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Article

Kami J. Silk, Sarah Sheff, Maria Lapinski, and Alice Hoffman

The environment influences health and risk outcomes, and communication campaigns often strive to reduce risk and promote positive health outcomes by raising awareness, increasing knowledge, influencing attitudes, and impacting intentions and behavior. Communication campaigns should be based on good formative research and theory, and they should be implemented with fidelity and a clear evaluation plan. Communication campaigns that address environmental influences are typically focused on promoting human, animal, or environmental outcomes despite the fact that all three are interconnected and would benefit from being considered in a larger ecological framework. The One Health approach reconceptualizes environmental influences by focusing not just on the environmental but also connections with human and animal health. One Health can be applied to communication campaigns to support efforts that acknowledge and promote the complexity of these relationships. Campaigns about environmental influences on health and risk range from a longstanding campaign built on individual activities to reduce environmental and personal risk to a sun smart campaign to reduce sun exposure risk to a lead-free campaign and an asthma-control campaign concerned about air quality. Other environmental campaigns focus on tobacco prevention, obesity prevention by addressing environmental influences as part of their strategy, climate control, and ocean species preservation—and that is only a sampling of popular campaign topics. These communication campaigns face similar challenges like lack of formative research and evaluation plans as well as atheoretical approaches to influence outcomes.

Article

Jen Ptacek, Kirstin N. Dolick, and Marifran Mattson

Advocacy can be defined as the systematic process set in motion by an individual or group of individuals to encourage, support, and empower others surrounding a topic in need of change. Individuals may become an advocacy group in support of an issue, such as health care, civil rights, environment, or labor. Advocacy groups often serve as mediators between vulnerable/underprivileged populations and policymakers or decision-makers. The Health Communication Advocacy Model (HCAM) is a tested advocacy model comprising five phases including assembling the team, formative research, message development, message implementation, and evaluation. HCAM also includes a correction loop allowing for revisions of campaign messages. The HCAM is an adaptable model that offers a perspective in which advocacy groups may be considered a dynamic framework for building successful campaigns. Once the advocacy group is established, members can agree upon goals and responsibilities and craft a position statement. The group can then develop messages to reach the intended target audience(s). Target audiences may include legislators, the population affected by the issue, and media organizations. When crafting messages, care should be taken to ensure messages are stimulating, motivational, culturally consistent, resource contingent, and without barriers. Advocacy groups may use a number of channels to send messages through, such as social media, rallies, press releases, and other media outlets. Overall, advocacy groups must address a variety of needs to effectively reach the target audiences and impact change.

Article

The design and dissemination of health and risk messages invariably involves moral and ethical issues. The choice of the topics, the focus on particular recommended practices, the choice of particular groups to be the intended recipients of the messages and their inclusion in or exclusion from the message development process, all raise ethical issues. Further, the persuasive tactics used to influence people to change their attitudes and beliefs and to adopt recommended changes in their lives also raise ethical concerns. For example, persuasive tactics may infringe on people’s privacy when people view images they may find intrusive, offensive, or cause them distress. Tactics that “tug” at people’s emotions may infringe on their unhindered ability to make a conscientious decision. Employing digital media and sophisticated advertising and marketing tactics also elicits ethical challenges both related to their manipulative potential and their differential reach: all of which may contribute to social and health disparities. In addition, the practices recommended in health and risk messages may conflict with values people cherish. For example, people could be urged to change the way they communicate with their spouses on intimate issues, relinquish the consumption of favorite traditional foods—or messages may raise issues that recipients find taboo according to their culture or religious beliefs. Health and risk messages may have unforeseen and unintended adverse effects that could affect people’s emotional and physical aspects by inadvertently contributing to people’s sense of guilt through shaming or stigmatization. Also, on the cultural and social level, such messages may contribute to an idealization of a certain lifestyle or commercialization of products and celebrities associated with the messages. Philosophical and ethical frameworks typically used in communication ethics, bioethics, communication campaigns, and social marketing literature emphasize the central guiding principles of personal autonomy and privacy with the aim to ensure equity and fairness. The obligation to avoid “doing harm” includes concerns regarding labeling, stigmatizing, and depriving; the obligation to help; the obligation to respect people’s autonomy to make free choices, particularly concerns regarding persuasion tactics and manipulations and the use of threat tactics, provocative appeals, distressing images, framing tactics, cultural sensitivity, and moral relativism; the obligation to obtain consent; the obligation to truthfulness; the obligation to sincerity; the obligation to correctness, certitude, and reliability; the issue of personal responsibility; equity obligations including concerns regarding segmentation and “targeting”; the obligation to comprehensibility; the obligation of inclusion; utility and efficiency considerations; the “harm reduction” approach; and concerns regarding social value priorities and “distortions,” which includes prosocial values as moral appeals.

Article

Advertising as a field and industry often has a contentious relationship with both health communication and public health due to legitimate concerns about how advertising for certain products, such as alcohol and tobacco, could contribute to less-healthy decisions and behaviors. While acknowledging such concerns, advertisers and their approach to solving communication problems could also provide valuable lessons to those working in health communication. Indeed, advertising agencies are designed to develop creative and effective messages that change consumer behavior—and health communication practitioners and scholars aim to change population-level behavior as well. The perspective and approach of the account planner in the advertising agency—a role whose chief responsibility is to bring the consumer perspective into every step of the advertising development process and inspire effective and creative campaigns—would be particularly valuable to those working in health communication. It was account planning work that shifted traditional milk advertising from promoting it as a healthy drink to the iconic “got milk?” campaign, which positioned milk as a complement that makes other food better—an approach that drove positive sales after years of declining milk consumption. Yet many who work in health communication and public health often know little of how advertising agencies work or their internal processes that might be productively adopted. This lack of understanding can also lead to misperceptions of advertisers’ work and intentions. As an example, one might assume dense medical language in prescription drug advertising is intended to add unnecessary complexity to the advertisements and obscure side effects; instead, advertising professionals who work on prescription drug advertising have often been trained on clear communication—but cannot fully utilize that training because of regulations that require medically accurate terminology that might not be comprehensible to most viewers. Improved understanding of how advertisers can act as agents of change, and increased dialogue between the fields of advertising and health communication, could contribute to improved health communication research, practice, and policy.

Article

Matthew W. Savage, Sarah E. Jones, Jenna E. Reno, and Shari Veil

University students, faculty, and staff are among those most vulnerable to cybersecurity risks due to their reliance on modern technologies, the nature of their online activities, and the open infrastructure of institutional networks. Furthermore, cyberbullying has emerged as a public health concern by the Centers for Disease Control and Prevention (CDC), which first warned of electronic aggression in 2008, or any type of harassment or bullying that occurs via email, chat, instant messaging, websites, blogs, or text messaging. Roberto and Eden emphasized the communicative nature of cyberbullying, defining it as the “deliberate and repeated misuse of communication technology by an individual or group to threaten or harm others” in 2010 (p. 201). In response to serious cybersecurity concerns and growing evidence of cyberbullying behavior, the national Stop.Think.Connect. (STC) campaign was developed to educate Americans on cybersecurity risks and equip citizens with tools for safe, respectful, and appropriate online behavior; however, it lacks targeted messaging for those on university campuses. Formative research is needed to ascertain the specific cybersecurity risks and challenges identified by those living and working on large university campuses. Research by Noar in 2006 demonstrates that formative evaluation leads to more successful campaigns. The process involves learning about target populations, discovering communicative determinants of behavior change, and testing message concepts. To that end, this case study is a first step in targeting STC campaign messages to university students, faculty, and staff. Specifically, we sought to identify the distinct cybersecurity needs faced by university students and personnel, their perceptions of the saliency of the problem, and potential motives for increasing their cybersecurity-enhancing behaviors. These activities are needed to implement the campaign on college campuses and to increase the likelihood of any future outcome evaluation efforts that yield evidence of campaign effectiveness. Currently, we are unaware of any outcome evaluation. Focus group methodology was conducted to examine the target audiences’ knowledge, interests, needs, and attitudes regarding the management of cybersecurity threats. Additionally, practical recommendations for enhancing STC campaign implementation on university campuses were ascertained. Results emphasized key ways to improve the theoretical underpinnings of the campaign using the Integrated Behavioral Model (IBM). We identified how determinants of behavior change can be utilized to strengthen campaign messaging. Students displayed laissez-faire attitudes toward cybersecurity, while faculty and staff attitudes demonstrated a much higher level of concern. Social norms for personal cybersecurity action taking were notably low among students as well as faculty and staff. Students displayed limited personal agency in regards to enacting cybersecurity measures, while faculty and staff had greater knowledge of steps they could take, but little faith that these actions would be efficacious. Finally, thematic recommendations for implementing an effective cybersecurity campaign on a university campus were identified.

Article

In today’s saturated media environment, it is incumbent for designers of health education materials to find more effective and efficient ways of capturing the attention of the public, particularly when the intent is to influence individual behavior change. Tailoring is a message design strategy that has been shown to amplify the effectiveness of health messages at an individual level. It is a data-driven and theory-informed strategy for crafting a message using knowledge of various factors that might influence the individual’s responsiveness to the message, such as their information needs, beliefs, motivations, and health behaviors. It also enhances the persuasiveness of a message by increasing its perceived relevance, drawing attention to the message, and encouraging deeper elaboration of the information. Tailoring content based on known antecedents of the intended behavioral outcomes has been shown to enhance tailoring effectiveness. Compared to generic messages, tailored messages are perceived to be more personally relevant, command greater attention, are recalled more readily, and encourage more positive evaluations of the information overall. Various meta-analyses have demonstrated the effectiveness of tailored interventions promoting a number of health behaviors, such as smoking cessation, healthy diet and nutrition, physical activity, and regular recommended health screenings. Advances in information and communication technologies have led to more sophisticated, multimodal tailored interventions with improved reach, and more powerful expert systems and data analysis models. Web technologies have made it possible to scale the production and delivery of tailored messages to multiple individuals at relatively low cost and to improve access to expert feedback, particularly among hard-to-reach population groups.

Article

Due to their sheer scope in trying to reach large sections of a population, and the costs necessary to implement them, evaluation is vital at every stage of the health communication campaign process. No stage is more important than the formative evaluation stage. At the formative stage, campaign designers must determine if a campaign is even necessary, and if so, determine what the campaign’s focus needs to be. Clear, measurable, and realistically attainable objectives need to be a primary output of formative evaluation, as these objectives help to guide the creation of all future campaign efforts. The formative stage also includes pilot testing any messages and strategies with the target audience prior to full-scale implementation. Once the campaign is implemented, process evaluation should be performed to determine if the campaign is being implemented as planned (i.e., fidelity), and also to document the dose of campaign exposure. Identifying problem areas during process evaluation can ensure they get fixed prior to the completion of the campaign. Detailed process evaluation also allows for greater ease in replicating a successful campaign attempt in the future, but additionally can provide potential reasons for why a campaign was not successful. The last stage is outcome evaluation—determining if the objectives of the campaign were achieved. While it is the last stage of campaign evaluation, campaign designers need to ensure they have planned for it in the formative stages. If even just one of these stages of evaluation is minimized in campaign design, or relegated to an after-thought, developers need to realize that the ultimate effectiveness of their campaigns is likely to be minimized as well.

Article

Celebrity politicians are having a profound impact on the practice of politics within the United States and United Kingdom in the 21st century. With the adoption of social media platforms, celebrity and image candidates have deployed new strategies for attracting constituents. Taken together, the proliferation of celebrity politics and the ubiquity of digital platforms have fostered a unique atmosphere in the contemporary political moment, wherein “outsider” candidates may leverage their fame to launch themselves into the public spotlight. In turn, through their celebrity brands and digital presence both populists such as the U.S. President Donald Trump and left-wing leaders including U.K. Labour leader Jeremy Corbyn have established an “authenticity” in which they “occupy” a public space to define their candidacies. Consequently, as celebrities and image candidates promote political agendas among target audiences/citizens, it is necessary to reflect upon their significance in election campaigns, policy agendas, and activism.

Article

A premise in health promotion and disease prevention is that exposure to and consequences of illness and injury can be minimized through people’s actions. Health campaigns, broadly defined as communication strategies intentionally designed to encourage people to engage in the actions that prevent illness and injury and promote wellbeing, typically try to inspire more than one person to change. No two people are exactly alike with respect to their risk for illness and injury or their reactions to a campaign attempting to lower their risk. These variations between people are important for health messaging. Effective campaigns provide a target audience with the right persuasive strategy to inspire change based on their initial state and psychosocial predictors for change. It is often financially and logistically unreasonable to create campaigns for each individual within a population; it is even unnecessary to the extent to which people exist in similar states and share psychosocial predictors for change. A challenging problem for health campaigns is to define those who need to be reached, and then intelligently group people based on a complex set of variables in order to identify groups with similar needs who will respond similarly to a particular persuasive strategy. The premise of this chapter is that segmentation at its best is a systematic and explicit process of research to make informed decisions about how many audiences to consider, why the audience is doing what they are doing, and how to reach that audience effectively.

Article

Editorial journalism and newspapers’ editorial opinions represent an area of research that can make an important contribution to our understanding of the relationship between the press and politics. Editorials are a distinctive format and are the only place in a newspaper where the opinions of a paper as an organization are explicitly represented. Newspapers and the journalists who write editorials play a powerful role in constructing political debate in the public sphere. They use their editorial voice to attempt to influence politics either indirectly, through reaching public opinion, or directly, by targeting politicians. Editorial journalism is at its most persuasive during elections, when newspapers traditionally declare support for candidates and political parties. Despite the potential of editorial opinions to influence democratic debate, and controversy over the way newspapers and their proprietors use editorials to intervene in politics, editorial journalism is under-researched. Our understanding of the significance of this distinctive form of journalism can be better understood by exploring four key themes. First, asking “What is editorial journalism?” establishes the context of editorial journalism as a unique practice with opinion-leading intentions. Several characteristics of editorial journalism distinguish it from other formats and genres. Editorials (also known as leading articles) require a distinctive style and form of expression, occupy a special place in the physical geography of a newspaper, represent the collective institutional voice of a newspaper rather than that of an individual, have no bylines in the majority of countries, and are written with differing aims and motivations to news reports. The historical development of journalism explains the status of editorials as a distinctive form of journalism. Professional ideals and practices evolved to demand objectivity in news reporting and the separation of fact from opinion. Historically, editorial and advocacy journalism share an ethos for journalism that endeavors to effect social or political change, yet editorial journalism is distinctive from other advocacy journalism practices in significant ways. Editorials are also an integral part of the campaign journalism practiced by some newspapers. Second, research and approaches in the field of political communication have attributed a particularly powerful role to editorial journalism. Rooted in the effects tradition, researchers have attributed an important role to editorials in informing and shaping debate in the public sphere in four ways: (1) as an influence on readers, voters, and/or public opinion; (2) as an influence on the internal news agendas and coverage of newspapers; (3) as an influence on the agendas and coverage in other news media; and (4) as an influence on political or policy agendas. Theorizing newspapers as active and independent political actors in the political process further underpins the need to research editorial journalism. Third, editorial journalism has been overlooked by sociological studies of journalism practices. Research provides a limited understanding of the routines and practices of editorial journalists and the organization of editorial opinion at newspapers. Although rare, studies focusing on editorial journalism show that editorial opinion does not simply reflect the influence of proprietors, as has often been assumed. Rather, editorial opinions are shaped by a complex range of factors. Finally, existing research trajectories and current developments point to new challenges and opportunities for editorial journalism. These challenges relate to how professional norms respond to age-old questions about objectivity, bias, and partisanship in the digital age.

Article

Public service announcements (PSAs) emerged after World War II in the United States as a promising strategy for increasing awareness of important social issues and changing beliefs, attitudes, and behavior. Research at that time showed that PSA campaigns had limited success in changing attitudes and behavior. Even so, both in the U.S. and internationally, sponsoring agencies and organizations continued to produce PSAs, hoping they would create significant behavior change. In the 1980s, a more informed view of what PSAs can achieve began to emerge as practitioners of social marketing demonstrated that media campaigns can produce behavior change when they are designed and executed according to the principles and best practices followed by the advertising industry. Beginning in the 1990s, PSA-based campaigns to promote public action through programs and policy change became more common. Research has shown that such campaigns can play a key role in shaping the public agenda, changing perceptions of social norms, reinforcing school- and community-based programs, and building support for and then publicizing changes in public policy, all of which can foster individual behavior change. PSAs and other media executions are best designed using a planning scheme that is grounded in advertising best practices and behavior change theory and that uses those media executions as part of a broader intervention effort. These various elements can be brought together by using a media planning guide that outlines how the campaign will work in sync with other intervention activities and what its key messages will be. In the United States, federal regulations that outlined broadcasters’ public service obligations were loosened in the 1980s, making it increasingly difficult to get donated time for PSAs and other public service messages. More broadly, the increased focus of broadcasters, cable networks, and print publications on generating revenue has magnified this problem. Faced with strong competition, campaign planners need a strategy for convincing media gatekeepers to give priority to their messaging. The rise of social media (e.g., Facebook, Instagram, Twitter) has opened up a new means of putting PSAs before the public. For example, once a message is posted on a video-sharing website such as YouTube, it can be linked to the sponsoring organization’s website, where additional intervention-related material can be found, as well as to websites hosted by other groups. Promotional efforts through national, state, and community organizations can draw an initial audience, with the hope that they will share the link with their social media and email contacts and that eventually the message will “go viral.” PSAs remain a viable media alternative for public communication campaigns, despite the fact that major media outlets do not often provide donated time or space for such advertising. In some cases, a PSA-driven campaign will be supported by a large budget, but while such campaigns have a better chance of success, the resources required are seldom available. The emergence of social media has created a new way to build an audience. Successful examples of social media campaigns are emerging, but why some campaigns take off and others do not requires additional study.