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to demonstrate that the choice of media vehicle was efficient. In addition, campaign planners need to estimate how many times an audience is exposed to a message to learn the message and then show that their plan will present the audience with the health message enough times for message learning to occur.
Evaluation
The last step in the campaign process is evaluation, which relates back directly to the situation analysis, goal, and objectives of the program. The measures of perfor- mance must relate directly to the objectives of the campaign and should use valid and reliable methods. Distinction must be made between output (communication products) and outcome (results and impact of actions taken).
Before a campaign is launched, campaign planners need to show their plans for evaluating the success of their campaign. Usually, research evaluating the campaign is done throughout the course of the campaign to catch any problems as early as possible. All messages must be copy tested to ensure that they are understood and that they resonate with the audience. Copy testing involves presenting audience members with the messages and creative executions before the campaign launches.
This can be done with focus groups and surveys. Then, campaign planners need to survey the audience during the campaign to make sure that they are learning the message and that the message is having the desired outcome. Finally, when the campaign ends, the campaign can be evaluated to see if it had the desired result and if it should be continued or if major changes should be made to the communication approach.
Process research assesses the campaign as it unfolds to ensure that the messages and the media connect with the target audience (Atkin and Freimuth 2013). If there is a problem with a message or a medium during the course of a campaign, certain aspects can be tweaked to ensure that there is a good fit between the audience and the message.
Campaigns can be evaluated in a variety of ways that may include memory tests, persuasion or motivation tests, and inquiry tests that measure the number of re- sponses to a campaign. In addition to testing the messages, campaign evaluation can assess media effectiveness and return on investment or ROI (Moriarty et al. 2009).
20 E. C. Crawford and C. C. Okigbo
are social marketing and social norms campaigns. The two approaches can be used interchangeably or exclusively.
Upstream Approaches
Instead of directly targeting a particular audience, sometimes health campaigns tar- get individuals that have interpersonal influence, or those who can create change through their relationship with the target audience. Another benefit of targeting this group is that opinion leaders or interpersonal influencers are more likely to have the ability to reform environmental factors that can shape behavior or influence policy and groups that work at the national or community level (Atkin and Rice 2013). An- other benefit of influencing opinion leaders first is that the campaign can be more proactive because it causes something positive to happen instead of simply respond- ing to a problem or crisis after it has occurred. It also encourages policy makers to take responsibility for health issues that affect the public (Lavack et al. 2008).
However, upstream initiatives might be necessary for downstream efforts to be effective (Kelly et al. 2005). In addition, many campaigns target the upstream audi- ence first and then focus their attention on the downstream audience. It is often best when campaigns involve both upstream and downstream elements.
Urban Nutrition Campaign in Oakland, CA: A group of public health profes- sionals were concerned about nutrition in urban areas of Oakland, California. To increase local awareness of healthy eating habits, they designed an educational pro- gram to increase fruit and vegetable consumption. However, when the campaign planners realized that the audience could not buy healthy food owing to the lack of grocery stores and farmers’ markets in the targeted neighborhood, the health profes- sionals decided to work with the local government. The local officials convinced Safeway to open a large grocery store (Bournhonesque and Mosbaek 2002). The public health professionals needed to focus upstream first to create the commu- nity change that would allow the neighborhood access to healthy food. After creat- ing this environmental change, public health officials could focus on educating the community about nutrition. A health campaign targeting local residents would have been wasted if the upstream audience had not been reached first.
International Urban Wellness Campaign: Urbanization is one of the biggest health challenges for the twenty-first century. Since 2007, half of the world’s popu- lation has been living in cities. By 2030, six out of ten people will be living in urban areas. Urbanization is related to many health issues such as clean water and envi- ronment, injuries and violence, disease, unhealthy diet and inactivity, and substance abuse. To help create a healthier urban environment, the World Health Organization (WHO) developed the campaign “1000 Cities, 1000 Lives” in 2010 to address issues related to urbanization and health. For the “1000 Cities” portion of the campaign, the WHO called upon city officials to open public spaces to health for one day in April. Cities around the world were encouraged to promote activities in the parks, conduct town hall meetings, engage in clean-up campaigns, and close off streets to
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motorized vehicles. Individual citizens were then encouraged to provide stories of urban health champions for the “1000 Lives” portion of the campaign (WHO 2010).
Downstream Approaches
A social marketing or public communication approach focuses on a health orga- nization’s need to be aware of and responsive to the audience’s needs and relies on more public relations efforts to promote its messages. While initiatives can be launched by public health professionals, the efforts are made in response to spe- cific needs, designed to meet those needs, effectively satisfy the needs, and are monitored to ensure that they continue to meet those needs (Lefebvre and Flora 1988). Social marketing campaigns work to impact voluntary behavior and change attitudes in order to improve personal and public welfare. To achieve this goal, the campaigns focus on the benefits of adopting a given behavior and reducing barriers that impede an audience members’ ability to change a particular behavior (Glanz et al. 2008). Social marketing adopts the 4Ps (product, price, placement, and promo- tion) to address behavior, costs, location, and method, respectively (Glassman and Braun 2010).
As useful as the social marketing approach is, it can also have drawbacks that may include lack of clearly defined objectives, poor definition of target audience, and some health organizations focusing more on their own needs instead of the audience’s needs (Lefebvre and Flora 1988).
According to the social norms approach, a person’s social environment provides important cues related to health behaviors. Most people easily reject behaviors that jeopardize others; however, certain negative health-related behaviors can be ad- opted because they only jeopardize the self. Social norms campaigns are designed specifically to reduce undesirable behaviors among members of a target audience and they can be helpful in reducing those behaviors that cause self-harm.
A social norms approach is based on two principles, which are that many people overestimate the popularity of certain undesirable behaviors among their peer group and then use their perception of peer norms as a standard by which they can evalu- ate their own behavior. Social norms health campaigns work to reduce unhealth- ful behaviors by correcting the audience’s perception of the occurrence of certain behaviors. Although norms are not laws that govern society, they have significant power over individuals and their social groups. For instance, descriptive norms, or the perception of prevalence of a behavior or group of behaviors, are the primary norming devices that social norms campaigns use to influence their target audiences (Cialdini et al. 1991). Descriptive norms are especially influential in motivating decisions to engage in decisions that adversely influence health such as high-risk drinking.
22 E. C. Crawford and C. C. Okigbo
In spite of the popularity of social norms campaigns, they often achieve mixed results. In fact, some research shows that social norms campaigns can actually increase the undesirable behavior that they intended to reduce (Perkins et al. 2005).
One reason for this is that people want to adopt the normative behavior. In the case of alcohol consumption, many college students do overestimate the prevalence of drinking on campus. However, between one-fifth and one-half of the college stu- dents underestimate the occurrence of drinking behavior. Therefore, a social norm- ing campaign could increase drinking among these students (Schultz et al. 2007). On many American campuses, there are illustrative health communication campaigns that encourage responsible drinking choices using campus media such as newspa- per ads, posters, electronic bulletin boards, flyers, banners, carabineers, and radio (Dartmouth College Health Services 2013). A social norms campaign approach as employed by the state of New Jersey, Hobart and William Smith Colleges, and the US Departments of Education on selected middle school (grades 6 to 8) students us- ing print media posters as the primary communication vehicle resulted in significant reduction in school bullying. The results from this campaign demonstrate that social norms campaigns could be a promising approach for reducing bullying at school (Perkins et al. 2011).
Conclusion
Although creating effective health communication campaigns can be challenging, an understanding of the campaign planning process, health campaign research and theory, and the target audience can increase the odds of success. In addition, in- tegrating research throughout the campaign process can help campaign planners develop messages that will resonate with the public and ensure proper coordination among sources, channels, audiences, and communication content.
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