Elsevier

The Lancet

Volume 376, Issue 9748, 9–15 October 2010, Pages 1261-1271
The Lancet

Review
Use of mass media campaigns to change health behaviour

https://doi.org/10.1016/S0140-6736(10)60809-4Get rights and content

Summary

Mass media campaigns are widely used to expose high proportions of large populations to messages through routine uses of existing media, such as television, radio, and newspapers. Exposure to such messages is, therefore, generally passive. Such campaigns are frequently competing with factors, such as pervasive product marketing, powerful social norms, and behaviours driven by addiction or habit. In this Review we discuss the outcomes of mass media campaigns in the context of various health-risk behaviours (eg, use of tobacco, alcohol, and other drugs, heart disease risk factors, sex-related behaviours, road safety, cancer screening and prevention, child survival, and organ or blood donation). We conclude that mass media campaigns can produce positive changes or prevent negative changes in health-related behaviours across large populations. We assess what contributes to these outcomes, such as concurrent availability of required services and products, availability of community-based programmes, and policies that support behaviour change. Finally, we propose areas for improvement, such as investment in longer better-funded campaigns to achieve adequate population exposure to media messages.

Introduction

Over the past few decades, media campaigns have been used in an attempt to affect various health behaviours in mass populations. Such campaigns have most notably been aimed at tobacco use and heart-disease prevention, but have also addressed alcohol and illicit drug use, cancer screening and prevention, sex-related behaviours, child survival, and many other health-related issues. Typical campaigns have placed messages in media that reach large audiences, most frequently via television or radio, but also outdoor media, such as billboards and posters, and print media, such as magazines and newspapers. Exposure to such messages is generally passive, resulting from an incidental effect of routine use of media. Some campaigns incorporate new technologies (eg, the internet, mobile phones and personal digital assistants), but recipients have so far generally been required to actively choose to seek information, for example by clicking on a web link, and discussion of these methods is not included in this Review.

Media campaigns can be of short duration or may extend over long periods. They may stand alone or be linked to other organised programme components, such as clinical or institutional outreach and easy access to newly available or existing products or services, or may complement policy changes. Multiple methods of dissemination might be used if health campaigns are part of broader social marketing programmes.1

The great promise of mass media campaigns lies in their ability to disseminate well defined behaviourally focused messages to large audiences repeatedly, over time, in an incidental manner, and at a low cost per head. As we discuss in this Review, however, that promise has been inconsistently realised: campaign messages can fall short and even backfire; exposure of audiences to the message might not meet expectations, hindered by inadequate funding, the increasingly fractured and cluttered media environment, use of inappropriate or poorly researched format (eg, boring factual messages or age-inappropriate content), or a combination of these features; homogeneous messages might not be persuasive to heterogeneous audiences; and campaigns might address behaviours that audiences lack the resources to change.

Section snippets

Direct and indirect methods to affect behaviour change

Mass media campaigns can work through direct and indirect pathways to change the behaviour of whole populations.2 Many campaigns aim to directly affect individual recipients by invoking cognitive or emotional responses. Such programmes are intended to affect decision-making processes at the individual level. Anticipated outcomes include the removal or lowering of obstacles to change, helping people to adopt healthy or recognise unhealthy social norms, and to associate valued emotions with

Evidence for health behaviour change

We discuss a range of media campaigns, from constrained experimental programmes with complex research apparatus funded specifically to test the promise of public communication, such as the Stanford Heart Disease Prevention Program,4, 5 to campaigns mounted as large-scale interventions on a regional or national scale, not operationally constrained by the need for outcome assessment, but to which analysis was later applied, such as the US National Youth Antidrug Media Campaign.6 These

Conclusions

Mass media campaigns can directly and indirectly produce positive changes or prevent negative changes in health-related behaviours across large populations. Our careful reading of topic-specific individual studies and more-general mass media reviews,42, 100, 101 and our collective experience in campaign research and evaluation across health behaviours has led us to the following conclusions about the conditions under which media campaigns work.

The likelihood of success is substantially

Search strategy and selection criteria

We searched Medline, PsychInfo, Embase, Soclit, Eric, and Communication and Mass Media Complete electronic databases to identify full-text review articles and non-reviewed notable studies published from 1998 onwards, in English, that we judged to represent advances in assessment methods or substantial increments in knowledge. We integrated review findings with evidence from robust and influential empirical studies that were published after the last review article identified.

Search terms

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