On Monday of this week (January 29, 2001), I [Jodi Thesenevitz] had the pleasure of attending one of the workshops in The Health Communication Unit's (THCU) annual Special Topics series - Evaluating Public Service Announcements. The facilitator was Dr. Charles Atkin, professor and chair of Michigan State University's (MSU) Department of Telecommunication. He teaches and conducts research on mass communication campaigns, particularly in the health domain.
I found the content of Dr. Atkin's three-hour presentation very rich and practical, and I am excited about sharing some of his main points. It was REALLY hard to choose which information to present in this bulletin, because ALL of it is enormously valuable. If you are interested in receiving the full document, or have any questions, please contact me at THCU (416-978-1188 or by email at [email protected]).
B. Selecting Clear and Realistic Objectives
PSA's are generally developed for one of three reasons: to prevent a behaviour from starting; to stop a behaviour (cessation); or to encourage adoption of a new behaviour.
This is difficult to accomplish, as changing behaviour is a complex process. In addition to increasing awareness and knowledge about a problem, you must convince a person that the problem is relevant to them, then change their beliefs, attitudes and often core values.
Finally you must bring them to the point where they intend to change their behaviour and give them the skills to carry it out.
Mass media behaviour change is even more difficult to accomplish. Many years of experience has shown that even in large, expensive, carefully controlled and monitored campaigns, getting people to change their behaviours by trying to impact on the intermediate steps on the way to behaviour change (awareness, knowledge, perceived relevance, beliefs,
attitudes, values, behavioural intentions, skill building), is challenging. Current research shows that, very rarely, are we having any effect on behaviour, and when we are, it is limited.
Dr. Atkin divides all messages into three types: persuasion, instruction and awareness-raising. The first two are the most difficult to accomplish using mass media. Persuasion messages include attempts to impact on beliefs, attitudes, values, behavioural intentions and
behaviours themselves. Instructional/skill building messages are also difficult, as time is limited and the interaction necessary to correct mistakes and answer questions is not available. The final type is awareness-raising. Dr. Atkin suggests a focus primarily on
awareness-raising PSA's, since they are the most likely to show an effect, and can prepare the audience for future, non mass media messages that focus on skill building or persuasion.
Here are a few examples of suitable objectives for awareness-raising PSA's.
* Create recognition of a topic or practice.
* Convey that the health problem is important.
* Convey simple forms of new information regarding the health topic.
* Trigger activation of a behaviour change among favorably disposed audiences.
* Foster compliance with social influences or policies.
* Stimulate interpersonal communication about the topic.
* Encourage further information-seeking about the topic.
* Sensitize individuals to subsequently encountered messages (outside the campaign).
There is evidence to show that working with the mass media to indirectly reach the audience may have more potential for affecting behaviours. For example, it may be more effective to target influential community members, or opinion leaders, who can act as role models to the group who actually needs to change.
The media might also indirectly change behaviour by affecting public opinion and the minds of legislators, who can implement public policies.
Many public health academics and practitioners are starting to put a greater emphasis on working with the media to cause behaviour change through these indirect pathways, instead of directly targeting the audience whose behaviour they wish to change.
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C. Choosing a Specific Focus Audience
Focus audiences should be defined as narrowly as possible, as the more alike members of the audience are, the more likely they are to respond similarly to a given PSA. It is also important to identify relatively receptive groups that are more amenable to influence, and to consider whether your focus will be those whose behaviour you want to change, opinion leaders, or policy-makers.
Keen attention should be paid to the focus audience's needs and preferences as the PSA is developed and distributed. Audience members should be consulted at the outset (formative evaluation) to gather input for message design. Preliminary versions of messages should be tested to determine potential barriers to success, and audience outcomes should
be carefully assessed to determine overall effects and isolate key contributing factors.
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D. Creating a Potent Message: Qualitative Features
To be successful, a PSA must first grab the attention of the intended audience. Then, the key message must be retained in the minds of the audience. To do this, it must use an appropriate type of appeal/incentive; use an appropriate messenger; be credible; be
understood and be considered relevant by the intended audience. Mechanical construction and creative execution of the message, are also important factors.
i) Choosing appeals/incentives
Present message content that links the desired health behavior to valued attributes or consequences that serve as positive incentives (or that links the unhealthy behavior to negative incentives). Appeals should build on existing values of the target audience.
There are many types of incentives including physical well-being, time/effort, economic, psychological, and social. The most frequently used type is physical health. Unhealthy outcomes (e.g., illness, injury, and premature death) tend to be featured more often than positive ones such as lengthy lifespan, wellness, and fitness.
There are dozens of motivational appeals along other dimensions. Drug campaigns can present negative appeals about looking uncool, alienating friends, peer disapproval or, losing trust of family. Psychological incentives might include low grades, feeling lazy, losing control, bad decisions, and anxiety. Economic incentives related to drugs are diminished job prospects, fines, cost of drugs, and less money.
People are most motivated when they believe there is a high likelihood that they will suffer a very painful consequence. In addition, threatening messages are generally more successful if the message provides instructional material demonstrating how to perform behaviors and boosting the confidence that the individual can do so successfully and material convincing the individual that the recommended behavior will reduce the danger.
When the designer is unable to offer any incentives that genuinely link a severe outcome with high probability, the next best approach seems to be to select a less severe, but likely result. In the case of drug campaigns, these might be loss of stamina, weight gain, or addiction.
Campaigns should present positive incentives (e.g., avoiding drugs or enjoying a drug-free lifestyle, being cool, gaining approval and respect).
Rather than relying on a handful of incentives in a public service campaign, it's advantageous to use multiple appeals across a series of messages to influence different segments of the target audience.
For messages about familiar health subjects, it is important to include some new appeals to complement the standard arguments.
It is often necessary to provide evidence supporting claims made in the message. The message should demonstrate how the evidence is relevant to the audience.
Special care should be taken with extreme claims that may strain credibility.
ii) Selecting a messenger
The messenger appears to deliver information, demonstrate behavior, or provide a testimonial. The source messenger (celebrity, official, expert, leader, ordinary person) is helpful in attracting attention, personalizing abstract concepts by modeling actions and consequences,
bolstering belief due to credibility, and helping people to remember the message. More information about this topic is available in the full article.
Credibility is the extent to which message content is believed to be accurate and valid. The trustworthiness and competence of the messenger and convincing evidence convey credibility.
Understandability contributes to processing and learning. Present materials in a comprehensive manner that is simple, explicit, and with enough detail.
To influence behaviour, the message must be applicable to the audience's situations and needs.
vi) High Quality Mechanical Construction
Technical aspects of message production are used to help attract attention, comprehension and retention. Atkin (1994) discusses guidelines for constructing key elements including theme, continuity, verbal copy, arrangement, dimensions, a-v factors and production quality.
vi) High Quality Creative Execution
Engaging styles and ideas help attract attention, and can augment the other key message qualities. Here are basic guidelines:
* Effectively use entertainment approaches for increasing the message attractiveness.
* Clever stylistic devices are a hallmark of health messages.
* Vivid presentation styles are helpful in communicating with low-involvement audiences.
* Realistic and personalized content enables the audience to relate it to their own experiences.
* A serious tone is the safest strategy for substantive arguments, provided it is not boring.
* The rational style is best suited for audiences who are already perceive a problem and are seeking a solution.
* Emotional appeals tend to work better in arousing drives and intensifying motivation
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E. Selecting Appropriate Channels and Vehicles
Campaign designers have a remarkably wide array of options for channeling health messages. There are myriad advantages and disadvantages of each channel and vehicle, assessed along a number of communicative dimensions (including reach, specialization, safeness, participation, depth, credibility and many more).
When disseminating health messages, designers most commonly rely on television, radio, newspapers, and printed materials, especially broadcast spots, press releases, and pamphlets. A more diverse variety of channels, and vehicles may produce impressive results. Atkins outlines some key advantages and disadvantages of 24 channels and modes in several resources (more information available in full article).
Some health campaigns have secured sufficient funds to support paid advertising (usually TV spots). However, most campaigns with limited funds face other weaknesses of conventional options. Four promising alternatives can be implemented at relatively low cost and potentially high exposure and impact:
* Applying creative public relations techniques in news and information media.
- aggressively placing guests on talk shows, regularly feeding the feature writers with compelling story ideas, and creatively staging pseudo events
* Embedding health messages in popular entertainment vehicles.
- quite successful in promoting health in Africa, Asia, and South America (Singhal and Rogers, 1999), but used sparingly in North America;), has considerable promise.
* Developing and promoting content in technologically advanced interactive channels.
- Web sites and CD ROM disks offering a wide array of health materials; the interactive capacity of these technologies offers a promising advance; particularly well suited for youth
* Utilizing the mini-media that are overshadowed by the glamour of broadcast media.
- Secondary media such as billboards, posters, flyers, banners, comic books, table tents, theater slides, bookmarks, buttons, shirts, and bumper stickers
For more information on these alternatives please contact THCU for the longer workshop paper.
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The elusive ideal in health campaigns is the magic bullet, where the right message appeal is sent through the right channel to the right target audience with impressive effects. Wallack (1989) refers to this unlikely scenario as the "media fantasy". However, a large amount of
messages must be disseminated in order to achieve meaningful impact.
Substantial quantity is usually a necessary condition for effective campaigns.
A good dissemination strategy considers the volume of messages, the amount of repetition, the prominence of placement, and the scheduling of message presentation.
* A substantial volume of PSA's is needed to attain adequate exposure. Maximum saturation conveys significance of the problem.
* Moderate repetition of specific PSA's may be needed to process the message, but high repetition leads to wearout and diminishing returns.
* Prominent placement of messages within media vehicles (e.g., prime-time, back page) enhances both exposure levels and perceived significance.
* To provide a common thread unifying the varied messages, the campaign needs continuity devices (e.g., logo, slogan, jingle, messenger).
* Scheduling is key; depending on the situation, campaign messages may be most effectively concentrated over a short period of time, or distributed in bursts or "pulsing".
* Finally, the overall duration of the campaign combines elements of volume and scheduling. For many health domains, a sustained campaign lasting at least one or two years may be required to achieve significant impact on behaviours.
The realities of health promotion and prevention often require exceptional persistence of effort over long periods of time. Perpetual campaigning is often necessary because focal segments of the population are in constant need of influence. There are always newcomers who are moving into the "at risk" stage of vulnerability, backsliders who are reverting to prior misbehavior, evolvers who are gradually adopting the recommended practice at a slow pace, waverers who are needing regular doses reinforcement to stay the course, and latecomers who are finally seeing the light after years of unhealthy habits.
Unfortunately, the limited resources available for most public service campaigns greatly restrict the quantity of messages disseminated. Among the campaigns that are described in the published literature, very few involve dissemination of a large sustained quantity of messages in mass media channels. This problem applies to many campaigns that are backed with resources to pay for time and space in the media. Presumably, meager quantity is even more of a problem for the vast majority of campaigns.
To maximize quantity, campaigners need to diligently pursue monetary resources from government, industry or association sources to fund paid placements and leveraged media slots, to aggressively lobby for free public service time or space, to skillfully employ public relations techniques for generating entertainment and journalistic coverage, and
to utilize the low-cost Internet channel of communication. Moreover, pseudo-quantity can be boosted by sensitizing audiences to appropriate content already available in the media and by stimulating information-seeking from specialty sources.
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Thank-you, once again to Dr. Atkin, for taking the time to share his research and generously giving us permission to distribute the content of his presentation.
Jodi Thesenvitz, on behalf of The Health Communication Unit