The Kings Fund has been looking at individual responsibility for health and self-care under the heading of Kicking Bad Habits.
One of the papers they have produced looks at the role of information campaigns. While the paper isn’t children and young people focused it is an interesting read.
The author points out our understanding of how to achieve behaviour change have developed over time; from a “hypodermic” injection of knowledge to more complex models, including ones which rely on social norms.
The paper then moves on from the theory behind information campaigns to look at some of the evidence for effectiveness.
Who: The Source
For the public, being able to trust who is delivering the message is clearly complex, particularly given the proliferation of sources in recent times. The paper points out that some of the old certainties about trust have also eroded:
Official sources or others endorsed by a government kite mark will not necessarily secure the public trust, connecting messages to a government source may in some cases have a negative effect.
The suggestion is that designing campaigns where there are a number of agencies and organisations saying roughly the same thing may be more credible.
What: Message Content
Simple messages (5 a day) are easier to remember than complex ones (daily/weekly units of alcohol), and the way the message is framed may have an impact, but it isn’t an easy relationship.
The paper points out that fear based messages have been shown to change young people’s attitudes to smoking, but it goes on to say:
these ’emotional appeals’ may have more impact on attitudes than on actual behaviour. Hastings and colleagues conclude that fear appeals demonstrate less impact in real world social marketing campaigns than in psychological experiments, possibly due to subjects having forced exposure to the material in experiments, sample groups that often consist of students, and measurement of short-term consequences (Hastings et al 2004).
How: The Channel
Clearly there are a number of different channels that can be used to get messages across, what is suggested is that the impact is most effective when it is sustained.
Hornik’s review of evaluations of public health campaigns found high exposure levels and messages that provoke changes in social norms to be key elements of effective campaigns (Hornik 2007). A systematic review by the Cochrane Collaboration found two examples of mass media campaigns that were effective in preventing the uptake of smoking among young people: both of these had ‘reasonable’ levels of exposure over a long period of time (Sowden and Arblaster 1998). Farelley’s review of anti-smoking mass media campaigns found substantial levels of exposure were required before a campaign would have an effect (Farrelly
et al 2003).
It is also thought that creating a longer term relationship with the recipients of the message is more effective, as is tailoring the message to the particular audience.
Media campaigns that are run in conjunction with other interventions are more likely to be effective, if more costly.
In Montana and New England students exposed to school education programme and a media campaign that focused on correcting social norms about smoking, influencing young people’s views on smoking and improving skills to refuse cigarettes had a 34 per cent smoking rate compared to 41 per cent among those who went through the education programme alone.
The author argues that the review gives three ways in which information campaigns can help make people healthier:
First, it can provide knowledge and facts that influence people’s beliefs about a behaviour and the outcomes of change. Second, it may influence perceptions of social norms, making healthy behaviour appear the ‘normal’ thing to do, Third, it may impact on someone’s ability to change, providing information that gives people the capabilities to change.
But getting the messages and mode of communication right isn’t always easy.
People need more than knowledge to be healthy, they need the skills to change; information campaigns must be coupled with other services and interventions if they are to bring about large changes in often complex and habitual lifestyle behaviours.