Speaking of Health Assessing Health Communication Strategies for Diverse Populations (2002) / Chapter Skim
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76 3 Health Communication Campaigns Exemplar INTRODUCTION This chapter focuses on diversity issues associated with large-scale public health communication campaigns. These campaigns include federal government-supported programs such as the National High Blood Pressure Education Program and the National Youth Anti-Drug Media Campaign; the state-sponsored antitobacco campaigns such as Florida's Truth Campaign and California's Anti-Tobacco Campaign; and privately sponsored programs such as the Campaign to Prevent Teen Pregnancy and the Avon Breast Cancer Crusade.
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Health Communication Campaigns 77 audience for enhanced levels of exposure to messages by purchasing time on stations with wide African-American listenership; a campaign may have shaped a message strategy for girls, meant to appeal to the particular beliefs that underpin their decisions about smoking; a campaign may have used actors well known to older audiences in advertisements to stimulate mammogram demand by those audiences. Often these special efforts are justified on the grounds that particular audiences are at greater risk, based on the sort of epidemiological evidence reviewed in other chapters in this volume, or more simply because different segments of the population are assumed to be responsive to different communication approaches.
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78 SPEAKING OF HEALTH TABLE 3-1 Campaigns -- Intended Populations National Campaign Racial/Ethnicity Gende National Safe Kids Campaign All ethnicities targetedb Male, Buckle Up America All ethnicities targetedb Male, (same Child Safety Seat Distribution Asian American, Hispanic/Latino, Male, Program (USNHTSA) Native American/Alaskan Native (same Folic Acid High-risk populations -- e.g., Asian Femal (March of Dimes)
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Health Communication Campaigns 79 Gender Age SES/Social Class Launch Date Male, Female ≤14 years Low income 1988 Male, Female ≤14 years, General and 1997 (same) parents, low-income grandparents no, Male, Female (parents)
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80 SPEAKING OF HEALTH National High Blood Pressure Asian American, Hispanic/Latino, Male, Education Program Asian American/Pacific Islander, (some Native American/Alaskan Native Youth Anti-Drug Media Campaign Asian American, Hispanic/Latino, Male, Native American, Asian American/ (femal Pacific Islander, Alaskan Native, Aleuts; (11 languages) Florida Pilot Project on Tobacco Asian American, Hispanic/Latino, Male, Control ("truth" campaign)
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Health Communication Campaigns 81 o, Male, Female Elderly, teenagers, Low income/ 1972 , (some different) youth education e o, Male, Female Youth -- 1998 an/ (female different)
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82 SPEAKING OF HEALTH gather systematic evidence about campaigns' diversity efforts and effects. In the following sections, we discuss the definition of a campaign, the various approaches campaigns have used to address diversity, and specific evidence about diversity effects.
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Health Communication Campaigns 83 norms, and/or by changing actual skills and confidence in skills (self-efficacy) , all of which are assumed to influence behavior.
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84 SPEAKING OF HEALTH sex practices to prevent HIV/AIDS; reduce illegal drug use; promote use of seatbelts, car seats, and bike helmets; reduce the practice of driving while alcohol impaired; encourage mammography and other disease-screening behavior; and promote healthy dietary choices for the prevention of cancer, cardiovascular diseases, diabetes, and other chronic diseases. Specifically, Congress authorized nearly $1 billion for the National Youth Anti-Drug Media Campaign between 1998 and 2002.
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Health Communication Campaigns 85 Authors have broken down these tasks in many ways. Sutton, Balch, and Lefebvre (1995)
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86 SPEAKING OF HEALTH for identifying disproportionate risks and outcomes, this broad level of epidemiological analysis rarely proves useful in identifying the relevant characteristics that best define the audiences for a health campaign. This is because any single group characterized by these broad demographic variables is actually composed of multiple diverse segments with different needs, experiences, attitudes, and behaviors.
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Health Communication Campaigns 87 begin with one of these audiences. For example, the National Youth Anti-Drug Media Campaign (1998)
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88 SPEAKING OF HEALTH are frequent visitors to malls, while others attend rock concerts. There are many settings and channels through which intrigued nonsmokers may be reached, and different subgroups are likely to be accessible through each setting and channel.
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Health Communication Campaigns 89 for whom it is not. The goal is to target segments of people who will respond in a similar way so that a health message can be designed to maximize its relevancy.
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90 SPEAKING OF HEALTH These strategies will be helpful insofar as the selected diversity characteristics enhance the persuasiveness of executions and access to channels and thus improve total exposure to and credibility of the antidrug messages. Good health communication segmentation may match the diversity categories that are the focus of this volume, but there is no assurance that this will be the case.
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Health Communication Campaigns 91 paigns often seek to reach the largest possible number of people who could benefit from the message. • Impact.
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92 SPEAKING OF HEALTH who have an interest in the outcome. Two factors are of particular importance for these decisions: (1)
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Health Communication Campaigns 93 the Depression Awareness, Recognition, and Treatment (D/ART) campaign commissioned scholarly papers and literature reviews, conducted focus groups with physicians and diverse members of the public, and used available demographic data (e.g., National Institute for Mental Health Epidemiologic Catchment Area study)
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94 SPEAKING OF HEALTH Such campaigns chose to make the tradeoff between size of audience and need, starting with broadly targeted campaigns, then later focusing more on targeted groups in greater need only after more resources became available to develop and disseminate subgroup-specific materials. The Back to Sleep Campaign, which at first targeted the full population, only later developed a targeted communication campaign for Native American/Alaskan Native populations, although this subgroup has had the highest rate of sudden infant death syndrome (SIDS)
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Health Communication Campaigns 95 a hallmark of the campaign (Office of National Drug Control Policy, 2000; Johnston, O'Malley, and Bachman, 2001)
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96 SPEAKING OF HEALTH gram gradually targeted new and expanded audiences, such as African-Americans, women, and specific age and income groups, among others (Roccella, 2002)
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Health Communication Campaigns 97 youth; develop ad executions that feature actors of those backgrounds, and use language particularly recognized in those communities.)
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98 SPEAKING OF HEALTH tended audience completes an assessment. Based on their answers, individuals then receive a particular form of the message (Kreuter et al., 2000b)
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Health Communication Campaigns 99 search base for making such decisions is limited. Adaptations may focus on channel strategies (given widely available media access information)
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100 SPEAKING OF HEALTH tion efforts that focus on social influences (peers, families) , public policy and environmental influences (policy makers, legislators, enforcement agencies)
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Health Communication Campaigns 101 stantial attention from external institutions may mean some loss of control of messages. If Oprah Winfrey and Peter Jennings are to address an important health issue, they will not permit campaign planners to write their scripts.
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102 SPEAKING OF HEALTH We continue our discussion of diversity and addressing heterogeneous audiences by presenting examples of how various campaigns have worked to reach the audiences. In doing so, we leave behind this alternative perspective on how campaigns have effects, and its somewhat chastening view about limits on how far one can and should go in implementing segmentation, or at least how helpful a research base will be in informing the right choices.
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Health Communication Campaigns 103 behavior. Similarly, the National Campaign to Prevent Teen Pregnancy communicates messages about sexual responsibility and advocates use of safer sexual behaviors to teens.
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104 SPEAKING OF HEALTH On the other hand, some campaigns use information about identified audience rewards and barriers to develop general communication strategies that will be effective across all intended populations, based on similarities across diverse groups. The Best Start Loving Support Campaign developed strategies to overcome common barriers to breastfeeding identified by the mothers in their audience (regardless of age and ethnicity)
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Health Communication Campaigns 105 appear to be available in many geographic areas of the country where high concentrations of these populations reside (National Heart, Lung, and Blood Institute, 2000)
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106 SPEAKING OF HEALTH dates to Web site visitors (e.g., Folic Acid Campaign) , tailored emails to campaign members or volunteers through electronic mailing lists (e.g., National Truth Campaign)
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Health Communication Campaigns 107 ate expertise. Examples for some people might include having regular mammograms, increasing folic acid intake, improving diabetes self-care behaviors, and encouraging parents to place babies on their backs when sleeping.
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108 SPEAKING OF HEALTH of messages. The tone of a message should "speak the language" of intended audiences.
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Health Communication Campaigns 109 are credible, attractive, and appropriate for intended audiences. Some campaigns have conducted extensive research to develop a consistent, carefully designed "signature" image or symbol (known as "product branding" in social marketing)
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110 SPEAKING OF HEALTH we conclude the section by presenting an agenda for such diversity-related research, rather than a summary of what is known. Good evidence exists that the periods of operation of some national campaigns have been associated with periods of improving overall levels of problematic health behaviors and health outcomes.
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Health Communication Campaigns 111 ably, this examination would focus on comparison between groups known for disparities at the start. The analysis would evaluate whether target groups differed in their rates of change, and if so which group was favored.
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112 SPEAKING OF HEALTH whether they produce differential rates of change for the disadvantaged population. For example, a focused campaign to reach Native American populations to stimulate active care seeking for diabetes might begin operating soon after a national campaign with the same objective.
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Health Communication Campaigns 113 their arguments, with an expectation that subgroups will identify the arguments in their ad to be more important and more likely to be persuasive. The test also could be done in a more elaborate way, relying on a pilot study with three arms: one of which used both ads, one of which used the preferred ad for each subgroup, and one of which used the not-preferred ad for each subgroup.
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114 SPEAKING OF HEALTH channels (churches, community groups) to reach out to the African-American community.
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Health Communication Campaigns 115 message strategy variation also will be persuasive for message execution variation. At the simplest level, assessment of alternative executions across target subgroups will provide some picture of whether something can be gained.
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116 SPEAKING OF HEALTH paign among middle and high school students, boys and girls, and non-Hispanic white, non-Hispanic Black, and Hispanic students (other ethnic groups not reported) (Florida Department of Health, 2000a)
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Health Communication Campaigns 117 tion. Only 51 percent of people with hypertension were told by physicians that they had elevated blood pressure and only 16 percent of them were taking medication to control it.
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118 SPEAKING OF HEALTH havioral Risk Factor Surveillance System, 1999b)
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Health Communication Campaigns 119 Study of SIDS, which has evaluated sleep position practices since 1992 (Willinger et al., 1998)
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120 SPEAKING OF HEALTH between major ethnic and racial groups. Table 3-2 presents the proportion of women over age 40 who had mammograms in the previous 2 years between 1987 and 1998.
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Health Communication Campaigns 121 what the committee found to be true, others of which are statements about what was not learned and needs to be better understood.
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122 SPEAKING OF HEALTH across diverse groups. As often as not, this evidence shows equal responsiveness across target subgroups, although there are exceptions.
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Health Communication Campaigns 123 3. There are alternative strategies for addressing multiple audiences, as already described; a particular program will need to choose its approach depending on what resources it has available for creating multiple campaigns and on the observed variation across populations with regard to behaviors and promising message strategies.
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124 SPEAKING OF HEALTH strate the magnitude, scale, and duration of initiatives needed to achieve behavior change. As the lead federal agency, the National Cancer Institute (NCI)
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Health Communication Campaigns 125 Additional strategies designed for African-American and Hispanic audiences included annual efforts for Minority Cancer Awareness Weeks and NCI's early detection campaigns -- Spike Lee's Do the Right Thing and Una communidad saludable. Para toda una vida.
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126 SPEAKING OF HEALTH vious activity is the pink ribbon signifying support for the fight against breast cancer. Breast Cancer Awareness Month is now sponsored by a variety of partners, including the American Cancer Society, American Society of Clinical Oncology, American Academy of Family Physicians, CDC, and NCI.
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