ee
een
(text) Communicating About Health Ch12
(Check this box to automatically unlock the text the next time you open the document.: Yes) Checked
(text) Remember my user name and password.
(text) If you are experiencing problems unlocking this document or you have questions regarding Protectedpdf files please contact a Technical Support representative:
In the United States: 1-877-832-4867
In Canada: 1-800-859-3682
Outside the U.S. and Canada: 1-602-387-2222
Email: technicalsupport@apollogrp.edu.
(text) This is a Protected PDF document. Please enter your user name and password to unlock the text.
(The protectedpdf technology is © Copyright 2006 Vitrium Systems Inc. All Rights Reserved. Patents Pending.)
(text) 1000-0001-A532-00110975
du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
CHAPTER 12
Planning Health Promotion
Campaigns
Do You Want to See Something Gross?
T
T
his headline reflects the powerful impact of audience analysis. It was designed
by a group of seventh graders to catch the attention of students in
their school. Intrigued by the headline, students view photographs of bacteria
growing on items they touch everyday and read information about the value
of hand washing. The campaign caught the students’ attention, and more. It
won a national award. (See Box 12.1 more on the campaign.)
As you will see in this chapter, different audiences have different preferences.
Designing health promotion messages that are both advantageous and
audience oriented is a multistage process.
Health-promoting behaviors are those that “enhance health and wellbeing,
reduce health risks, and prevent disease” (Brennan & Fink, 1997,
p. 157). These behaviors include lifestyle choices, medical care, prevention efforts,
and activities that foster an overall sense of well-being.
Health promotion campaigns are efforts to influence large numbers of
people to engage in health-promoting behaviors (Backer & Rogers, 1993).
These efforts may involve the use of many communication channels, from faceto-
face communication to mass media. The term health promoter includes
anyone involved in the process of creating and distributing health promotion
messages. This includes volunteers in the community, employees of nonprofit
health agencies, public relations and community relations professionals, production
artists, media decision makers, and more. As this list suggests, health
promotion offers diverse career opportunities for communication specialists.
This chapter considers the challenges of promoting health behaviors among diverse
members of the population. It opens with a brief overview of health campaigns,
describing some particularly notable ones. The chapter then guides the
reader through the first four stages of designing a health promotion campaign:
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
338
V. Health in the Media 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
Chapter 12. Planning Health Promotion Campaigns 339
Steps 5 through 7 in designing and implementing a campaign are covered in
the next chapter. Keep in mind that it is important to know all the steps before
you actually begin. Although evaluating and refining the campaign is the final
step, you must consider from the beginning how you will accomplish those
goals later on. (The steps in these chapters are based on recommendations by
Brown and Einsiedel, 1990, and reflect an abbreviated version of the steps recommended
by the CDC [Donovan, 1995].)
¦
BACKGROUND ON HEALTH CAMPAIGNS
“Live long and prosper,” the Vulcan salutation on Star Trek, seems to say it all.
A long and healthy existence—isn’t that what life is all about? You might think
so. But it turns out that Vulcan logic is not always able to explain human behavior,
as Mr. Spock discovered.
Early health campaigns were designed with the confidence that humans
want nothing so much as their own health and longevity. From that viewpoint
it follows that, if people know a behavior is unhealthy, they will not act that
way. Likewise, they should go to great lengths to pursue health-enhancing outcomes.
Seen this way, persuasion was not an issue. All people needed was reliable
information. The motivation to comply with it was presumably already
there, as innate as the animal instinct for survival.
Motivating Factors
Influencing human behavior is not that simple. People are motivated by a number
of factors that make them more or less receptive to health information and
more or less motivated to change their behavior. Sometimes people do things
they know to be unhealthy because the behavior is inexpensive, convenient, socially
rewarding, or fun (Brown & Einsiedel, 1990). For instance, research indicates
people may drink alcoholic beverages even though they believe them to be
unhealthy because they are reluctant to give up the social ritual of drinking with
friends (Brennan & Fink, 1997). Conversely, people sometimes change their behavior
without knowing much about the change or the reasons for it. They may
try a behavior (like taking vitamins) simply because someone in authority tells
them to, or because the change seems interesting, easy, fashionable, and so on.
In these instances, knowledge may follow behavior change.
Research has not always been encouraging about health campaigns’ actual
effects. Campaigns have been criticized for naively seeking to change people’s
behavior without changing their circumstances (Green, 1996) and for assuming
that knowledge reaches and affects all people equally (Brown & Walsh-
Childers, 1994).
In reality, campaigns may raise awareness, but unless the recommended
behaviors are compatible with people’s beliefs and are supported within their
social networks, campaigns are unlikely to change people’s behavior (Ratzan,
V. Health in the Media 12. Planning Health
Promotion Campaigns
© The McGraw-Hill
Companies, 2004
Click here to place an order for a similar paper and have exceptional work done by our team and get A+results
Click here to place an order for a similar paper and have exceptional work done by our team and get A+results
340 Part Five. Health in the Media
BOX 12.1 PERSPECTIVES
Gross! Wash Your Hands
You need not have a Madison Avenue address or a huge budget to design
a top-quality health campaign. A group of seventh graders in Nebraska
recently made the news by creating a national award–winning multimedia
campaign to get kids in their school to wash their hands more.
The students designed a multimedia campaign with the headline,
“Do You Want to See Something Gross?” featuring pictures of bacteria
cultures found on common items. They created their own DVD movie, a
computer slide presentation, t-shirts, bookmarks, and posters in multiple
languages.
So impressive was the campaign that its creators—science students
at Goodrich Middle School in Lincoln and their teacher, Jennifer Kiser—
earned $2,000 for their school and an all-expense-paid trip to
Goodrich Middle School students Irina Sulejmanovic, Kam McKinney, and Kristen
Benson (left to right, front row) celebrate the success of their handwashing campaign
with science teacher, Jennifer Kiser (back left) and principal, Dr. Bess Scott
(back right). Photo by James Kegley.
V. Health in the Media 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
Chapter 12. Planning Health Promotion Campaigns 341
Washington, D.C., where they were honored at a reception overlooking
the White House.
The award and student campaign are part of a national program
called Healthy Schools, Healthy People—It’s a SNAP, sponsored by the Soap
and Detergent Association, the Centers for Disease Control and Prevention,
and the U.S. Department of Health and Human Services. SNAP
stands for the School Network for Absenteeism Prevention, an initiative to engage
middle school students as peer educators and leaders in a “stayhealthy”
movement.
As participants in SNAP, the Lincoln Middle School class downloaded
an online tool kit that provides facts and statistics about the benefits of
hand washing. Here the students and Mrs. Kiser describe the process of
creating and implementing the campaign.
Question: Why were you interested in creating this campaign?
Kam McKinney: We had learned about bacteria and viruses and how
they relate to us, how we become exposed to different diseases and I
wanted to know what I could do to stay healthy. We were interested
in this project as a class because it was different from reading about
bacteria, it was actually hands-on and gave us the opportunity to apply
what we already knew to learn things we did not know.
Question: How did you know what types of campaign messages
would appeal to students in your school?
McKinney: We felt the campaign messages needed to attract the attention
of middle school students. Our bacterial culture pictures really
got the attention of the students in the building because it was
growing on the things they were touching regularly. We felt the
I-movie was something that was new and innovative, yet different
from just reading the information. We also felt that giving students
tools such as saying your “ABC’s” or singing “Happy Birthday” twice
while washing their hands was an easy way to remember how long
they should wash.
Question: What was your biggest challenge in creating and imple
menting the campaign?
Irina Sulejmanovic: The largest challenge was creating a survey that
would give us good data for our campaign ads. We spent many nights
after school tallying the data to make sure that we were properly informing
our students about what was happening with hand washing
and the spread of diseases in our school.
continued
du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
342 Part Five. Health in the Media
BOX 12.1 PERSPECTIVES
Gross! Wash Your Hands, continued
Question: How do you know if the campaign messages worked?
Kristen Benson: We know that almost all of the student population
uses the hand sanitizer on their way into the lunchroom. We are hoping
to see an increase in students attending school and a decrease in
students who are ill. We will be doing some follow-up data to check
these things out.
Question: What advice do you have for other health campaign managers?
Mrs. Kiser: I think the most important tool for anyone who is managing
a campaign is the students. When students are given ownership of
something they go above and beyond what we as teachers could ever
imagine they could do. It is pretty amazing!
For More Information:
¦
For a free program tool kit and information about the SNAP program
and sponsors, visit www.itsasnap.org.
¦
For more about the Goodrich Middle School campaign, go to
Goodrich.lps.org/stories/storyReader$133.
Payne, & Massett, 1994). Health promoters have discovered they cannot simply
educate people about health and presume they will adjust their lifestyles accordingly.
A range of factors must be taken into account. This means the promoter
must know the audience, and consider not just why audience members should
act in recommended ways, but also why they may find it difficult to do so.
Exemplary Campaigns
This section describes five exemplary health promotion campaigns. Each provides
an inspiring lesson for promoters. Together, these examples illustrate that
health promoters must often do more than simply give out information if they
are to succeed. Sensitivity to audience needs, problem-solving skills, assessment,
and careful planning and follow-through are required as well.
Go to the Audience A health promoter interviewed by a student of mine
once said, “You can’t talk to people where you wish they were. You have to talk
to them where they really are.” His words characterize one quality of good
campaigners: They know their audiences well and design campaigns to suit
those audiences.
V. Health in the Media 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
Chapter 12. Planning Health Promotion Campaigns 343
A case in point is an HIV-prevention effort in rural Alabama. Roger
Myrick (1998) describes how a local campaign director became personally acquainted
with community members, church leaders, and business people. Realizing
that many high-risk members of the community lived in a low-income
housing project, the local director organized a neighborhood event. He set up
tents on a nearby sports field and offered free food, door prizes, and music by
a popular disc jockey. Crowds of people attended, were informed about HIV
and AIDS, and were offered free testing. Myrick reports that the project was
successful because it was entertaining, educational, and consistent with community
values.
Click here to place an order for a similar paper and have exceptional work done by our team and get A+results
Click here to place an order for a similar paper and have exceptional work done by our team and get A+results
Another exemplary campaign was designed to reach elderly African-
American women, who are at high risk for breast cancer but are often unable
to afford cancer screening and are hard to reach via traditional media. The
campaigners noted that the women they most wanted to reach had a favorite
place for swapping stories and sharing information—the beauty salon (Forte,
1995). With this in mind, they arranged for salons in Los Angeles to show an
educational video about breast cancer throughout the day. The video featured
African-American women and emphasized that they are at high risk for cancer.
Salon clients were also given pamphlets about breast cancer and were offered
free mammograms at a local clinic or in a mobile unit scheduled to visit the salon
on a regular basis. According to Deirdra Forte, the beauty of this program
was that “by showing the video where African-American women already exchange
information and socialize, they are more likely to understand and accept
the benefit of mammography” (paragraph 22). The campaign was honored as
one of the year’s best by the U.S. Department of Health and Human Services.
Take Action Another lesson is that health promotion comes in many forms,
and sometimes actions are as important as words. When the leaders of an extensive
heart health campaign in New York City realized that preschoolers in the
area received 40% of their daily saturated fat from whole milk served at school,
they put down their pens for a while and rolled up their sleeves (Shea, Basch,
Wechsler, & Lantigua, 1996; Wechsler & Wernick, 1992). In addition to public
education, community involvement, and a multimedia campaign, the health
promoters convinced schools to serve low-fat milk. The program won awards
for its open-eyed, innovative approach.
Measure Your Success The value of combining media exposure, community
outreach, and scientific research was demonstrated by the Minnesota Heart
Health Program (MHHP), which was one the most extensive health campaigns
in American history (Luepker et al., 1994). It was conducted for 13 years
(1980–1993) and involved nearly half a million people in the upper Midwest
(Luepker et al.). The goal of MHHP was to lower heart-disease risk factors
(cholesterol, high blood pressure, and smoking) and increase heart-healthy behaviors
such as exercise. It included an extensive mass media campaign, educational
programs in schools, and the involvement of local organizations.
du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
344 Part Five. Health in the Media
What made MHHP extraordinary was its dedication to charting the health
outcomes of people exposed to campaign messages. It is a good example of how
to establish goals and measure your success. Researchers monitored people’s behavior
over a period of years and compared people touched by the campaign to
people in other communities. Over time, they found modest but significant decreases
in high blood pressure, high cholesterol, and smoking in communities
involved in the program (Luepker et al., 1994). There was also a notable increase
in physical activity among female school children involved in the heart-
healthy education programs (Kelder, Perry, & Klepp, 1993).
Encourage Social Support An award-winning program called the 90-Second
Intervention is being used to lower Americans’ risk of high blood pressure
(Fishman, 1995). The intervention program is based on the principle that
recruiting social support for healthy behaviors increases the likelihood that
people will stick to them. The 90-Second Intervention was designed because
many Americans (about 50 million) are at risk for high blood pressure, but
compliance with medical advice is notoriously low, mostly because people
with high blood pressure feel OK most of the time so they do not perceive a
reason to change their lifestyle or continue medication. (Despite the lack of
symptoms, high blood pressure can lead to strokes, heart disease, and kidney
disease.)
The campaign planners reasoned that people would be more likely to follow
medical advice (1) if their doctors were not the only ones imploring them to eat
right, exercise, and stay on medication and (2) if they received daily encouragement.
Therefore, they designed a simple intervention program that takes place
in the doctor’s office. During a check-up, the doctor asks the patient to call a
loved one and ask that person to commit to becoming a “health partner.” The
partner’s role is to exercise with the patient, help maintain a healthy diet, and so
on. The genius of the plan is that it makes healthy behaviors socially rewarding.
The health partner and patient both benefit from the healthy activities they enjoy
together, and the doctor is no longer the only one concerned about the problem.
The 90-second phone call is presumably well worth the effort.
Implications
Successful health promotion recognizes that people do not necessarily change
their behaviors because they are presented with new health information. As you
will see in this chapter and the next, even award-winning campaigns sometimes
have small or hard-to-evaluate effects. Campaigners must take into account
the concerns, habits, and preferences of the people they wish to influence.
Campaigns with the best chance of succeeding talk to people where they are,
whether it is the beauty salon, athletic field, or doctor’s office. They make it
practical for people to adopt healthy behaviors, even if it means changing public
policy or offering free treatment. Good health campaigns are thorough and
backed by long-term commitment. Furthermore, they speak with many voices,
du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
Chapter 12. Planning Health Promotion Campaigns 345
including the concerned tones of loved ones, the calm assurance of experts, and
the printed and recorded messages of mass media. Here are four principles embodied
by the campaigns just described:
¦
Know your audience.
¦
Take action when words are not enough.
¦
Establish goals and measure your success.
¦
Encourage social support for healthy behaviors.
¦
PLANNING A HEALTH CAMPAIGN
To illustrate the steps in planning a health campaign, imagine that the staff of a
university sports recreation department has asked you to help recruit new participants.
Specifically, they would like to increase the number of people who go
to the campus gym in their free time to take part in basketball and aerobics. The
recreation department will not benefit financially from the added enrollment,
but the staff wishes to increase participation because physical activity improves
people’s health. In accepting this project, you take on the role of health promoter.
The rest of the chapter guides you through the initial steps of creating a
campaign. The hypothetical sports recreation campaign is admittedly a small-
scale effort, but many influential campaigns are aimed at small audiences, and
improving health habits among even a small group is a momentous goal. Furthermore,
the steps given apply well to large and small campaigns.
Step 1: Defining the Situation and Potential Benefits
If you are like many people, your first instinct is to post fliers and send a story
about the recreation program to the campus newspaper. Those may be effective
steps, but before you begin, take the advice of professional campaign planners
and do some preliminary research to assess potential benefits and the
current situation (Nowak & Siska, 1995).
Benefits At this stage, you should be interested in learning what benefits
(if any) your efforts might achieve. Following are some questions you might
research:
¦
Would these behaviors (aerobics and basketball) actually improve people’s
health?
¦
Would everybody benefit from these activities?
¦
Are there some people who would not benefit?
¦
Are there alternative ways to get the same benefits?
Answers to these questions can be obtained by reading published literature
and talking with experts in the field. Such preliminary research will prepare
du Pré: Communicating
du Pré: Communicating Health in the Media
12. Planning Health
© The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
346 Part Five. Health in the Media
you to share useful knowledge with others and may help you decide if the project
is worthwhile.
Current Situation Assuming that you find reasonable evidence to believe
that people might benefit from basketball and aerobics, the next step is to assess
the current situation. Following are some questions to guide your preliminary
research. The same questions will be useful later in guiding audience
analysis. Remember that experts, program leaders, current participants, and
nonparticipants are all valuable sources of information. In addition to these
general questions, you may want to add some specific questions relevant to
your campaign.
¦
How many people currently participate in the recommended behavior?
¦
What types of people participate and for what reasons? (Of interest is
demographic information such as age, sex, and income, as well as cultural,
personal, social, or personality variables that might be relevant.)
¦
What are the strengths and weaknesses of the program (from the perspective
of participants and nonparticipants)?
¦
What types of people do not participate?
¦
What are their reasons for not participating?
¦
What factors are most important to participants and nonparticipants
(e.g., cost, convenience, social interaction)?
¦
Do people consider the potential benefits of this behavior important?
Why or why not?
¦
Are there any conditions under which nonparticipants might participate?
¦
How do the people in your audience usually receive information (i.e.,
fliers, newspaper, radio, e-mail)?
¦
Through what channels do they prefer to get information?
¦
What information sources do they trust?
Preliminary answers to your questions may surprise you. You may find, for
instance, that current sports recreation participants are not primarily concerned
about health benefits. They go to the gym because their friends are there
and they enjoy the social aspects of aerobics and basketball. Or you might find
that some people will not participate no matter how healthy physical activity is
because they are afraid of looking foolish on the basketball court or out of
shape in aerobics classes. Perhaps recreational programs are scheduled when
many people cannot attend them. If these factors are important, simply educating
people about the health benefits of exercise may not do much good.
Diverse Motivations Keep in mind that health concerns are not people’s only
motivation. People are most receptive to options that satisfy them on many levels
(intellectual, emotional, personal, social, etc.). In assessing the situation, it is
V. Health in the Media 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
Chapter 12. Planning Health Promotion Campaigns 347
important not to assume that everyone is motivated in the same way as you.
Consider (and ask about) the diversity among people who might participate in
the sports recreation program. Your audience is probably not just traditional
college students (a diverse group in itself), but international students, middle-
aged and elderly students, experienced students and newcomers, university faculty
and staff members, and maybe even community members and children.
In Step 2, you will attempt to learn about your audience and choose a portion
of it to target. Being sensitive to diverse beliefs and motivations can help
you understand why people behave as they do. This understanding is crucial to
your success as a health promoter.
Step 2: Analyzing and Segmenting the Audience
After assessing the health benefits and the current situation at the sports recreation
department, you are ready to analyze the audience. This will involve asking
a larger number of people many of the questions you asked in preliminary
research.
Audience research may seem an unnecessary step, but experienced campaign
planners know better. Audience analysis allows health promoters to collect
important data about people’s behaviors and preferences. Additionally, it
helps them identify a target audience and determine how best to reach and
motivate that audience. Edward Maibach and Roxanne Parrott (1995) applaud
promoters for considering the audience’s needs before they determine campaign
goals. As they put it, audience-centered analysis “means that health messages
are designed primarily to respond to the needs and situation of the target
audience, rather than to the needs and situation of the message designers or
sponsoring organizations” (p. 167).
Data Collection There are several ways to learn about potential audience
members. Preexisting databases are a good place to start (Salmon & Atkin,
2003). For example you might request demographics about the student body
and usage statistics from the intramural department.
You should also find out more specific information about the target audience’s
beliefs, values, and habits. This section describes the comparative advantages
of using interviews, questionnaires, and focus groups to learn about
the people you wish to influence.
Interviews Interviews are a useful way to collect information. In an interview,
one person asks another person questions, either in person or over the
phone. Here are different interview strategies and the advantages and limitations
of each (based on Frey, Botan, Friedman, & Kreps, 1991).
¦
Highly scheduled interviews. Interviewers are given specific questions
to ask and are not allowed to make comments or ask additional questions.
This helps minimize the interviewers’ influence on respondents’
du Pré: Communicating
du Pré: Communicating Health in the Media
12. Planning Health
© The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
348 Part Five. Health in the Media
answers, but it does not allow for follow-up questions or clarifications.
Answers are typically brief, but easy to tally and compare.
¦
Moderately scheduled interviews. Interviewers are given a set of questions
but are allowed to ask for clarification and additional information
as they see fit. These interviews are more relaxed and conversational, but
less precise, than highly scheduled interviews.
¦
Unscheduled interviews. Interviewers are given a list of topics but are
encouraged to phrase questions as they wish and to probe for more information
when it seems useful and appropriate. These interviews are
useful for collecting information about respondents’ feelings, but they
do not yield answers that can be easily compared or tallied.
Questionnaires Questionnaires are another popular way to collect audience
information because they can be administered to large numbers of people in
less time than it would take to interview them. A questionnaire asks respondents
to write down their answers to a list of questions. In general, written responses
are more limited than interview responses, but people may be more
willing to answer sensitive questions in writing, especially if surveys are conducted
anonymously.
Communication Skill Builders: Designing a Questionnaire Here are some guidelines
for designing an effective questionnaire (based on Arnold & McClure, 1989;
Frey et al., 1991).
¦
Keep it brief. People are most likely to complete the questionnaire if it is
no longer than one page.
¦
Seek immediate response. If people take time to complete the survey right
away, the response rate will be higher.
¦
Collect demographic information. Demographic information includes
age, sex, income, college major, occupation, and the like. Ask respondents
to select the appropriate responses from a list of all possibilities.
(These are called fixed alternative questions.) This will make it easy
for respondents to answer and easy for you to count and compare
answers.
¦
Ask about knowledge and behaviors. A mixture of open and closed questions
will yield the most useful information. Open questions allow respondents
to express ideas in their own words (e.g., How do you feel
about basketball and aerobics?). Closed questions require very brief answers
(e.g., Do you prefer basketball or aerobics?).
¦
Pilot (pretest) the questionnaire. Try the questionnaire on a few people
before making a full set of copies. Ask them to indicate if any questions
are confusing or leading, if the fixed alternative questions include all
possible answers, and if they can think of other questions that should be
added.
V. Health in the Media 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
Chapter 12. Planning Health Promotion Campaigns 349
¦
Allow for anonymity. If you think people may wish to respond anonymously,
provide a way for them to fill out questionnaires privately and
submit them without revealing their identity (as in a drop box or
through the mail).
Focus Groups A third option for collecting information is the use of focus
groups. A focus group involves a small number of people who respond to
questions posed by a moderator (Berko, Wolvin, & Curtis, 1993). The moderator
encourages group members to speak openly on topics relevant to the
campaign. Members’ comments are usually recorded so they can be studied
later. Focus groups are useful for learning the target audience’s feelings about
an issue. Lisa Goldman and Stanton Glantz (1998) used focus groups to gauge
the effectiveness of various strategies used in antismoking campaigns. Kim
Witte (1997) used focus groups to ask teenage mothers about the impact of
peer pressure and education on young people’s sexual behavior.
Whether you use surveys, questionnaires, or focus groups, it is important
to think carefully about whom you include. Choosing people to include is
called sampling the population. Interviews and surveys allow you to collect information
from a large number of people. Make sure your sample reflects the
diversity in the population you are considering. By contrast, focus group
members are usually chosen because they are members of a target group (like
nontraditional students or freshmen). Too much diversity can make it hard to
develop a focused discussion. Just be careful not to assume that focus group responses
reflect the views of the population overall.
Communication Skill Builders: Conducting Focus Groups Experts offer the following
tips for conducting effective focus groups (based on Greenbaum, 1991;
Katcher, 1997):
¦
Determine what type of information you most want to collect. Bruce
Katcher (1997) advises: “You must be clear from the outset what you really
want to learn from the participants and how you will use the information”
(paragraph 7). For example, are you more interested in the
opinions of people who already use the sports recreation center or people
who are not yet involved?
¦
Design a list of open questions to get the information you most want.
¦
Appoint (or hire) a facilitator to lead the focus group discussion. A good
facilitator helps people feel comfortable expressing their opinions, allows
everyone to contribute to the discussion and does not influence members’
responses. Many experts recommend using a facilitator not associated
with the promotion effort because focus group members may feel
more comfortable voicing criticisms and because the facilitator may be
more objective.
¦
Choose 7 to 10 people from your target audience to make up the focus
groups.
du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
350 Part Five. Health in the Media
Box 12.2 RESOURCES
Careers in Health Education and Promotion
If you are considering a career educating people about healthy behaviors,
you might wish to become acquainted with the following organizations
and programs:
¦
American Public Health Association: www.apha.org
¦
Area Health Education Centers: www.nationalahec.org/main/
ahec.asp
¦
Center for Disease Prevention and Control Division of Health Communication:
www.cdc.gov/od/oc/hcomm/aboutdivision.html
¦
National Institutes of Health: www.nih.gov
¦
Social Marketing Institute: www.social-marketing.org
¦
Society for Public Health Education: www.sophe.org
¦
Recruit people who share similar characteristics relevant to your program.
For instance, it is more effective to conduct separate focus groups
with people who use the workout facilities and those who do not. Too
much diversity among participants makes it difficult to develop key
ideas and may discourage some people from participating.
¦
Click here to place an order for a similar paper and have exceptional work done by our team and get A+results
Click here to place an order for a similar paper and have exceptional work done by our team and get A+results
Arrange to conduct the focus group in a conference room or another
comfortable area. (It is customary to provide refreshments for focus
group participants.)
¦
Arrange to unobtrusively audiotape and videotape the session (with
participants’ permission).
¦
Review the information collected.
¦
Consider conducting multiple focus groups with different members of
your target audience.
Segmenting the Audience The next step is to use the data you have collected
to identify a target audience. Following are some questions to consider:
¦
Who is currently involved (and not involved) in the recommended
activity?
¦
What are people’s reasons for participating (or not)?
¦
Who stands to benefit from the recommended behaviors?
¦
Who is in most need of these benefits?
¦
Who might reasonably be expected to adopt these behaviors?
¦
Is there anyone who should not be encouraged to participate?
V. Health in the Media 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
Chapter 12. Planning Health Promotion Campaigns 351
Remember that some campaigns do more harm than good by recommending
behaviors inappropriate for the audience. For example, vigorous exercise is not
right for everybody. As you consider who should receive information about the
sports recreation program, it may be tempting to target everyone possible.
However, research suggests that appealing to an entire population at one time
does not usually pay off. Because people tend to evaluate information based on
its relevance to them, a broad message may seem too general for anyone to take
personally (Slater, 1995). Furthermore, tastes differ, and what appeals to one
group does not necessarily appeal to others. Messages that try to satisfy everyone
very often become so generic they do not interest anyone. The odds are
that, even on small campuses, the population is varied enough to make audience
segmentation preferable.
Segmenting the audience means identifying specific groups who are alike
in important ways and whose involvement is important to the purpose of the
campaign (Slater, 1995). As you attempt to segment the audience, avoid grouping
people based on superficial attributes. Characteristics such as race and income
are not reliable indicators of how people think and behave (Williams &
Flora, 1995). People within those categories may have very divergent viewpoints.
Identifying groups on the basis of similar goals and experiences is
harder to do, but more productive.
Be open to unexpected combinations. For instance, freshmen and university
staff members may be alike in that they feel out of place at the campus
gym. Where the campaign is concerned, this similarity may be more important
than the differences between these groups. Based on these similarities, you
might decide that both freshman and staff members would respond more enthusiastically
to personal invitations than to bulletin board notices.
It is sometimes difficult to decide where to draw the line in segmenting an
audience. Nurit Guttman (1997) describes the dilemma of choosing between
a small audience of high-need individuals and a large audience whose needs
are less severe. There is no definitive rule for choosing, but health promoters
who are sensitive to audience needs and health benefits are most likely to make
reasonable judgments.
Based on your audience analysis, you might decide to target your sports
recreation campaign toward people new on campus (students, staff, or both),
to community members, or to nontraditional students. You might find that
current participants do not reflect the racial and ethnic diversity on campus,
or that the current membership is mostly men or women, or that people
with disabilities are not as involved as they could be. Consequently, you
might direct the campaign toward groups that are currently underutilizing
the sports recreation program or those people who have the greatest need of
the benefits it offers. And do not forget the current participants. Maybe their
involvement can be improved. The possibilities are numerous, making it especially
important to research the audience before choosing a segment of it
to target.
du Pré: Communicating
du Pré: Communicating Health in the Media
12. Planning Health
© The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
352 Part Five. Health in the Media
Audience as a Person Once a target audience has been identified, Lefebvre et al.
(1995) recommend imagining the audience as a single person, complete “with
name, gender, occupation, and lifestyle” (p. 221). With this “person” in mind,
they pose the following questions for consideration:
¦
What is important to this person?
¦
What are the person’s feelings, attitudes, and beliefs about the behavior
change (including perceived benefits and barriers)?
¦
What are his or her media habits?
Lefebvre and co-authors say that imagining the audience as a person is useful
in focusing the campaign and in creating messages that seem personal and
immediate.
Audience Profiles Every audience, and every audience member, is unique,
but some overall characteristics may help guide your efforts. Here is some information
that may be useful to you as you attempt to understand your target
audience.
Young Audiences The age of your target audience may have some affect on
how members perceive health messages. Although it is difficult to make generalizations
about adult audiences, the developmental stages of youth often have
relatively predictable effects on children and teenagers.
Children are an important audience. As Erica Weintraub Austin (1995)
points out, it is easier to prevent bad habits than to break them. Sending consistent
messages to children early on may prevent them from developing unhealthy
behaviors. Adults are in a good position to help. Evidence supports
that children are strongly influenced by adults. On the bright side, they tend to
follow their parents’ advice (Henriksen & Jackson, 1998). However, children
often seek to emulate adult behaviors—even the unhealthy ones. Glantz
(1996) cautions that portraying behaviors such as smoking as “adult-only”
may actually make them seem more appealing to youngsters.
Adolescents often believe they are unlike other people and that others do
not understand them (this is called personal fable). Consequently, they are
likely to assume health warnings do not apply to them (Greene, Rubin, Hale, &
Walters, 1996). Teenagers also tend to be extremely self-conscious and feel that
people are scrutinizing their appearance and behavior (this is called imaginary
audience). This makes them sensitive to peer pressure and social approval,
which can work for or against health promotion efforts (Greene et al., 1996).
Researchers emphasize the importance of peer support for healthy behaviors.
Austin (1995) reminds promoters that teens’ immediate social concerns may
outweigh their long-term health considerations. In Austin’s words, adolescents
may “care more that smoking will make their breath smell bad than that they
could develop cancer” (p. 115).
du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
Chapter 12. Planning Health Promotion Campaigns 353
Sensation-Seekers In the 1990s, Rolling Stone magazine ran an advertisement
that proclaimed, “Why Women Find a Little Prick Attractive.” Beside the
headline is a photograph of a beautiful woman in a black teddy. In smaller
type below, the reader learns that the prick is a small mark on a man’s finger
where he has drawn blood to verify he is not HIV-infected (Ivinski, 1997).
The advertisement touts an at-home HIV test. It concludes: “And if the
woman in your life is having any doubts—don’t worry. That little prick is sure
to satisfy her.”
As you might imagine, “The Little Prick” ad drew considerable comment.
At least one critic considered it irresponsible to portray a serious subject such
as HIV in such a whimsical (some would say tasteless) manner. As Pamela
Ivinksi (1997) expressed it:
Using sex to sell a test that determines whether someone has contracted a
virus that’s often transmitted during sex, and then subtly implying in the
copy that the user shouldn’t worry because he’ll probably test negative, and
he can use that fact to attract women for more sex, is a little bit creepy, not
to mention misleading and even cynical. (paragraph 8)
The advertisement’s creators acknowledged that the ad was not for everyone,
but argued that it was shocking and sexy enough to make young men pay attention
to an important topic.
Adolescents and young adults are more likely than others to be high
sensation-seekers, meaning they enjoy new and intense experiences (Everett
& Palmgreen, 1995; Zuckerman, 1994). The danger with high sensation-seekers
is that risky behaviors appeal to them. Not only are they less likely than
others to take precautions, they are more apt to be in dangerous situations in
the first place. For instance, high sensation-seekers typically have more sexual
partners than other people do, but they are less likely to use condoms (Sheer &
Cline, 1995). The intense messages that sensation-seekers enjoy may be too
much for most audiences, making it difficult to target high-risk individuals
without offending others. (For ethical considerations about health promotion,
see Box 12.3.)
Underinformed Audiences In their article “Lessons From the Field,” three
noted health promotion specialists urge campaign designers not to overlook
marginalized members of society. They write:
Conducting communication research within diverse ethnic/racial/underserved
communities will be especially important in the future. Attention to
these audiences is a necessity, not a nicety…. Working with an audience for
the first time inevitably brings frustrations as one discovers that principles
applied successfully in the past with other populations do not necessarily fit
in other contexts. Our experience has been that the potential payoff is worth
the initial frustration. (Edgar, Freimuth, & Hammond, 2003, p. 627)
V. Health in the Media 12. Planning Health
Promotion Campaigns
© The McGraw-Hill
Companies, 2004
354 Part Five. Health in the Media
Box 12.3 ETHICAL CONSIDERATIONS
The Politics of Prevention—Who Should Pay?
Health promotion may seem like a win-win situation. If people can be encouraged
to prevent disease and injuries, they will enjoy better health and
the nation’s health costs will be kept under control. How far should we
carry this line of reasoning? Should people who work hard to be healthy
get cut-rate health care? Should they be given advantages when competing
for jobs? If people knowingly engage in unhealthy behaviors, should
society help pay for their medical bills?
Experts estimate that Americans pay more than $100 billion each year
to treat injuries and diseases that are largely preventable (Johnson &
Bootman, 1995). The expense eats up tax money and leads to hikes in
health insurance rates. As Daniel Wikler (1987) puts it, “The person who
takes risks with his [or her] own health gambles with resources which belong
to others” (p. 14). Some theorists argue that people who continue
risky behavior (like smoking, overeating, or driving without seatbelts)
when they know it is bad for them should pay from their own pockets
when their behavior leads to medical expenses.
In a related issue, some feel that companies that profit from selling
unhealthy products should pay part of the health bill. State and federal
governments have sought damages from tobacco companies in the last
decade, charging that it is unfair for tobacco companies to make huge
profits while others foot the enormous bill of treating tobacco-related
illnesses. Around the world, about 11,000 people die every day from
tobacco-related illnesses—totaling nearly 5 million a year (WHO, “Health
Impact,” n.d.). The expense is magnified by the impact on society. In
general, smokers cut 13 to 14 years off their life expectancy (MMWR,
2003). Experts estimate that smoking cost Americans $150 billion between
1995 and 1999 in terms of medical expenses and lost productivity
(MMWR, 2003). Some companies now refuse to hire smokers or people
who are extremely overweight because they are at greater health risk, and
thus likely to cost the company more money in health benefits and sick
leave. Similarly, some insurance companies offer a discount to people
who do not smoke and those who remain accident-free or complete informational
programs such as defensive driving courses.
On the other side of the issue, some worry that government and employers
are becoming too much involved in people’s lifestyle decisions.
Some charge that groups like Mothers Against Drunk Driving (MADD)
are taking a good thing too far by seeking to punish people for drinking
even small amounts of alcohol (DiLorenzo & Bennett, 1998). Similarly,
policy analyst Will Crawford (1997) warns that the government may
soon be telling people what to eat in the name of controlling obesity.
Some people say that increasing the “sin taxes” on alcohol and tobacco
V. Health in the Media 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
Chapter 12. Planning Health Promotion Campaigns 355
will hurt consumers, not companies, and they are afraid the taxes will be
extended to cover snack foods and other not-so-healthy items. All in all,
opponents of tighter health requirements say you cannot control the
risks people take without controlling their freedom to choose.
What Do You Think?
1.
Should people who knowingly take health risks pay more for health
insurance? Should they be denied insurance? Should they be denied
health services?
2. Should people be required by law to engage in healthy practices
(like being immunized or exercising regularly)?
3.
Should it be against the law to sell or advertise products known to
have a high health risk? Does it matter if such products are addictive?
4. Do you agree with the rationale behind many states’ seatbelt and
motorcycle helmet laws—that people who neglect safety precautions
not only endanger their own lives, but increase the trauma
and expense for everybody?
5. In your opinion, which of the following behaviors (if any) should be
grounds for denying or limiting health benefits? On what criteria do
you make your judgments?
¦
Smoking
¦
Engaging in unprotected sex
¦
Exceeding the speed limit
¦
Snow skiing
¦
Neglecting to exercise regularly
¦
Overeating
¦
Playing football
¦
Rescuing accident victims
6. If a person has a family history of a disease, should he or she be
required by society to take extra health precautions?
Suggested Sources
Califano, J. A. (1994). Revealing the link between campaign financing
and deaths caused by tobacco. Journal of the American Medical Association,
272, 1217–1218.
Crawford, W. (1997, October). Taxing for health? Consumers’ Research
Magazine, 80, 34.
Faden, R. R. (1987). Ethical issues in government sponsored public
health campaigns. Health Education Quarterly, 14, 27–37.
continued
du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
356 Part Five. Health in the Media
Box 12.3 ETHICAL CONSIDERATIONS
The Politics of Prevention—Who Should Pay? continued
Goodman, L. E., & Goodman, M. J. (1986, April). Prevention—How
misuse of a concept undercuts its worth. Hastings Center Report, 16,
26–38.
Gostin, L. O., Arno, P. S., & Brandt, A. M. (1997). FDA regulation of tobacco
advertising and youth smoking: Historical, social, and constitutional
perspectives. Journal of the American Medical Association, 277,
410–419.
Veatch, R. M. (1980). Voluntary risks to health. Journal of the American
Medical Association, 243, 50–55.
Wikler, D. (1987). Who should be blamed for being sick? Health Education
Quarterly, 14, 11–25.
Unfortunately, people most in need of health resources and information are often
the least likely to benefit from health information campaigns. (See Box 12.4
for more on the knowledge gap hypothesis.)
The challenge for health promoters is to come up with specialized and
innovative means of disseminating information to people most in need of it.
For example, Satya Krishnan (1996) recommends that clinics educate people
with low reading skills by showing instructional health videos in their waiting
rooms.
As you complete Step 2, it may seem that you have already done a lot of
work and you still do not know what the campaign will involve. Your hard
work will not go to waste. Research shows that campaigns launched without a
clear understanding of the audience, current situation, and potential benefits
are often frustrating to create and ineffective at reaching their goals. With a target
audience in mind, you are ready for Step 3.
Step 3: Establishing Campaign Goals and Objectives
Click here to place an order for a similar paper and have exceptional work done by our team and get A+results
Click here to place an order for a similar paper and have exceptional work done by our team and get A+results
By this point you should have a fairly clear impression of the sports recreation
department, its potential benefits, and the people you most want to reach with
your campaign. Collecting and analyzing data has prepared you to establish
goals for your campaign.
Goals state in clear, measurable terms exactly what you hope to achieve
with the campaign. You might consider the following questions:
¦
What exactly do you want people to start/stop/continue doing?
¦
If the goal is a behavior, when (and for how long) should it occur?
¦
How will you know if your campaign has been successful?
V. Health in the Media 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
Chapter 12. Planning Health Promotion Campaigns 357
Box 12.4 THEORETICAL FOUNDATIONS
The Knowledge Gap Hypothesis
The knowledge gap hypothesis proposes that people with plentiful information
resources (such as newspapers, televisions, computers, and well-
informed friends and advisors) are likely to know more and to continue
learning more than people with fewer information resources (Tichenor,
Donohue, & Olien, 1970). Income and education are highly linked to resource
availability and media habits. Consequently, people of high socioeconomic
status tend to be knowledge rich, and people of low status
tend to be knowledge poor. The gap remains even when less educated
persons are highly motivated to learn the information (Viswanath, Kahn,
Finnegan, Hertog, & Potter, 1993). New information often increases the
knowledge gap rather than diminishing it. In other words, the people
who already know a lot learn more, and the others fall farther behind.
Unfortunately, people who are information poor are often most in
need of health information. William Brown (1992) reports that members
of minority cultures in the United States are at highest risk for contracting
AIDS, but they are less informed than others about AIDS and perceive
themselves to be less vulnerable than others.
There are several reasons underprivileged persons are hard to reach
with health messages. One barrier is ethnic. Underprivileged audiences
tend to be disproportionately comprised of people from minority cultures.
They may be skeptical about mainstream messages, either because
they seem irrelevant or because they mistrust the sources. For example,
African Americans trust media outlets (magazines, television stations,
and radio stations) owned by African Americans more than they trust
other media (Holden, 1998; “Study Reveals,” 1998).
Second, underprivileged people are more likely than others to rely on
television instead of newspapers and magazines (Engelberg, Flora, &
Nass, 1997). Partly because print sources are more detailed, newspaper
readers are typically more knowledgeable than TV viewers. Thus, underprivileged
persons’ media habits often put them at a disadvantage.
Third, underprivileged audiences may have different priorities. A high-
tech AIDS message was perceived negatively by African Americans, who
felt that science and technology cause people to lose jobs (Walters,
Walters, Kern-Foxworth, & Priest, 1997). Other research shows that people
worried about violence and hunger may feel long-term health issues
are the least of their worries (Holtgrave, Tinsley, & Kay, 1995).
Finally, underprivileged audiences are more likely to trust interpersonal
sources (like friends and health professionals) than they are to trust messages
in mainstream media (Engelberg et al., 1997). This makes it difficult
to reach underprivileged people in large numbers.
du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
358 Part Five. Health in the Media
Relevant to the sports recreation campaign, you may decide that your goal is
to sign up 40 freshmen in 3 months. Or perhaps you have decided to focus on
students with disabilities or newcomers. Your goal may be to get at least 20
current participants to bring an individual from one of those groups to an
event.
Make sure your goals are oriented to the overall purpose of the campaign.
For instance, if people participate in aerobics only once, will there be health
benefits? If not, it may be important to set a goal for continued participation—
perhaps attendance once a week for at least 2 months. Think ahead about how
you will assess the campaign’s effects. This may involve follow-up surveys or
sign-up sheets to keep track of participation. Setting measurable goals allows
you (and others) to determine if the campaign has been a success. It is important
to set meaningful and realistic goals and to consider in advance how you
will test the effectiveness of your campaign.
Health promoters are increasingly being held accountable for their efforts
(McGrath, 1995). Accountability means demonstrating how the results of a
project compare to the money and time invested in it. For example, a medical
center reorganized its marketing and public relations department because patient
surveys consistently showed that people chose the medical center based
on their doctors’ advice, not on advertising. The hospital did not completely
discontinue advertisements (employee surveys showed the ads raised workplace
morale), but the medical center redirected part of its effort into marketing
services directly to physicians.
Step 4: Selecting Channels of Communication
A channel is a means of communicating information, either directly (in person)
or indirectly (through media like TV or radio or computers). To select the
best channels for your campaign, consider what channels your target audience
uses most and trusts most.
Sometimes channel selection is limited by time or money. Your sports
recreation enrollment effort will probably not involve full-color magazine ads
or sophisticated television commercials. Nevertheless, as a health promoter,
you should be familiar with all types of channels. Moreover, do not assume too
quickly that a channel is out of your reach. For example, you may not produce
television commercials, but you might book appearances on local television
talk shows.
Channel Characteristics You should also consider the advantages and limitations
of different channels. Experts suggest that channels for a health campaign
be evaluated in terms of reach, specificity, and impact (Schooler,
Chaffee, Flora, & Roser, 1998). Reach refers to the number of people who will
be exposed to a message via a particular channel. Specificity refers to how accurately
the message can be targeted to a specific group of people. Impact is
how influential a message is likely to be.
du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill
about Health: Current Promotion Campaigns Companies, 2004
Issues and Perspectives,
2/e
Chapter 12. Planning Health Promotion Campaigns 359
Television has a larger and more diverse audience than any other medium
(Warner, 1987). As such, it has immense reach. However, because the audience
is so large and diverse, it is hard to tailor messages to particular viewers. Thus,
television has low specificity (although that is changing somewhat with the
creation of special-interest cable and satellite programs). Radio stations and
large-circulation newspaper