for bicyclists, skateboarders, and motorcyclists, and reductions in speeding, driver fatigue, and drink driving. The average associated pass up in vehicle crashes has been estimated to be at to the lowest degree 7%,83 and of booze-impaired driving to be 13%.84 Results of designated commuter programmes have been less conclusive.85 The virtually notable road safety campaigns have promoted seat belt use.86 The Click It or Ticket program in North Carolina, The states, was associated with an increase in seat chugalug use from 63% to lxxx% and lowered rates of highway deaths, and became a model for other state and national programmes.87 A version in Washington state, United states of america, reported gains from 83% up to 95% of seat chugalug use.88 Law enforcement and repeated cycles of short-term mass media exposure seem, therefore, to have been of import components of road safety campaign effectiveness.83,84,87,88
The need for organ donation and transplantation is increasing worldwide.89,90 Organ donation campaigns have been infrequent, and the few assessed have had mixed results. Public misconceptions and mistrust of physician'due south end-of-life decisions have been cited as primal barriers to change.90 News media surrounding the World Transplant Games Federation international events seems to exist associated with increased organ donations in the cities where events were held, but increases were non sustained subsequently media exposure dropped.89
Although few data for blood donation campaigns have been published, a few studies report sizeable increases in claret donors in association with mass media campaigns. For example, during China'southward national campaign to promote safe donation, which used celebrities and a patriotic message, the number of voluntary blood donors rose from 55 to 96 320 in one urban center between 1993 and 2001.91 In Republic of ghana, assay of a low-cost radio entrada that promoted voluntary blood donation from 2003 to 2006 showed an associated high response from immature male person donors attending for repeat donation who had not previously done so.92
According to reports from the Centers for Affliction Control and Prevention and WHO, youth violence, intimate partner violence, child maltreatment (sexual and physical abuse), and mental disorders are preventable behaviours that take negative effects on national rates of injuries and deaths, and on concrete health conditions.93–95 Researchers take begun to call for the abandonment of victim-perpetrator models and instead advocating mass media interventions to redress adventure factors, such as skill deficits and parental dysfunctions.94,95 Every bit yet, campaign effectiveness is unclear.95 Examples of promising programmes with mass media components include a campaign for professional person training that lowered rates of child maltreatment outcomes,96 an intimate partner violence programme for which increased reported bystander responses were reported,97 and a entrada that was associated with reduced rates of bullying in schools among children aged 12–14 years.94 A review of suicide prevention campaigns undertaken in several countries found improvements in attitudes nearly causes and handling of low, simply outcomes, such equally the charge per unit of suicide acts, did non change.98
Mass media campaigns to reduce delays in prehospital response for heart attacks and other emergency health disorders have been related to increased agreement of symptoms only no sustained lowering of response times or mortality rates.99 Researchers have called for extension of campaign duration to increase exposure, and strengthening of the messages by concurrently offering customs programmes, targeting of loftier-risk and rural populations, and investigation of patients' barriers to action.99
Conclusions
Mass media campaigns can straight and indirectly produce positive changes or forbid negative changes in health-related behaviours beyond large populations. Our conscientious reading of topic-specific individual studies and more-general mass media reviews,42,100,101 and our collective experience in entrada research and evaluation across health behaviours has led the states to the following conclusions well-nigh the conditions under which media campaigns work.
The likelihood of success is essentially increased by the application of multiple interventions102 and when the target behaviour is 1-off or episodic (eg, screening, vaccination, children's aspirin use) rather than habitual or ongoing (eg, food choices, sun exposure, concrete activity). Concurrent availability of and admission to central services and products are crucial to persuade individuals motivated by media messages to human activity on them. The creation of policies that support opportunities to change provides additional motivation for alter, whereas policy enforcement tin can discourage unhealthy or unsafe behaviours. Public relations or media advocacy campaigns that shape the handling of a public wellness issue by news and entertainment media as well represent a promising complementary strategy to conventional media campaigns.103
Diverse hindrances to the success of mass media campaigns exist. Pervasive marketing for competing products or with opposing messages, the power of social norms, and the bulldoze of addiction oft hateful that positive campaign outcomes are not sustained. Greater and longer-term investment will exist required to extend effects. The increasingly fractured and chaotic media environment poses challenges to achieving adequate exposure to planned media messages, rather than making broad exposure easier. Conscientious planning and testing of campaign content and format with target audiences are, therefore, crucial (panel).98,102
For all the reasons described in a higher place, isolation of the independent effects of mass media campaigns is hard. Substantial testify has, however, been garnered from written report designs that, in isolation, are less than classically first-class, but in aggregate yield a substantial trunk of back up for the conclusion that mass media campaigns tin alter population health behaviours.
Acknowledgments
MAW is supported by an Australian National Health and Medical Research Council Principal Research Fellowship. RCH is supported past a grant from the US National Cancer Found P20-CA095856-06. We thank Susan Mello and Judith Stanke for assistance in literature searches.
Footnotes
Contributors
All authors participated in the preparation of this Review and have seen and approved the concluding version.
Conflicts of interest
We declare that we have no conflicts of interest.
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