Public Health Campaigns That Change Minds

How do you motivate an individual to quit smoking? Persuade a community to vaccinate their children? Incentivize a whole nation to eat better?

These types of questions are at the heart of every health communication campaign, which aim to change how people think about their health and simultaneously provide them with the resources and incentives to improve it.

Health communication professionals who spearhead these projects play a powerful role in curbing harmful behaviors and promoting good ones among at-risk communities and individuals. Creating an effective campaign isn’t just a matter of raising awareness, though. These initiatives are carefully structured to ensure that they’re effective in addressing the health challenge they set out to solve.

In Essentials of Public Health Communication, Claudia Parvanta outlines how health communication campaigns are constructed with the ecological model in mind. That approach takes into account not just physiological health variables, but also social and cultural factors that influence health on a variety of levels. These include individual behavior and physiology; family, community and social networks; living and working circumstances; and state, national and global conditions.

The size and reach of a campaign depends on the scope of the problem being addressed. Campaigns that seek to change behavior on a national scale, for instance, need to address more ecological levels than ones working to address a public health problem specific to a particular city or town. So how is a successful communications campaign put into motion?

Parvanta describes the process as a wheel that is in constant motion. Before anything else, campaign leaders need to determine whether there is sufficient evidence to suggest that a health problem definitively exists within a certain population. If so, they then need to determine if interventions have been conducted in the past and, if so, whether they were successful. In addition, they must identify whether those strategies can be improved or adapted in the current intervention.

The development phase of a campaign helps identify its objectives and the desired behavior changes or attitudes leaders hope to effect among the target population. The development stage also ensures that the campaign’s messaging and materials account for the psychographics of a given audience — not just who they are, but what they value and why. Understanding why a harmful behavior or attitude exists is crucial to reversing it.

Evaluating whether a campaign has actually succeeded in changing behavior is a rigorous but crucial part of any intervention initiative. In addition, continued funding and support for many campaigns can depend heavily on whether it has been demonstrably effective. The challenge lies in not only measuring the reach of a campaign, but also determining whether the messaging results in the desired and intended behavior change.

The CDC advises intervention teams to make evaluation an ingrained part of a health communication plan throughout its execution, rather than something that is “tacked on at the end.” They identify two types of evaluation: formative and summative. Formative evaluation typically takes place during a campaign’s development or in early implementation stages, and provides information about how the intervention process could be revised or improved. Summative evaluations tend to occur at the end of an operating cycle. Findings from this type of evaluation identify the outcome or impact of the program, and are used to decide whether a program should be adopted, continued or modified for improvement.

Proper evaluation and the right combination of tools, says Patrick Remington, author of Communicating Public Health Information Effectively, is key to initiating sustainable behavior change.

“Knowledge and implementation of health communication principles can greatly enhance the practice of public health,” he writes. “Fundamentally, health communication emphasizes the importance of communicating (why), the audience, and the message to be communicated, and it stresses the need for a plan of action. Public health professionals must understand their audiences and the environments in which they operate; this is a key tenet of successful health communication.”

How do these processes work in practice? In this digital age, health communication and social marketing are finding new and more creative ways to encourage long-lasting behavior changes that result in better health. Following are two examples of U.S.-based intervention campaigns that successfully changed the behavior of their target audience and improved public health outcomes.

Issue: Smoking

Year Founded: 2000

Borne out of successful youth-focused anti-smoking pilot programs in Florida, Massachusetts and California, the truth campaign was produced and funded by the Truth Initiative. The Initiative (formerly the American Legacy Foundation) is a nonprofit that was established in 1999 under the Master Settlement Agreement between the country’s five largest tobacco companies and 46 states, the District of Columbia and five territories. The campaign became a household name during the early 2000s for its unyielding illustration of tobacco-related harm.

Truth used a tactic known as countermarketing, which seeks to decrease demand for a product — like cigarettes — by using traditional marketing strategies to highlight that product’s shortcomings. In this case, countermarketing was used to show what might have happened to the tobacco industry’s iconic Marlboro Man if he kept up his smoking habit. One of the campaign’s most recognizable ads focuses on a “singing cowboy” — intended to closely resemble the Marlboro Man — whose addiction led to a laryngectomy. The cowboy now must rely on an electronic voicebox to sing and speak.

The results: Several studies found that the original pilot campaigns reduced the likelihood that youths would continue to smoke later in life or start smoking at all. Another study found that the vast majority of youth in the state ages 12-17 could recognize at least one of the campaign advertisements. A study in the March 2005 issue of the American Journal of Public Health found the truth campaign led to declines in teen smoking rates nationwide.

Issue: Substance abuse and suicide among men

Year Founded: 2012

As of 2012, men ages 24-54 accounted for the largest number of suicide deaths in Colorado. In an effort to offset the stigma that discourage men from seeking help — namely that asking for help isn’t “masculine” — the Colorado Office of Suicide Prevention collaborated with the Carson J Spencer Foundation, a nonprofit dedicated to suicide prevention among working-age people, and Cactus, a Denver-based creative advertising agency, to create the Man Therapy campaign. The initiative — a multifaceted, web-based resource that features a fictional character named Rich Mahogany — uses humor to reach its target audiences. The goal of the Man Therapy campaign “is to provide men, and their loved ones, a place to learn more about men’s mental health, to examine their own wellness and to consider a wide array of actions designed to put them on the path to treatment and recovery.”

In planning the campaign, leaders sought to change a series of attitudes — such as reducing stigma around mental health conditions among men — and behaviors — such as increasing the number of men who self-screen for mental health conditions. In addition to humorous videos, the site features resources that allow men to learn more about their mental health, such as an 18-point head inspection, a suicide prevention therapist finder and an online support group. Visitors can also send resources and cards to men they may know who are struggling.

In an interview with The New York Times, Cactus chief executive Joseph Conrad said, “the stigma around mental health for men is even greater than it is for the general population. We thought humor would really crack that stigma and draw men in.”

Results: To better understand the effectiveness of the campaign, implementers of Man Therapy evaluated its outcomes using three strategies: website analytics, pop-up survey questions and in-depth survey questions. Eighteen months after launch, more than 19,000 visitors had accessed crisis information using the site, and nearly 20,000 had used the “Worried About Someone” resource. Close to 60,000 18-point head inspections were completed. The pop-up survey found that 83 percent of visitors would recommend the site to a friend in need, and 51 percent agreed or strongly agreed that they were more likely to seek help after visiting the site.

As chronic and infectious — but preventable — diseases continue to threaten public health in the 21st century, the need for targeted, nuanced health communication will remain high. Interventions that consider social and cultural determinants of health have the ability to improve wellness for individuals and large communities alike. Professionals in this field can build careers in a variety of environments, from private firms and insurance companies, to large government agencies and nonprofits.

Are you considering a career in this field? Learn more about the health communication focus area offered through MPH@GW.

Citation for this content: MPH@GW, the online MPH program from the Milken Institute School of Public Health at the George Washington University