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du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill

about Health: Current Promotion Campaigns Companies, 2004

Issues and Perspectives,



Planning Health Promotion


Do You Want to See Something Gross?



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


V. Health in the Media 12. Planning Health © The McGraw-Hill

about Health: Current Promotion Campaigns Companies, 2004

Issues and Perspectives,


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].)



“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

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340 Part Five. Health in the Media


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


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,


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”


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.


du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill

about Health: Current Promotion Campaigns Companies, 2004

Issues and Perspectives,


342 Part Five. Health in the Media


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


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,


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


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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.

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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


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.


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,

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about Health: Current Promotion Campaigns Companies, 2004

Issues and Perspectives,


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.



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



Would these behaviors (aerobics and basketball) actually improve people’s



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

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12. Planning Health

© The McGraw-Hill

about Health: Current Promotion Campaigns Companies, 2004

Issues and Perspectives,


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

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Issues and Perspectives,


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


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’

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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


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



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


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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


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350 Part Five. Health in the Media


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/



Center for Disease Prevention and Control Division of Health Communication:



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.


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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



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?

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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.

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12. Planning Health

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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


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


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).

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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

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Companies, 2004

354 Part Five. Health in the Media


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,


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?


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)?


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?




Engaging in unprotected sex


Exceeding the speed limit


Snow skiing


Neglecting to exercise regularly




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.


du Pré: Communicating du Pré: Communicating 12. Planning Health © The McGraw-Hill

about Health: Current Promotion Campaigns Companies, 2004

Issues and Perspectives,


356 Part Five. Health in the Media


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,


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,


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


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

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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?

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Issues and Perspectives,


Chapter 12. Planning Health Promotion Campaigns 357


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.

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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


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.

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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

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