Spokesperson question

Spokesperson question

In order to earn full participation points, your messages must be related to the course topics for the week and include new ideas, personal perspectives and examples, or relevant follow-up questions. You MUST research support for your position in your substantive messages. This research MUST include either a reference from one of the texts, the Electronic Reserved Readings, or a scholarly JOURNAL article that is found in the UoPX library. You MUST cite the author in your answer, and then reference the author and publication (in APA format) at the bottom of your post! NO citation and NO reference means NO credit! Participation messages must be at least 150 words excluding the question, the reference and your signature.


What factors should you keep in mind when choosing a spokesperson?
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du Pré: Communicating du Pré: Communicating 13. Designing and © The McGraw-Hill
about Health: Current Implementing Health Companies, 2004
Issues and Perspectives, Campaigns
Designing and Implementing
Health Campaigns
An adolescent on a city street pulls back an orange curtain and quotes a tobacco
industry document proposing to use ice cream trucks to promote the
sale of drugs.
he TV spot described above, like other messages of the truth campaign, is
simple and direct. In another, a young man reveals a tobacco industry plan
to target gay and homeless persons. The plan was called Subculture and Urban
Marketing—Project SCUM for short.
The truth campaign’s website introduces the concept this way:
We called ourselves truth because we knew we’d never have to make this
stuff up. It’s all in there like some kind of messed up soap opera. The tobacco
industry was required to make all these documents available to us, the
public, so we can figure out for ourselves what’s going on—and what’s been
going on for a while. All we have to do is pull back the curtain and show it.
Kinda like a mutant Vanna White. (www.thetruth.com)
As part of the largest anti-tobacco campaign ever aimed at young audiences,
the truth campaign has drawn the attention of both researchers and
adolescents. The rebellious, youth-oriented nature of the ads makes them appealing
to the target audience, youth ages 12 to 17. A report in the American
Journal of Public Health reveals that teens’ awareness of anti-tobacco messages
nearly doubled in the first 10 months of the truth campaign. Youths exposed
to truth campaign messages were significantly less likely than others to consider
smoking “cool” and more likely to believe that tobacco companies lie to
sell their products (Farrelly, Healton, Davis, Messeri, & Haviland, 2002).
By contrast, evidence shows that the “Think. Don’t Smoke” campaign led
by the Philip Morris tobacco company had a boomerang effect. Youths exposed
to that campaign were slightly more likely than others to begin smoking
in the next year (Farrelly et al., 2002). Analysts suggest that the Philip Morris
ads do not damage the reputation of the tobacco industry in youth’s eyes. In
fact, the industry looks more respectable because of the messages (Farrelly
et al., 2002). Following this study, some public health advocates asked Philip
Morris to remove the PSAs from television (“Legacy Today Urged,” 2002).
(Philip Morris PSAs continue to run.)
du Pré: Communicating du Pré: Communicating 13. Designing and © The McGraw-Hill
about Health: Current Implementing Health Companies, 2004
Issues and Perspectives, Campaigns
366 Part Five. Health in the Media
Like many health promotion efforts today, the truth campaign is based on
social marketing. Social marketing means that campaign designers apply the
principles of commercial advertising to pro-social campaigns such as health
promotion efforts (Lefebvre & Flora, 1988). The rationale is that many of the
techniques used to sell goods and services work equally well when promoting
healthy lifestyles. From a social marketing perspective, health-related behaviors
have a price tag of sorts. They “cost” something, either in terms of money,
time, energy, or some other investment. Although the cost does not translate
into profits for the health promoter, the promoter is a salesperson of sorts,
who tries to keep the cost as low as possible and convince people that the
“price” of the recommended behavior is worth paying.
Because the concern in social marketing is primarily with what the “consumer”
needs, health promoters make a great effort to understand the audience,
assess its needs, and target specific people truth campaign designers
clearly understood their audience. Matthew Farrelly and colleagues (2002)
The “truth” brand builds a positive, tobacco-free identity through hard-
hitting advertisements that feature youths confronting the tobacco industry.
This rebellious rejection of tobacco and tobacco advertising channels
youths’ need to assert their independence and individuality, while counter
ing tobacco marketing efforts. (paragraph 2)
Social marketing is also devoted to using multiple channels and conducting
follow-up research to measure the success of campaign efforts. This process
is exemplified by the Partnership for a Drug-Free America (PDFA), which has
won many awards by applying the expertise of advertising professionals to the
antidrug campaign. (See Box 13.1 for more about PDFA’s efforts.)
PDFA is one of many groups devoted to improving public health. Also involved
in this effort are the Ad Council, the American Heart Association, the
American Lung Association, the Muscular Dystrophy Association, and others.
Chapter 12 provided a guide through the first four stages of creating a health
campaign to increase participation in a university sports recreation program:
Step 1: Defining the Situation and Potential Benefits
Step 2: Analyzing and Segmenting the Audience
Step 3: Establishing Campaign Goals and Objectives
Step 4: Selecting Channels of Communication
The process continues in this chapter with a description of key theories and
techniques to create health promotion campaigns. The hypothetical sports
recreation campaign helps illustrate how a health promotion effort comes together.
Keep in mind that the same steps apply to campaigns of various sizes
on any number of health topics.
This chapter begins by introducing five influential models of behavior
change: the health belief model, social cognitive theory, the embedded behaviors
V. Health in the Media 13. Designing and © The McGraw-Hill
about Health: Current Implementing Health Companies, 2004
Issues and Perspectives, Campaigns
Chapter 13. Designing and Implementing Health Campaigns 367
model, the theory of reasoned action, and the transtheoretical model. It goes on
to describe the three final stages in campaign development:
Step 5: Designing Campaign Messages
Step 6: Piloting and Implementing the Campaign
Step 7: Evaluating and Maintaining the Campaign
The theories described here emphasize that people make lifestyle decisions
based on a complex array of factors including personal perceptions, skills, social
pressure, convenience, and more. Each theory described has earned considerable
respect among health communication scholars and health promoters.
Space is not available to discuss each theory in great detail, but this introduction
should help orient the reader to the rich theory behind health campaign efforts
and provide opportunities for further investigation. Applying these
theories to health campaigns can have a positive effect—at least sometimes.
Keep in mind that theories are only guiding principles, not magic formulas. No
one theory works all of the time, or with every audience.
Health Belief Model
The health belief model proposes that people base their behavior choices on
five primary considerations (Rosenstock, 1960; Stretcher & Rosenstock, 1997).
Namely, people are most motivated to change their behaviors if they believe
they will be adversely affected if they do not change,
the adverse effects will be considerable,
behavior change will be effective in preventing the undesired outcome,
the effort and cost of preventive behavior is worthwhile, and
they are moved to action by a novel or eye-opening occurrence such
as a brush with danger, a compelling warning message, or an alluring
In short, motivation is based on an individual’s perception of personal susceptibility,
serious consequences, worthwhile benefits, justifiable costs, and cues to
The health belief model emphasizes that motivation is a complex process.
Considering the factors just outlined, it seems naive to assume people will
change simply because someone tells them to do so. A campaign message may be
a cue to action, but unless someone has reason to believe the recommended behavior
is useful and worthwhile, and will prevent an outcome that is otherwise
likely to occur, the recommendation will probably not be motivation enough.
V. Health in the Media 13. Designing and
Implementing Health
© The McGraw-Hill
Companies, 2004
368 Part Five. Health in the Media
Unselling Drugs With Madison Avenue Know-How
Advertising agencies are usually interested in selling products and
services—and they’re very good at it. But Ginna Marston had a different
idea. What if the top advertisers in the country tried to “unsell” something?
Namely, illegal drugs.
In 1986 she helped launch the nonprofit Partnership for a Drug-Free
America (PDFA). A former advertising professional herself, Marston was
optimistic that, given the chance, professionals around the country
would apply their talents to the anti-drug effort.
“At the time, a lot of people were looking
at the end results of drug abuse—addiction,
crime, and things like that,” Marston
explains. “We said, ‘One thing we can do
from a communication standpoint is start
at the front end of the problem.’ Considering
that drug use is initially a choice, maybe
we can influence people before they start.”
From the beginning, the aim was simple
and clear. “We try to make drugs seem uncool,
unwise, less normal, and more consequential,”
says Marston. The idea was to
promote this message with help from leading
market researchers, copywriters, designers,
producers, media decision makers, and
others. By combining their talents and resources,
Marston and her associates hoped to create and distribute antidrug
messages as carefully researched and appealing as
multimillion-dollar campaigns—but without the cost.
Industry professionals answered the call. Marston marvels at how
willing people were to set aside their professional rivalries and work together.
“It was unprecedented in our business, having all these ad agencies
working together on the same campaign,” she explains. “You see
creative directors from some of the top agencies in the country. Usually
they’re competitors, but they sit elbow to elbow reviewing ideas. It’s really
From its first media release (the now famous “This is your brain on
drugs” fried-egg series), PDFA was able to capture audiences’ interest.
The secret of the campaign’s success, says Marston, is careful research
and clearly focused messages. From PDFA headquarters in New York
City, Marston serves as executive vice president, founding member, and
director of program development, working with 30 paid staff members
to research drug abuse trends, establish campaign goals, meet with
Ginna Marston
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Issues and Perspectives, Campaigns
Chapter 13. Designing and Implementing Health Campaigns 369
concerned citizens and community leaders, and coordinate the efforts of
volunteers across the country.
No idea gets off the ground without careful research beforehand. The
PDFA staff uses focus groups, surveys, and interviews to collect the viewpoints
of experts, drug users, potential drug users, national and community
leaders, and others. They attend community meetings where they
V. Health in the Media 13. Designing and
Implementing Health
© The McGraw-Hill
Companies, 2004
370 Part Five. Health in the Media
Unselling Drugs With Madison Avenue
Know-How, continued
talk to people battling drug addiction. They also interview young people
to see how they feel about drugs and what they know.
The research helps to identify target audiences and develop clear
strategies for reaching them. That clarity is reflected in the ads PDFA creates.
“The better spots are those where there is a single message,”
Marston reflects. “We’re concerned with whether the message is clear
and: Does it make sense? Is it meaningful and credible to our target
Keeping in touch with audience members has earned PDFA a valued
reputation, Marston says. “We have the kind of credibility that you only
get over the long run when people know you’re listening to them and
telling the truth.”
“A lot of people assume drug abuse is an epidemic in inner cities and
there’s nothing we can do,” Marston says. “We found that most of these
inner-city kids had negative feelings about drug use. They had seen what
drugs could do and they didn’t like them. They knew the facts and figures
about drugs. They wanted something positive—a show of support.”
When PDFA identified the drug Ecstasy as an emerging threat, the
staff asked industry professionals to create a series of messages that
shows how deadly the drug can be. As with all PDFA efforts, the Partnership’s
Creative Review Committee (made up of industry executives) reviewed
the ideas and helped refine the best ones. They eventually
approved production of the “Coroner’s Mosaic” series shown here.
PDFA has also joined the White House effort to unsell marijuana and
is working with the Robert Wood Johnson Foundation on a campaign to
change attitudes about drug treatment. “It’s not enough to stop children
from experimenting with drugs,” Marston says. “We have to encourage
families with a problem to get the help they need.”
PDFA devotes a great deal of research to assessing the effects of campaign
messages. Often, they use a pretest–posttest design, tracking drug
abuse in a particular area before and after campaign messages are released
there. The object is to see who is exposed to campaign messages
and if those messages make a difference.
To people who are interested in careers such as hers, Marston recommends
an education in public health. She says many public health
programs now incorporate mass media strategies in the curriculum, appreciating
how powerful the media can be. “It’s been a positive experience
for me,” Marston says, “working with people in the industry to
change society for the better.”
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Issues and Perspectives, Campaigns
Chapter 13. Designing and Implementing Health Campaigns 371
For example, if you are trying to increase participation in your university’s
sports recreation program, you might consider how strongly members of your
target audience believe the benefits you propose would actually help them.
Let’s say your audience analysis reveals a number of statements such as, “I
know exercise is good for people. But I’m young and healthy. I don’t have to
worry about that yet.” According to the health belief model, people who feel
this way will not be motivated to seek the benefits proposed because they simply
do not believe they need those benefits. Your job as a promoter is to either
(1) convince them they do need the benefits proposed or (2) appeal to them
on the basis of another need (such as their desire to look good, meet people, or
win awards).
Conversely, if people do not know about the benefits of exercise, your role
is to educate them. Knowledge does not assure behavior change, but it is an
important foundation for it. Research shows that people sometimes change
their behavior without being well informed. However, these people are less
likely to maintain the new behavior than others, especially if the change requires
effort or discomfort (Valente, Paredes, & Poppe, 1998).
The health belief model is a widely used and studied theory of health-
related behavior change. On the whole, researchers suggest it provides a useful
framework for assessing audiences and organizing campaigns (Kohler,
Grimly, & Reynolds, 1999). However, people are affected to varying degrees
by the components named in the model. People who do not change their behaviors
usually perceive that it would be too difficult or costly to do so. On
the other hand, people are most likely to make changes if they feel personally
at risk. To appreciate the factors that influence individual perception, campaign
designers should also review theories that focus on cognitive, environmental,
and social influences.
Social Cognitive Theory
Returning to the sports recreation campaign, imagine that everything seems to
be in your favor. People are aware of the recreation program. They know about
the benefits. They even feel they would benefit personally. Yet they do not plan
to participate. This may seem very puzzling. What’s a health promoter to do?
A promoter familiar with social cognitive theory would consider the environment.
Social cognitive theory holds that people make decisions considering
the interplay of internal and environmental factors (Bandura, 1986,
1994). Internal factors include knowledge, skills, emotions, habits, and so on.
Environmental factors include social approval, physical environment, institutional
rules, and the like. According to the theory, people are most comfortable
when internal and environmental factors are in sync. This may
explain why changing people’s minds (the goal of most campaigns) does not
necessarily change their behavior (Maibach & Cotton, 1995). Without corresponding
changes in people’s environments, behavioral change is unlikely. In
your campaign, people may not participate in recreational activities because
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of environmental factors—others might laugh at them, the hours are not
convenient, or they do not know anyone at the gym.
Social concerns sometimes outweigh personal concerns, even when the behavior
in question is particularly risky. For instance, research indicates people
sometimes wish to use condoms during sex, and plan to use them, but abandon
their intentions because they are too embarrassed to bring up the subject
(Edgar, 1992). Especially between new partners, it may seem more socially acceptable
for sex to “just happen” than to talk about it in advance. Social considerations
of this sort reflect the influence of environmental factors. Significantly,
people who do insist on condom use are typically good communicators—
skilled at asserting themselves, understanding other people’s feelings, self-
disclosing, and managing conflict (Edgar, 1992; Monahan, Miller, & Rothspan,
1997). The implication is that communication skills can help people overcome
environmental challenges.
Let’s apply social cognitive theory to your sports recreation campaign. If
you find that people in your target audience want to participate in recreational
activities but are reluctant to do so, your job may be to help them develop new
skills, improve the social atmosphere at the gym, suggest different hours, or
make other changes that reduce the risk of participating.
Overall, social cognitive theory suggests that health promoters must do
more than make people aware of health risks. They must do what they can to
make healthy behaviors practical and socially acceptable. It is also important
to teach people communication skills such as empathy, assertiveness, and effective
self-disclosure, which may build their confidence enough to try new
Embedded Behaviors Model
The embedded behaviors model (Booth-Butterfield, 2003) is similar to social
cognitive theory in that it recognizes internal and external influences on
health-related behavior. However, the embedded behaviors model also includes
consideration of the behavior itself: its frequency, complexity, familiarity
or novelty, and links to other behaviors. In short, the embedded behaviors
model suggests that behaviors are enduring to the extent that they are an integral
part of an individual’s lifestyle or self-image and are supported by internal
and external factors.
Some behaviors, such as switching to a salt substitute, are relatively easy to
change because the change does not alter one’s lifestyle and because equally
desirable alternatives are available. However, other behaviors (such as tobacco
use) may be extremely difficult to give up. In a study of teen smoking, Melanie
Booth-Butterfield (2003) reports that “Smoking is much more complex than
simply buying cigarettes and smoking them” (p. 179). Some teen smokers say
they feel a sense of belonging around others who smoke (although they typically
insist peer pressure has not influenced them). They report that their cigarettes
become like friends who are “always there” (p. 178) and that smoking is
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Chapter 13. Designing and Implementing Health Campaigns 373
a way to manage their moods by relieving boredom and either soothing or energizing
Theory of Reasoned Action
The theory of reasoned action (TRA) is based on the assumption that people
are rational decision makers. They do not just happen to behave one way or
another. Instead, they make decisions and deliberate choices based on two primary
considerations: (1) how strongly they believe a behavior will lead to positive
outcomes and (2) the perceived social implications of performing that
behavior (Ajzen & Fishbein, 1980).
TRA is similar to social cognitive theory in that both consider personal
and social influences. However, TRA is more global in focus. Its predictive
power lies in assessing the attitudes and behaviors of large numbers of people
(Ajzen & Fishbein, 1980). Because TRA is designed to make generalizations, its
founders do not consider it necessary (or even helpful) to focus on specifics
such as personality, rules, or emotions. The effects of these variables tend to
even out over large numbers of people. By the same token, TRA does not assume
that small changes will make much difference overall. As Ajzen and Fishbein
put it, “Changing one or more beliefs may not be sufficient to bring about
change in the overall attitude” (p. 81).
It may seem that the macrolevel focus of TRA is not very helpful in planning
your sports recreation campaign. Indeed, your target audience may be
too small to make broad generalizations very useful. But TRA is of interest theoretically
because it suggests that people make behavior changes based on their
overall beliefs and perceptions. Small changes may not have much effect if they
are outweighed by larger concerns. For example, imagine that a new study suggests
it is healthy for men to wear panty hose to protect their skin from the
sun. Do you suppose you could get the men on your campus to do so? Probably
not. Their belief in the health benefits of panty hose is probably outweighed
by their desire to be socially acceptable. Luckily for you, physical
exercise is widely accepted, and you are likely to have a good chance of getting
new participants for the sports recreation program. In your case, small changes
may make a difference because what you propose is already in line with people’s
overall intentions.
Transtheoretical Model
In analyzing the audience for your sports recreation campaign, imagine that you
find some people want to exercise, but many of them are not doing so. You may
even find that people plan to go to the gym but do not make it there. This is an
important finding because it helps you understand your audience’s state of mind.
According to the transtheoretical model, people may not proceed directly from
thinking about a problem to changing their behavior (Holtgrave et al., 1995;
Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992).
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Instead, they tend to change in stages. According to the model, change typically
involves the following five stages:
Precontemplation: Not aware of a problem.
Contemplation: Thinking about a problem.
Preparation: Deciding to take action.
Action: Making a change.
Maintenance: Sticking to the change for 6 months or more.
The implication is that people react differently to health promotion efforts depending
on their current stage. Information that gets attention is called for
when people are unaware of a problem. But skills training and encouragement
may be more useful for those already prepared to make a change. Furthermore,
people who have already adopted the recommended behavior should be
encouraged to continue it.
For example, the AIDS quilt project is effective partly because it does not
push directly for behavior change. Instead, the project stimulates interest by
involving people firsthand in an emotionally moving display about AIDS. Participants
in the traveling quilt project report an increased interest in information
about AIDS and safer sex practices (Knaus, Pinkleton, & Austin, 2000). In
other words, many move from precontemplation to contemplation.
Another component of the transtheoretical model is the observation that
people do not simply change from one stage to another like pieces on a chess
board. Change is a process characterized by a range of activities including consciousness
raising, self-reevaluation, changes in social opportunities, and increased
or diminished relational support. (For a more thorough description of
these factors, see Prochaska, Johnson, & Lee, 1998).
From this perspective, people choose options by weighing the relative pros
and cons among a complex array of considerations. For example, Alan DeSantis
(2002) describes the camaraderie in a cigar shop in which the regulars meet to
smoke and drink, seemingly impervious to the antismoking messages of loved
ones and media campaigns, and even to the smoking-related death of their
Within days, and sometimes hours, after wives and children have implored
their husbands and fathers to quit smoking, the local press has reported on
the “latest findings from the New England Journal of Medicine” or 20/20 has
broadcasted its latest investigative report on the hazards of cigar smoking,
the regulars at the cigar shop light back up with only the smell of cigar
smoke on their minds. (DeSantis, p. 169)
DeSantis details how cigar shop regulars—who highly value their get-togethers—
rationalize their habit through collective arguments that cigar smoking is poorly
understood by the medical establishment, is actually no more dangerous than
mowing the lawn or driving on the freeway, and is actually beneficial in that it relieves
their stress. Members regularly tell of cigar smokers (such as George Burns
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Chapter 13. Designing and Implementing Health Campaigns 375
and Milton Berle) who lived long lives and of health advocates who died
young. Everyone in the shop knows the story of a heart surgeon who stopped
by one day and reportedly said, through a “relaxing” exhale, “Now how can
that be bad for you?” (p. 185).
The cigar shop study illustrates the difficulty of changing behaviors embedded
in social and environmental contexts. It also emphasizes that change is
not automatic or linear. The stages described are only a general guide. People
may remain in one stage indefinitely, lose interest, or skip steps.
Considering change as a stage-based process reveals some key challenges
and opportunities for health campaign managers. One challenge is that people
do not simply overhaul their behavior as soon as they hear new information
(Maibach & Cotton, 1995). Change agents must be sensitive to barriers and
motivations as well. Second, the transtheoretical model reveals why prevention
efforts are particularly challenging. Campaign planners are wise to seek incremental
change rather than radical transformations (Prochaska, Johnson, &
Lee, 1998). Pushing for too much change can be counterproductive. Edward
Maibach and David Cotton (1995) report that inundating audience members
with messages inappropriate to their stage of change may actually discourage
them from proceeding. Rather than accelerate the change process, they may
avoid the issue entirely. Considering that 70% to 80% of people in high health-
risk populations are not ready to change their behavior (DiClemente et al.,
1991), this is a serious consideration.
The transtheoretical model presents opportunities for important contributions
as well. Without motivational health campaigns, members of at-risk populations
are likely to “remain stuck in the early stages” (Prochaska, Johnson, &
Lee, 1998, p. 64). Therefore the potential for making positive change is profound.
Likewise, the model suggests that changes, once made, must be supported. Effective
campaigns are not simply one-shot affairs, but ongoing programs that
support change and commitment.
The health belief model proposes that decisions are based on perceived need,
value, and opportunity. Outside influences are instrumental, but motivation
ultimately comes from within. Because the health belief model is based almost
entirely on perceptual factors, it presents a challenge to researchers and campaign
planners. In keeping with the theory, they must conduct careful audience
analysis to gauge audience response to health messages.
Social cognitive theory observes that people are unlikely to make choices
that are not consistent with both internal and external factors. Successful
health promotion sometimes requires changing the environment and people’s
The embedded behaviors model and theory of reasoned action include
consideration of social implications. Behaviors are embedded, thus not easily
changed, to the extent that they are interwoven with a person’s lifestyle and
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Synopsis of Behavior Change Theories
Embedded behaviors model: The likelihood for behavior change is related
to the behavior itself—how frequent, complex, familiar, or novel it is
and how interwoven it is with other valued behaviors.
Health belief model: People are more or less motivated to change their
behavior based on their perception of personal susceptibility, serious
consequences, worthwhile benefits, justifiable costs, and cues to actions.
Language expectancy theory: People evaluate, and are variably influenced
by, messages considering how they compare to expectations. Messages
are especially influential when they are more desirable than
Extended parallel process model: People evaluate threatening messages,
first, to determine if they are personally at risk, and second, to
judge whether they can prevent a harmful outcome. If they perceive a risk
but do not feel they can avoid a bad outcome, they are likely to avoid the
Social cognitive theory: People make decisions considering the interplay
of internal factors such as skills and knowledge and environmental
factors such as environment and social approval.
Theory of reasoned action: People make rational and deliberate
choices based on how strongly they believe a behavior will lead to positive
outcomes and the perceived social implications of performing that
Transtheoretical model: People tend to change in stages ranging from
precontemplation, to contemplation, preparation, action, and
beliefs. Changing a behavior at the price of sensory, personal, social, and cultural
rewards is unlikely unless a realistic and pleasing alternative exists. The
theory of reasoned action challenges campaign planners to balance perceived
risks against social expectations.
The transtheoretical model holds that people typically advance through a
series of stages in which they think about a problem, consider what to do
about it, and decide whether to take action. If they change their behavior, they
may or may not maintain the change over time. From this perspective, it is important
to consider what stage best describes target audience members because
they are likely to react to information differently depending on their state of
It is important to point out that health promotion efforts need not be restricted
to any one theory or to one-way communication. The theories described
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Chapter 13. Designing and Implementing Health Campaigns 377
here support that people are not simply passive recipients who can (or should)
be told what to do. Ratzan et al. (1994), among others, encourage health promoters
to engage people in cooperative dialogues about health. This two-way
communication is expected to help health promoters and the public better understand
and assess health concerns, develop options that make sense in everyday
life, and promote a sense of trust, openness, and cooperation.
It is also important to consider the ethical ramifications of health promotion.
Although promoters mean well, their efforts can needlessly alarm people,
scapegoat segments of the population, and stigmatize ill or disabled persons.
(See Box 13.3 for more on the ethical concerns of health promotion.)
This section discusses the three final stages in developing a health campaign:
designing campaign messages, piloting and implementing the campaign, and
evaluating and maintaining the effort.
Step 5: Designing Campaign Messages
The first step in designing an effective campaign is to carefully review the data
collected during preliminary research and audience analysis. Campaign messages
should be designed considering the audience’s needs, the benefits of the
proposed behavior, the goals of the campaign, and the communication channels
to be used (see Chapter 12 for a review of these steps). Holtgrave and colleagues
(1995) recommend that campaign designers determine what aspect of
the problem is most important to the target audience, and then make that the
focal point of the campaign. The next sections provide guidance in selecting a
personality for the campaign and deciding what approach to take.
Choosing a Voice Every campaign message has a voice. It may seem masculine,
feminine, young, old, friendly, casual, stern, or so on. The voice embodies
the mood and personality of the campaign.
Just as Lefebvre et al. (1995) recommend that you imagine the target audience
as a person with a name, gender, occupation, and lifestyle, it is useful to
imagine your campaign as a person. Here are some questions to consider in
finding that voice:
What is the campaign’s personality and mood?
Is this an authority figure or a friend?
Is this a logical or an emotional person?
Is this the sort of person to whom the audience is likely to respond?
Even when words appear in print, the tone of the message gives the reader
a sense of who is “talking” and what type of relationship the writer wishes to
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Three Issues for Health Promoters to Keep in Mind
Health promoters are faced with several ethical considerations. They
must decide how to warn audiences without needlessly frightening them.
They must be careful not to blame people for ill health, while at the same
time encouraging people to prevent any illnesses they can. All the while,
they must walk a fine line between making people concerned about illness
and making them worried sick.
When early evidence of a health risk surfaces, is it better to warn the public
right away or wait for more conclusive evidence? This question poses a
dilemma for health promoters. On the one hand, researchers suggest
people are wary of premature announcements that are later shown to be
inaccurate. Health news writer Alan Rees (1994) contends that “the average
individual is caught in a withering crossfire of conflicting health messages
and is inclined to disregard them all” (paragraph 7). For example,
the public was long urged to increase their exposure to sunlight to ensure
sufficient amounts of Vitamin D. Now people are encouraged to avoid
sunlight to lower their risk of skin cancer (Parrott, 1995). Conflicting
messages such as these may confuse people and cause them to ignore
health advisories.
On the other hand, it may take months or years to compile conclusive
evidence. All the while, people may be exposed to health risks they might
have avoided. People are likely to be angry if health officials are aware of
potential risks yet do not warn the public.
It is difficult to know where the responsibility for personal health lies. For
example, if children are not vaccinated, (a) is it the parents’ fault for not
bringing them to a doctor, (b) the government’s fault for not providing
neighborhood health services, (c) the city’s fault for not providing better
public transportation to the health unit, or (d) health officials’ fault for
not educating parents about the need for immunization? Although all of
these factors probably contribute to the problem, part of a health promoter’s
job is to identify what conditions most need improvement. In
doing so, however, it is easy to scapegoat (blame one person or group
for the whole problem).
Scapegoating presents an ethical dilemma. It makes sense to focus attention
on the condition or people with the greatest chance of making a
difference. The typical health promotion message cannot describe all the
factors that contribute to a problem. However, focusing on one aspect
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or group of people may seem to place blame (Burdine, McLeroy, &
Gottlieb, 1987). For example, a campaign that admonishes parents to
bring their children in for vaccinations may alienate parents who do not
have transportation to the public health unit and cannot afford private
care. These parents may feel frustrated and criticized, and they may resent
promoters’ efforts. Second, people not held to blame may feel the
problem is no longer their responsibility. Ruth Faden (1987) asserts that
government promotes the idea that people are personally responsible for
their health partly because this lets government off the hook. There is little
imperative to make sweeping social changes or health care reform if it
seems that health is solely the product of voluntary lifestyle changes.
Evidence fuels both sides of the debate, suggesting that personal
choices and empowerment are important to health, but at the same
time, personal efforts are often constrained by environmental factors beyond
individuals’ control (such as money to afford medical care or sanitary
living conditions). Health promoters may find themselves trying to
identify key objectives without ignoring that every objective is intertwined
with others.
Prevention is the process of avoiding undesirable outcomes. People wear
helmets to avoid head injuries, they are immunized to avoid diseases,
and so on. Typically, the worse the potential outcome, the more people
will try to prevent it. Health promoters try to motivate people by showing
them how bad undesirable outcomes can be.
The dilemma is that, in portraying some conditions as undesirable, promoters
may stigmatize some people as undesirable. Guttman (1997)
warns that campaigners’ good intentions sometimes backfire when they
make people so frightened of diseases that they avoid the people who
have them. For instance, an image of a child with a disability may be
frightening enough to make children observe safety rules, but how are
they likely to feel about children with disabilities? The same dilemma
applies to AIDS publicity. People may become so frightened that they
overprotect themselves by avoiding people who have AIDS.
What Do You Think?
Should health promoters release information about potential
health risks immediately or wait for more conclusive evidence?
How long is it reasonable to wait?
What constitutes conclusive evidence?
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in Mind, continued
2. Can you think of a way to promote public health without seeming
to place the blame on certain people or groups?
3. Do you think it is possible to warn people about health hazards
without stigmatizing people who have already been affected?
Suggested Sources
Burdine, J. N., McLeroy, K. B., & Gottlieb, N. H. (1987). Ethical dilemmas
in health promotion: An introduction. Health Education Quarterly, 14,
Faden, R. R. (1987). Ethical issues in government sponsored public
health campaigns. Health Education Quarterly, 14, 27–37.
Guttman, N. (1997). Ethical dilemmas in health campaigns. Health
Communication, 9, 155–190.
Guttman, N., & Ressler, W. H. (2001, April–June). On being responsible:
Ethical issues in appeals to personal responsibility in health campaigns.
Journal of Health Communication, 6(2), 117–136.
Leask, J., & Chapman, S. (2002, February). “The cold hard facts:” Immunization
and vaccine preventable diseases in Australia’s newsprint
media. Social Science & Medicine, 53(3), 445–457.
Musham, C., & Trettin, L. (2002, August). Bringing health services to the
poor through social marketing: Ethical issues. Journal of Health Care for
the Poor and Underserved, 13(3), 280–287.
Rees, A. M. (1994). Consumer enlightenment or consumer confusion?
Consumer Health Information Source Book, 4, 10–11.
establish with the reader. Lefebvre et al. (1995) describe how carefully Nike
considered the presentation of its “Just do it” advertising slogan. They say the
creators decided not to use an exclamation mark after the statement and not
to have an announcer say it aloud. “The concern was that the wrong voice, the
wrong delivery, and the wrong inflection could have doomed the ads for many
viewers” (Lefebvre et al., p. 224).
Of course, the source is even more apparent when the audience can see or
hear a spokesperson deliver the message. Research suggests that messages have
more impact when the target audience trusts the spokesperson and thinks the
spokesperson is capable and attractive (Atkin, 1979).
Well-known spokespeople have potential drawbacks, however. Overly attractive
or controversial people may distract viewers from the actual message
(Salmon & Atkin, 2003). Moreover, famous spokespeople may behave in ways
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that contradict or cloud health campaign messages. For example, when Mark
McGwire broke the major league home run record in 1998 even people who
did not follow baseball knew about it. In the subsequent media coverage, it was
revealed that McGwire had used androstenedione, a dietary supplement meant
to speed muscle development. About 24% of the people who heard about his
use of androstenedione wanted to learn more about, and about 22% said they
would like to try it (Brown, Basil, & Bocarnea, 2003). In Australia, a pharmaceutical
company paid a well-known soccer star the equivalent of $123,000 to
stop smoking. He didn’t. Fortunately for the promoters, the publicity surrounding
the failed attempt increased sales of nicotine replacement therapies
nonetheless (Chapman & Leask, 2001).
There is also some evidence that audiences are most likely to believe people
who are similar to them, an effect called source homophily (Rogers, 1973).
For example, African-American women who watched a breast care video were
twice as likely to perform breast self-exams when the video was moderated by
an African-American woman as when the moderator was a White or Hispanic
woman (Anderson & McMillion, 1995).
The source of a message can affect how audiences interpret it. Typically,
aggressive messages have high impact if they come from sources perceived to
be competent and respectable. However, aggressive messages from negatively
evaluated sources are not likely to change people’s minds (Buller, Borland, &
Burgoon, 1998). One study suggests that audiences respond favorably when
spokespersons defy stereotypes, as when a young woman presents an aggressive,
logical argument about condom use (Perse et al., 1996).
Celebrities can be effective spokespersons, especially if the audience identifies
strongly with them. On the day basketball star Magic Johnson announced
he had HIV (November 14, 1991), the National AIDS Hotline received 10 times
as many calls as usual. After the extensive news coverage, public knowledge
about HIV transmission increased, especially among young people, and the
number of people seeking HIV tests increased dramatically (Casey et al., 2003).
After studying public reaction to the announcement, William Brown and
Michael Basil (1995) concluded that people reacted so strongly because they felt
they knew Magic Johnson.
Spokespersons may be especially important when the audience is not highly
interested in the topic. Evidence suggests that less interested individuals are likely
to judge information on a superficial level, perhaps by how entertaining it is or
how much they like the spokesperson (Petty & Cacioppo, 1986). If the announcement
is not interesting and appealing, they may ignore it altogether.
Designing the Message In designing an effective health campaign message, it
is important to consider audience expectations and the role of logic, emotion,
and novelty.
Audience Expectations A message is only effective if the target audience responds
to it. In a study of messages promoting early screening for prostate
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cancer, Juanne Nancarrow Clarke (1999) found that nearly all the messages
embodied themes of male sexuality, machoism, and brotherhood. Although
these messages may appeal to some men, others are probably turned away by
an image they do not feel applies to them.
Language expectancy theory holds that people are influenced by messages
that are more desirable than they expected based on cultural norms and
circumstances (Siegel & Burgoon, 2002; Burgoon, 1989). If a speaker held in
high regard delivers a message that is even better (e.g., more appropriate, useful,
or skillful) than expected, listeners are apt to change their attitudes and behaviors
in response. By the same token, a speaker who is regarded unfavorably
may change people’s mind through language choice and behaviors that exceed
the audience’s expectations.
For example, David Buller and colleagues (2000) found that parents of elementary
school students responded favorably to a highly intense message
about sun protection if the message presented an acceptable solution. The
messages began by describing the problem in intense language: “A bad sunburn
is embarrassing. So is the peeling skin that follows a sunburn. Worse than
peeling skin and redness are the deadly problems which can follow these annoyances
. . .” (p. 273). Readers were then presented with a solution (using sunscreen
year-round). The authors speculate that this message was effective
because it was arousing enough to be memorable and because it provided a
clear, culturally appropriate solution. On the other hand, a highly intense message
without a promising solution might dissuade audience members from
changing their attitudes or behaviors.
Based on language expectancy theory, audiences may react differently to
highly intense messages depending on what they expect to hear and who is delivering
the message. This is important to keep in mind as you consider the following
research about logical and emotional appeals.
Logical and Emotional Appeals A logical appeal attempts to educate audiences
and demonstrate a clear link between a behavior and a result. For example,
it is logical to eat less if that will result in greater health and a longer life.
An emotional appeal may suggest that people should feel a certain way regarding
their health or their behaviors. For example, they should be frightened
if they are exposed to AIDS, proud if they have quit smoking, or guilty if they
are endangering others. If the emotions are rewarding, they are called positive
affect (affect is another word for emotion). If they are undesirable emotions,
they are called negative affect. Campaigns encourage people to strive for positive
outcomes and avoid negative ones. Research quoted in this section describes
the usefulness and the limitations of various emotional appeals.
Positive Affect Appeals Campaigns may promote positive emotional rewards
in the form of popularity, a sense of accomplishment, honor, fun, or happiness.
For example, a nutrition information program helped people feel confident
and optimistic about their ability to reduce fat intake (Chew, Palmer, &
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Kim, 1998). These people were subsequently more concerned about nutrition
than others and were more likely to monitor their diets. The researchers concluded
that providing nutrition information was not very helpful unless people
felt empowered to make a difference.
Campaigns may also inspire positive affect because the messages themselves
are pleasant or entertaining. For instance, the audience may enjoy the
music, humor, graphics, or the attractiveness of a spokesperson featured in a
campaign message (Monahan, 1995). Research shows that pleasant messages
hold people’s attention, but people may not take these messages as seriously as
fearful ones (Monohan, 1995).
Negative Affect Appeals Some campaigns attempt to motivate people by making
them feel anxious, fearful, or guilty. Kim Witte (1995) proposes that, if people
are not at all anxious about a health topic they probably are not motivated
to learn about it or to take action. However, if they are overly anxious, they may
wish to avoid the subject. The extended parallel process model (Witte, 1997)
proposes that people evaluate a threatening message, first, to determine if they
are personally at risk, and second, to judge whether they can prevent a harmful
outcome. If they perceive a risk but do not feel they can avoid a bad outcome,
they are likely to soothe their anxiety by avoiding the issue.
Jerold Hale and James Price Dillard (1995) calculate that about 26% of
PSAs use fear appeals. Their effectiveness varies. For instance, women responding
to a cancer screening campaign said they would not like to hear messages
that escalated their fears about cancer or mammography (Marshall, Smith, &
McKeon, 1995). They were already frightened by these topics, and they wanted
clear information. However, Murray Millar and Karen Millar (1998) found that
people who were not anxious about health risks were not very interested in prevention
information. Intense messages might get their attention.
Guilt, a feeling of remorse about having done something wrong, is a
strong emotion. Consequently, it is a useful tool for advertisers and health
campaigners. Bruce Huhmann and Timothy Brotherton (1997) assert that
people typically feel sorry or ashamed when they have behaved badly, especially
when others are hurt by their actions. Advertisers who bring these feelings
to the surface, and offer a way to make retributions, may find that people
are willing to cooperate to soothe their consciences. Huhmann and Brotherton
found that 1 in 20 magazine advertisements included a guilt appeal, ranging
from, “I wish I had started saving for my children’s college education when
they were young” to “Last night, two million children in the U.S. went to bed
hungry.” Relevant to health promotion, a study about antismoking efforts concluded
that it is an effective strategy to warn smokers that secondhand smoke
can harm loved ones (Goldman & Glantz, 1998). Appealing to smokers’ sense
of responsibility is sometimes more effective than warning them about their
own health risks.
Overall, negative affect is a popular component of persuasive messages,
but it must be used carefully. Research suggests that messages aimed at highly
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anxious or fearful people should help them develop a sense of confidence and
control (or they are likely to avoid the messages). However, messages aimed at
unanxious people should encourage them to become somewhat concerned (or
they are likely to ignore the messages). All the while, campaigners must consider
the ethical implications of influencing people’s emotions, especially to
the extent of making them feel extremely fearful or ashamed.
Novel and Shocking Messages Novel messages tend to catch people’s attention
and stick in their memory (Parrott, 1995). Some messages are novel (new or
different) without being shocking (intense or improper). For instance, posting
health warnings in public restrooms is an effort to use an unexpected format
to reinforce the risks of smoking and drinking during pregnancy. It is a novel
approach, but not particularly shocking.
At other times, novel messages may be shocking, either because they deal
with topics not usually discussed in public or because they are purposefully
controversial so they will attract attention. One difficulty surrounding AIDS
awareness is that health promoters must deal with delicate issues like premarital
sex and anal intercourse. Particularly when AIDS first became a
health concern, these were not socially acceptable topics for mass media
Where AIDS is concerned, it is still difficult to balance decorum with the
need for public awareness. In 1994, controversy arose concerning a poster
campaign in New York City. The posters (which were hung in subway terminals)
read “Young, Hot, Safe!” and showed images of homosexual couples kissing
while holding condoms, gloves, and spermicide (“Controversy Heats Up,”
1994). Some people felt the posters were indecent, while others argued that
they communicated an important message to a high-risk group. At any rate,
the posters were eventually removed from the subways.
Shocking or intense messages may be especially appealing to high sensation-
seekers, who often find mild messages boring and are apt to engage in risky behaviors
(Zuckerman, 1994). In Maureen Everett and Philip Palmgreen’s (1995)
study of college students, high sensation-seekers responded favorably to anti-
cocaine PSAs featuring heavy metal music and vivid, complex visuals. Overall,
they remembered more about these PSAs than others and rated themselves less
likely to use cocaine in the future. Likewise, novel antidrug PSAs shown on
television were shown to be successful with sensation-seeking adolescents
(Donohew, Lorch, & Palmgreen, 1998).
One difficulty about using novel images to attract attention is that the
novelty wears off (Walters et al., 1997). Relying on novelty may mean becoming
ever more risque. All in all, it is hard to know where to draw the
Step 6: Piloting and Implementing the Campaign
It is important to pilot (pretest) a campaign before launching it full-scale.
Piloting usually involves selecting members from the target audience to review
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More About Designing Health Campaigns
For guidance on creating your own health campaign, visit the following
The Community Tool Box: http://ctb.ku.edu
The American Public Health Association: http://www.apha.org
The CDC offers a CD-ROM tutorial for health communication planning
and evaluation. Contact the CDC at (404) 639-7290 for details.
The National Cancer Institute offers free copies of its Making
Health Communication Programs Work: A Planner’s Guide in print and
on CD-ROM. To order a copy, call 1-800-4-CANCER or visit
the campaign materials and comment on them. Salmon and Atkin (2003) say
early feedback is crucial:
The feedback from the audience can reveal whether the tone is too righteous
(admonishing unhealthy people about their incorrect behavior), the recommendations
too extremist (rigidly advocating unpalatable ideas of healthy
behavior), the execution too politically correct (staying within tightly prescribed
boundaries of propriety to avoid offending overly sensitive authorities
and interest groups), and the execution too self-indulgent (letting
creativity and style overwhelm substance and substantive content). (p. 453)
Some questions to consider include these (adapted from Donohew, 1990):
Are written messages easy to read and understand?
Are recorded messages easy to understand?
Do messages seem relevant and important?
Are the messages appealing? Why or why not?
Is the spokesperson effective?
Does the information seem controversial or offensive?
It may be useful to survey people before and after they are exposed to the campaign
materials to see if there is any change in their knowledge, attitudes, and
intentions. When possible, it is also advisable to survey people a week or
month after they are initially exposed to campaign materials to see how much
they remember and whether message effects are still present. Remember to
allow time to refine campaign messages based on the results of pretesting.
Planning ahead will improve the campaign’s likelihood of success.
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Once campaign messages have been created, piloted, and refined, it is time
to distribute them through the chosen channels. In some cases (as with one-
on-one communication and community presentations), health promoters
have direct contact with audience members. With the majority of channels,
however, health promoters must rely on others to share their messages. For instance,
editors and news directors choose what PSAs to publicize and when,
and what topics to cover in the news. On a social level, community opinion
leaders focus on some issues more than others, affecting what the people
around them think and believe. People such as these, who decide what information
will be publicized and how, are known as gatekeepers. Gatekeepers decide
what messages will reach the public (Shoemaker & Reese, 1991).
Good campaigners employ a variety of communication channels to help
ensure that messages make it to target audience members through one gate or
another. The wise health promoter realizes the importance of gatekeepers, includes
them in campaign planning, and considers their point of view. John
McGrath (1995) observes that media gatekeepers are bound by multiple pressures
(e.g., operating budgets, audience demands, and time constraints). The
promoter who gets to know gatekeepers personally and makes it easy for them
to pass along information has a better chance of getting through to an audience.
Step 7: Evaluating and Maintaining the Campaign
A campaign is not over when it has been released to the public. Effective health
promotion requires that campaign managers evaluate the success of the project,
help audience members maintain any positive changes they may have
made, and refine and develop future campaign messages.
Evaluation The effects of a campaign may be evaluated in several ways. A
pretest–posttest design means that campaigners survey people before the campaign
is released, then survey them again afterward (Wimmer & Dominick,
1997). The survey may indicate if people’s attitudes, knowledge, or actions have
changed since the campaign was conducted. Keep in mind that if changes have
occurred, they may or may not be the result of campaign exposure.
To evaluate the impact of the truth campaign, researchers conducted telephone
surveys with 6,897 youth ages 12 to 17 before the campaign began
(Farrelly et al., 2002). The survey participants were chosen to represent teens
in different ethnic and racial groups, urban and nonurban areas, and areas with
and without other anti-tobacco campaigns. The youth were asked to indicate
their level of agreement or disagreement with statements about the tobacco industry,
the social acceptability of smoking, and their intention to smoke within
the next year. In follow-up interviews after the campaign’s release, 10,692 youth
were asked if they remembered seeing any anti-tobacco campaigns, and if so,
what they remembered about them. They also answered the same set of questions
about perceptions of the tobacco industry, the social acceptability of
smoking, and their intention to smoke in the next year. To factor out as many
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intervening variables as possible, researchers statistically controlled for such factors
as the number of parents in the household, amount of television viewing,
the presence of smokers in the household, and parental messages about smoking.
With the data collected, researchers were able (1) to gauge the extent to
which target audience members saw and remembered the campaign and (2) to
compare youth attitudes before and after the campaign.
Another way to evaluate a campaign’s success is to study actual behavior
changes such as the number of people who sign up for basketball or the number
of hospital admissions or calls to a hotline.
These evaluation techniques are useful, but it is always difficult to know
precisely what effects a campaign has had. For one thing, the campaign is not
the only factor influencing people’s attitudes and behavior. They may be affected
by personal experiences, news stories, or other occurrences. Imagine
trying to evaluate the impact of an AIDS awareness program that happened to
coincide with Magic Johnson’s public announcement that he had HIV. Second,
campaigns often have indirect effects. For instance, the campaign may have
reached influential members of the community, who in turn spread the word
to others. Thus, people who were not exposed to campaign messages personally
may be affected by them. Third, sometimes the success of a health campaign
is reflected in what does not occur over the long run. For example, the
coordinators of a drug-free program in elementary schools may not know if
they have been successful until the children involved are adolescents or adults,
by which time they will have been influenced by many other factors as well.
When undesired behaviors do not occur, it is difficult to know how many people
might have adopted those behaviors if not for the campaign.
Sometimes health campaigns have unintended or undesirable consequences.
Audiences may be so turned off by the message that they actively avoid
the subject or lose trust in the sender. Here is an extreme example. When I was
in college, the 1936 film Reefer Madness made a comeback—not as the frightening
documentary it was originally designed to be but as a comedy. College
students flocked to the local midnight movie to see the jerky-action black-andwhite
film. In the film, young people smoke what the narrator (a high school
principal) calls “demon weed” and immediately become shaky, wild-eyed, and
demented. They listened to “evil jazz” music and become serial killers—threats
so incredulous to young audiences in the 1980s that the movie dialogue was
often drowned out by their laughter. We can only imagine the extent that the
outdated movie damaged the credibility of antidrug messages at the time.
For better or worse, sometimes the best campaigners can do is evaluate the
reach (number of people exposed to campaign messages) and specificity (the
type of people exposed to the campaign). For this purpose, promoters can survey
audience members and keep track of when and where campaign messages
are publicized.
Maintenance Maintaining behaviors that have been positively influenced by
a campaign involves continued encouragement and skills training. Keep in
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More About Assessing the Impact
of Health Campaigns
The following sources offer excellent advice about measuring the affect of
your campaign.
Hornik, R. C. (Ed.). (2002). Public health communication: Evidence for behavior
change. Mahwah, NJ: Lawrence Erlbaum.
Murray-Johnson, L., & Witte, K. (2003). Looking toward the future:
Health message design strategies. In T. L. Thompson, A. M. Dorsey,
K. I. Miller, & R. Parrott (Eds.), Handbook of health communication
(pp. 473–495). Mahwah, NJ: Lawrence Erlbaum.
mind that people are most apt to continue new behaviors if they fully understand
the benefit of doing so (Valente et al., 1998). Because some people try
new behaviors without fully understanding them first, do not assume that
people who begin a behavior are fully educated about it. Encouragement, incentives,
and continued skills training can help people overcome setbacks they
are likely to encounter (Maibach & Cotton, 1995).
Social marketers conduct extensive audience analysis and strive to create messages
with the same appeal as commercial messages. The results of social marketing
are measured, not in sales figures or profit margins, but in public
awareness and improved health. These outcomes are often realized in subtle
ways over long periods of time, but social marketers work hard to gauge the
success of their efforts and apply what they learn to future campaigns.
Theories of behavior change explain the conditions under which people
are likely to make lifestyle changes. The overall message is that behavior is influenced
by a complex array of factors, and campaign designers who fail to
consider and accommodate audience members’ beliefs and opportunities may
be ineffectual or even harmful. In designing campaign messages health promoters
should consider audience needs, campaign goals, and benefits of the
recommended behavior. Campaign messages have different voices ranging
from stern to casual and friendly. Often, the spokesperson influences the way
the message is perceived. Research suggests that people typically respond most
favorably to spokespersons who are similar to them, likable, and attractive. A
celebrity may be an effective spokesperson or a public liability.
Campaign messages often have a logical and an emotional appeal. Some
campaigns motivate audiences through positive affect such as the promise of
pleasure and happiness. Negative affect appeals may induce people to change
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by stirring up feelings of anxiety, fear, and guilt. According to the extended
parallel process model, anxiety is a powerful motivator except when the threat
is so overwhelming people would rather avoid the issue. Novel and shocking
messages typically create interest, but they may be controversial.
It is recommended that health promoters pilot new campaigns before implementing
them. Testing campaign messages on sample audience members
can reveal unanticipated reactions and ambiguities in time to improve the
messages before they are publicly released. Finally, health promoters should
evaluate campaigns once they are released, apply what they have learned to future
efforts, and compare the results with their stated goals.
social marketing logical appeal
health belief model emotional appeal
social cognitive theory positive affect
internal factors negative affect
environmental factors extended parallel process
embedded behaviors model model (EPPM)
theory of reasoned action guilt
(TRA) novel messages
transtheoretical model shocking messages
scapegoat piloting
source homophily gatekeepers
language expectancy theory pretest–posttest design
1. What do you think of the truth campaign? Has it influenced the way you
regard the tobacco industry? What is appealing (or unappealing) about
the campaign to you?
2. According to the health belief model, what five criteria affect people’s
decision to make behavior changes?
3. Explain what role internal and environmental factors play in social
cognitive theory. What internal and environmental factors influence
your health-related behavior?
4. According to the embedded behaviors model, what factors influence how
likely people are to change particular behaviors? What behaviors are
embedded in your lifestyle? What would it take to change those
5. What factors influence people’s behavior according to the theory of
reasoned action?
du Pré: Communicating du Pré: Communicating 13. Designing and © The McGraw-Hill
about Health: Current Implementing Health Companies, 2004
Issues and Perspectives, Campaigns
390 Part Five. Health in the Media
6. What are the stages of change in the transtheoretical model? What can
result if campaigners expose audience members to messages inconsistent
with their stage of change?
7. What are the implications of blaming (scapegoating) people for
engaging in risky health behaviors?
8. What are some questions to consider when choosing a “voice” and
“personality” for your campaign?
9. What is meant by source homophily?
10. What factors should you keep in mind when choosing a spokesperson?
11. In what circumstances are positive affect messages usually effective?
12. Explain the extended parallel process model as it relates to negative affect
13. What types of audiences are likely to respond favorably to shocking or
intense messages?
14. What are some questions to consider when piloting campaign materials?
15. What role do gatekeepers play in health promotion efforts?
16. Why is it often difficult to accurately assess the impact of a health
Evaluating Messages
Bring recordings or copies of health-related commercials or PSAs to class. Analyze
the messages in small groups or as a class. Consider the following questions:
1. How would you describe the voice or personality of each message?
2. Who do you think the target audience is, and why? Are you a member of
the target audience?
3. What is the central message of each advertisement or PSA?
4. How do the different messages compare to each other?
5. Do you think the messages are effective? Which do you prefer and why?
6. Why do you think the creators chose the graphics and words they did?
7. What are the health-related implications of these messages?

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