New Publications Show Health Communication Works

We are all familiar with health communication campaigns that use mass media to deliver messages promoting behavior change, but are they really effective? According to a systematic review from CDC’s Community Guide Branch, health communication campaigns can change health behaviors when combined with the distribution of free or reduced-price related products. Researchers conducted a systematic review on the effectiveness of health communication campaigns that promote healthful behavior when combined with distribution of related products necessary to perform a behavior (e.g., bicycle helmets or condoms) or facilitate one (e.g., nicotine replacement therapies).

Based on these findings, the Community Preventive Services Task Force an independent, nonfederal, volunteer group of public health and prevention experts issued the following recommendation for these types of campaigns:

Based on strong evidence of effectiveness for producing intended behavior changes, the Community Preventive Services Task Force recommends health communication campaigns that use multiple channels, one of which must be mass media, combined with the distribution of free or reduced-price health-related products (defined below).

Because results were positive across all of the six behaviors evaluated, the Community Preventive Services Task Force concluded that these findings are likely to apply to a broader range of health-related products that meet the review’s product eligibility criteria in the intervention definition. The effectiveness of interventions promoting the use of health-related products other than those distributed in the reviewed studies should be assessed to ensure applicability.

The systematic review focused only on interventions that included a mass media component; therefore, this recommendation is specific to such interventions. The results may or may not apply to campaigns that do not include a mass media component, which were outside of the scope of the review.

The effectiveness and economic reviews as well as the Task Force recommendation are included in the September 2014 issue of the American Journal of Preventive Medicine:

• Mass Media Health Communication Campaigns Combined with Health-Related Product Distribution: A Community Guide Systematic Review. Authors: Robinson MN, Tansil KA, Elder RW, et al.
• Economics of Mass Media Health Campaigns with Health-Related Product Distribution: A Community Guide Systematic Review. Authors: Jacob V, Chattopadhyay SK, Elder RW, et al.
• Combination of Mass Media Health Campaigns and Health-Related Product Distribution is Recommended to Improve Healthy Behaviors. Authors: Community Preventive Services Task Force

Concept and Definition

Definitive evidence demonstrates the impact of health communication campaigns on increasing knowledge and awareness, and on altering beliefs, perceptions, and attitudes of targeted audiences. It has been argued, however, that when used as a single strategy, such campaigns do not generally result in sizeable changes in health behavior. This Community Guide review aimed to establish whether health communication campaigns, implemented within the scope of a broader social marketing framework, actually strengthened the link between health communication campaigns and initiation and maintenance of population-level health-related behavior change.

To be included in the review, the intervention had to combine two components to increase the appropriate, repeated use of evidence-based, health-related products:

1. A health communication campaign that uses messages to increase behavior change through multiple channels, one of which must be mass media, to provide multiple opportunities for exposure; and
2. Distribution of a product that facilitates adoption and maintenance of health-promoting behaviors, sustains cessation of harmful behaviors, or protects against behavior-related disease or injury. To reduce cost-, access-, and convenience-related barriers among targeted users, the products were free or discounted.

The review included health-related products that met the following criteria:

1. Have been shown through an evidence-based process to improve health-related outcomes
2. Are tangible
3. Are not a service (e.g., mammogram)
4. Are not exclusively available through prescription or administration by a health professional
5. Require repeated use for desired health promotion and/or disease and injury prevention effects (e.g., wearing a helmet) rather than a one-time behavior (e.g., installing smoke alarms); and,
6. Are not a specific food product (e.g., oatmeal) marketed as being “healthy”

Results

Researchers found 22 studies published between 1980 and 2009 that met the criteria for inclusion in this review. Of the health-related products that met the inclusion criteria, 6 were represented:

• Child safety seats
• Condoms
• Pedometers
• Recreational safety helmets
• Over-the-counter nicotine replacement therapy (OCT-NRT)
• Sun-protection products

Several other eligible products were not represented (e.g., insect repellent, oral health products, and wrist and elbow pads) for a variety of reasons. These include: an eligible product may not have been identified for a literature search; no interventions distributing the product were found; the effectiveness of eligible interventions was not studied; or the studies did not assess the intervention effects on outcomes of interest.

The intervention was associated with a median increase of 8.4 percentage points in the proportion of people engaging in a healthful behavior related to use of the product distributed. Although the magnitude of intervention effects varied, favorable results were found for interventions promoting all of the evaluated products, the median outcomes of which are provided below. (Note: interventions distributing pedometers and sun-protection products provided data that could not be expressed as an absolute percentage point change).

• Child safety seats increase of 8.6 percentage points
• Condoms increase of 4.0 percentage points
• Smoking cessation increase of 10.0 percentage points
• Recreational safety helmets increase of 8.4 percentage points

The included communication campaigns disseminated their product-use messages through several different channels, which always included mass media (e.g., television, radio) and nearly always included small media (e.g., brochures, posters), over periods of time that ranged from one week to 36 months. Messages also were commonly disseminated via interpersonal communication (e.g., peer outreach, hotline numbers), community events (e.g., health fairs, festivals), and occasionally through social media (e.g., through social networking websites such as Facebook ). Some campaigns were accompanied by other activities such as provision of services (e.g., HIV testing, quitline counseling) or environmental changes (e.g., new or enhanced walking trails). Results demonstrated effectiveness regardless of the number of distinct channel categories that disseminated the product-use message (e.g., mass media, small media, interpersonal communication).

Only two campaigns disseminated their messages using Internet or social media channels. As part of today’s rapidly changing media environment, the Internet and social media are gaining prominence in health promotion due to their strong potential for conveying targeted messages in a cost-effective manner. The availability of these options has the potential to make health communication campaigns with product distribution feasible for many organizations that would have difficulty funding an intervention centered on traditional mass media channels. The assessment of effectiveness of product promotion and distribution interventions that use social media as a primary communication channel will be an important area for future research.

According to Katherine Lyon Daniel, PhD, associate director for communication, CDC, “These results suggest that combining mass media health communication campaigns with distribution of any of a variety of health-related products that meet the inclusion criteria specified above is likely to be effective in influencing the intended health behaviors.”

The Task Force and The Community Guide

The Community Preventive Services Task Force (Task Force) is an independent, nonfederal, unpaid body of public health and prevention experts that provides evidence-based findings about community preventive programs, services, and policies to improve health. The Task Force bases its findings on systematic reviews of the scientific literature. With oversight from the Task Force, scientists and subject-matter experts from the Centers for Disease Control and Prevention (CDC) conduct these reviews in collaboration with a wide range of government, academic, policy, and practice-based partners. The CDC is mandated to provide administrative, research, and technical support for the Task Force.

The Community Guide is an essential resource for people who want to know what works in public health. It provides evidence-based recommendations and findings about public health interventions and policies to improve health and promote safety.