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Health Communication and Social Marketing: Campaigns That Include Mass Media and Health-Related Product Distribution

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What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review of 22 studies (search period 1980 - 2009). The review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to health communication and social marketing.

Context

Health communication campaigns apply integrated strategies to deliver messages designed, directly or indirectly, to influence health behaviors of target audiences. Messages are communicated through various channels that can be categorized as:

  • Mass media (e.g., television, radio, billboards)
  • Small media (e.g., brochures, posters)
  • Social media (e.g., Facebook©, Twitter©, web logs)
  • Interpersonal communication (e.g., one-on-one or group education)

Drawing on concepts from social marketing, a health communication campaign can be combined with other activities such as distribution of products to further influence health behaviors. The current review was devised to evaluate the effectiveness of the combination of health communication campaigns that meet specific criteria with the distribution of health-related products that also meet specific criteria.

Summary of Results

Twenty-two studies with 25 study arms qualified for the review.

  • Results from analyses show that effects were favorable for the following outcomes:
    • Health promoting behaviors: absolute median change of 8.4 percentage points (Interquartile Interval [IQI]: 2.7 to 14.5 percentage points; 20 study arms)
      • Use of child safety seats: absolute median change of 8.6 percentage points (IQI: -9.2 to 9.6 percentage points; 3 study arms)
      • Use of condoms: absolute median change of 4.0 percentage points (IQI: -4.0 to 10.8 percentage points; 4 study arms)
      • Use of helmets: absolute median change of 8.4 percentage points (IQI: 2.1 to 18.5 percentage points; 10 study arms)
      • Smoking cessation: absolute median change of 10.0 percentage points (IQI: 3.1 to 16.9 percentage points; 3 study arms)
    • The remaining 5 study arms also evaluated interventions with generally favorable results, but reported results that could not be expressed as percentage point changes in health behaviors: condom use, 2 study arms; physical activity (pedometer use), 2 study arms; and sun protection product use, 1 study.

 

Summary of Economic Evidence

An overall conclusion about the economic merits of the intervention cannot be reached because available economic information and analyses were incomplete.

The economic review is based on evidence from 15 studies (search period January 1980–December 2009). Included studies provided limited economic information on health communication campaigns to increase use of child booster and car seats (1 study), pedometers (1 study), condoms (4 studies), recreational helmets (5 studies), and nicotine replacement therapy (4 studies). There were no studies of interventions that promoted use of sun protection products.

There were several limitations to the quality of the cost and benefit estimates.

  • Intervention costs
    • Most of the studies included either the cost of media or the cost of the product distributed, and not both.
    • Volunteer labor and in-kind contributions were not valued.
    • Target populations were not specified making per capita calculations impossible.
  • Economic benefits
    • Monetized benefits from healthcare averted and productivity gains, and quality-adjusted life year (QALY) saved were rarely estimated or modeled.
    • Most studies reported proximal benefits such as quits among smokers or reductions in unprotected sex.
  • Cost-benefit and cost-effectiveness
    • Overall assessments could not be made because of incomplete assessments of costs and benefits.

Applicability

Results suggest that health communication campaigns that include mass media, and product distribution interventions are applicable to:

  • A wide variety of broad or narrowly-defined populations provided they are appropriately segmented and targeted.
  • Products evaluated in this review and products that were not included but meet the criteria. Interventions were shown to be effective for:
    • Both free and discounted products
    • Single use (e.g., condoms) and reusable (e.g., recreational safety helmets)

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

  • The majority of the campaigns researched were short-term; therefore, additional research is needed to assess the sustainability and effectiveness of long-term campaigns.
  • There is a common research gap related to the explicit efforts made to gather the most information from all targeted individuals. There is a need to increase and improve the collection on different demographic characteristics. This would help explain the differential effect of the campaigns on age gender, and race/ethnicity.
  • There is also a need for researchers to design campaigns comparing the intensity of different study arms. Campaign intensity provides informative evidence on how much promotion is necessary for a targeted audience to receive a message in order to help increase the likelihood of a behavior change.

Identified Research Needs for Better Reporting

  • Better reporting on intervention details, including descriptions of the methods used to develop campaigns, combined with the use of more consistent terminology within the field, would improve future research and translation activities.

Identified Evidence Gaps - Economic Review

  • More complete and high quality economic evaluations of these interventions are necessary.
  • More complete and high quality economic evaluations of these interventions are necessary.
  • Most studies evaluated proximal outcomes specific to the interventions. Economic outcomes for healthcare use and workplace productivity and expected QALY saved need to be estimated or modeled to operationalize cost-benefit and cost-effectiveness assessments.

Study Characteristics

  • Included studies evaluated campaigns to promote use of child safety seats (3 study arms), condoms (6 study arms), recreational safety helmets (10 study arms), pedometers (2 study arms), over-the-counter nicotine replacement therapy (3 study arms), and sun protection products (1 study).
  • Communication campaigns used several different channels, always with mass media (e.g., TV, radio, newspapers) and nearly always including small media (e.g., brochures, posters, fliers) and interpersonal communication (e.g., peer outreach, hotline numbers),over periods of time that ranged from 1 week to 36 months.
  • Most often, messages were disseminated via community events (e.g., health fairs, festivals), and occasionally through social media (e.g., Facebook).
  • Some campaigns were accompanied by other activities such as providing services (e.g., HIV testing, quitline counseling) or environmental changes (e.g., building walking trails).
  • Studies were conducted in a wide range of urban, rural, and suburban settings in the U.S. (20 study arms), Australia (2 study arms), Canada (1 study arm), Belgium (1 study arm), and Israel (1 study arm).
  • Many papers did not report details on population demographics, such as race, age, and education. Populations that were addressed, however, included African Americans, people of Hispanic origin, low-income groups, and men who have sex with men.

Publications

Robinson MN, Tansil KA, Elder RW, et al. Mass media health communication campaigns combined with health-related product distribution: a Community Guide systematic review. American Journal of Preventive Medicine. 2014;47(3):360-71.
Jacob V, Chattopadhyay SK, Elder RW, et al. Economics of mass media health campaigns with health-related product distribution: a Community Guide systematic review. American Journal of Preventive Medicine. 2014;47(3):348-59.
Community Preventive Services Task Force. Combination of mass media health campaigns and health-related product distribution is recommended to improve healthy behaviors. American Journal of Preventive Medicine. 2014;47(3):372-4.

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