Health Promotion

Media Campaigns Think of as many slogans as you can from health promotion campaigns (3 min)

There are three methods of health promotion: Media campaigns Legislation Fear arousal In today’s lesson we will be looking at media campaigns and the research that indicates they are effective. Why is it important that we have evidence to demonstrate the effectiveness of health promotion by the media?

What are the common means of getting health messages across to the general public? Radio adverts (informational and jingles) Television adverts Posters Leaflets Major sporting events sponsorship Magazine/newspaper articles Speakers go into schools etc.

A Scottish media campaign on drink driving showed that the numbers of people drinking at home between August 2006 (before the campaign) and December 2006 (after the campaign) did not change significantly. However, there was a gradual decline among those who claimed to drink at home at least once a week from 75% in December 2005, to 73% in August 2006 and 71% in December 2006 (Scottish Government, 2007). What can you conclude from this media campaign? Some campaigns do not work as they result in change of attitude which does not result in a behavioural change

Television Campaigns https://www.youtube.com/watch?v=48Dc7bqU_Dg Do you think it is effective? How could you test the effectiveness of this type of advert? http://psychyogi.org/cowpe-c-1989-media-campaign/

Methodology: A quasi experiment where a media campaign was shown in 10 UK television areas between 1976 and 1984. An analysis of the number of chip pan fires reported to the fire brigade between 1976 and 1982. Two quantitative consumer surveys to see if the people had an awareness of chip- pan fire hazards.

Procedure: There were two television campaigns, one called overfilling and the other, in-attendance. Each were 60 seconds long and showed the initial cause of the fire and how to put it out. Three of the 10 areas were shown the campaign a year later. The number of chip pan fires was analysed for each area.

Findings: The net overall decline in each area over the 12 month period was between 7 and 25%. The largest decline was during the campaign. IN one area there was a decline of 33% during the campaign, 17% 6 months afterwards and 15% over the next 15 weeks. ‘Overlap’ areas, which received two television stations showed the least impact. Questionnaires showed an increase in the awareness of chip pan fire advertising and the mention of a chip pan fire being a danger increased.

Conclusions: The advertising proved effective as shown by the decline in chip pan fires. The behaviour change is seen more during the campaign and decreases over time. The individual is less likely to be influenced by the comparison if overexposed to it- living in overlap areas.

Evaluation Methodological issues? Social desirability bias Self-report measures- not wanting to be seen as being ‘dangerous’ Not all fires are reported If the person puts the fire out themselves Ecological validity A real advert on TV Usefulness Being informed gave people power to act in dangerous situations

Bicycle helmet laws and educational campaigns Legislation Bicycle helmet laws and educational campaigns

Legislation - background Is a law of set of laws that have been enacted by a legislative body (Parliament) How does this work? How is this helpful? Relate to health? Health can be promoted in this manner. Any examples? 2007- Smoking ban in all enclosed and public spaces Legal age to buy cigarettes

Discuss – Legislations vs. educational campaigns Is legislation an effective means of encouraging healthy behaviour?

Aim: To review the impact of the passing of a law promoting cycle helmet wearing in children.

Methodology: A natural experiment – data collected by survey (children answered the questions with help from parents) Howard County, Maryland, USA, requiring children under 16 years of age riding bicycles to wear a helmet. Independent design as children automatically fell into one of 3 counties. (Howard County, Montgomery County and Baltimore

Participants: Children from 47 schools in Howard County and 2 control groups; Montgomery county where a bicycle helmet law was already passed. Baltimore county Age ranges were; 9-10 years, 12-13 years and 14-15years. 7322 children were sent questionnaires.

Details Howards county – brought in the legislation Montgomery – used extensive educational campaigns Baltimore – acted as control. No particular measures to increase helmet use.

Procedure: A questionnaire was sent out, containing a 4-point likert. Topics covered by the questionnaire; Bicycle use Peer pressure Awareness of the law Helmet ownership

Findings: Response rates were between 41 and 53% across the age ranges in all 3 counties. Howard county (legislation passed) - Reported bicycle helmet usage increased from 11.4% to 37.5% after the passing of the law Montgomery (educational) 8.4 to 12.6% Baltimore (control) 6.7% to 11.1% The self report method used here correlated with an observational study by Cote et al (1992), which found similar rates of cycle helmet usage

Conclusions: Although many children did not routinely wear a helmet, Howard County did show a significant increase in the reporting's of helmet wearing. The area using educational campaigns was not significantly different to the area using no campaign. Passing legislation is more effective than using educational campaigns alone and educational campaigns are not necessarily effective at all.

Issues: Had a control group Generalisability Ecological validity Shows the difference that the legislation campaign makes Not due to chance Generalisability Large sample – 7322 children From USA only Ecological validity Legislation was passed in natural environment Social-desirability bias Self-report Do not want to be seen as breaking the law

Debates: Usefulness Legislation has more of an effect on promoting healthy behaviours than educational campaigns Shows how educational campaigns are not significantly different to no campaign Free will vs Determinism – does society have the right to override our free choices?

In class – peer mark activity How has legislation been used as a method of health promotion? (10)

H/W Peer mark the 10 marker on Legislation using this mark scheme and the scheme from your folders.

The effects of fear arousal Janis and Feshbeck The effects of fear arousal

Key facts about dental health Worldwide, 60–90% of school children and nearly 100% of adults have dental cavities. Dental cavities can be prevented by maintaining a constant low level of fluoride in the oral cavity. Severe periodontal (gum) disease, which may result in tooth loss, is found in 15–20% of middle-aged (35-44 years) adults. Globally, about 30% of people aged 65–74 have no natural teeth. Oral disease in children and adults is higher among poor and disadvantaged population groups. Risk factors for oral diseases include an unhealthy diet, tobacco use, harmful alcohol use and poor oral hygiene, and social determinants.

A fear appeal is...... a persuasive message which emphasises the harmful physical/social consequences of failing to comply with the recommendations of the message

The HEALTH BELIEF MODEL suggests that perceived threat is necessary for a person to change their behaviour. The most obvious way to introduce this threat is through FEAR APPEALS. Think about recent anti-smoking campaigns, healthy eating, and drink driving…. The list is endless! What we need to ask ourselves is how EFFECTIVE these appeals are.

What do you think of the following?.............. Consider whether each one is a mild, moderate or strong fear appeal. Why? Would it alter your behaviour? Why or why not? What emotions does it arouse for you?

1

2

3

4

5

6

HEALTH PROMOTION A classic study into the use of fear in health promotion was carried out by Janis and Feshbach in 1953 who devised a study looking at promoting oral hygiene.

AIM: To study the motivational effects of fear arousal in health promotion PARTICIPANTS The entire freshman year of a large Connecticut high school, average age 15 years. METHOD: 4 groups of Ps. 3 were given a 15 min lecture on tooth decay and oral hygiene.

Strong fear appeal GROUP 1 were given a They received pictures and descriptions of diseased mouths, including explanations about the pain of tooth decay and gum disease and awful consequences like cancer and blindness.

moderate fear appeal GROUP 2 were given a They received similar pictures and descriptions but they were much less disturbing and dramatic.

GROUP 3 were given a lecture about teeth and cavities - But without referring to very serious consequences and using diagrams and x-rays rather than emotive pictures. This is a MINIMAL FEAR APPEAL

Highest appraisal BUT “horrible” Janis and Feshbach LECTURE FORM STRONG MODERATE MINIMAL CONTROL INCREASED ANXIETY INFORMATION AQUIRED APPRAISAL OF COMMUNICATION CHANGE IN HEALTH CARE 42 % increase 24 % increase 0% increase No difference No difference No difference No difference Highest appraisal BUT “horrible” Lowest appraisal 8% increase 27 % increase 36% increase 0 % increase

CONCLUSIONS; The strong fear appeal created the most worry in the students and was rated as more interesting. BUT The overall effectiveness of a health promotion campaign is likely to be REDUCED by the use of strong fear appeal. It produced the least change in behaviour.

Aims: To investigate the consequences on behaviour and emotions of fear appeals in health promotions.

Methodology: A lab experiment showing fear arousal material. Data collected through questionnaires on emotional reactions and changes in dental practice. Independent measures including the same speaker and same content on the causes and preventions of tooth decay.

Procedure: Questionnaire given one week before the lecture on dental health. A 15 minute illustrated lecture delivered in a standard manner by the same lecturer. Questionnaire handed out immediately after the lecture asking about emotional response to it. A follow up one week later about the long-term effects.

Findings: All lectures conveyed the required information and there was no difference in the amount of knowledge on dental health in the 3 groups. Strong fear appeal was seen in a positive light and a high level of dislike was reported. Moderate and minimal arousal has increased brushing by 44 and 50% whilst strong fear arousal only increased by 28%. Necessary

Conclusions: Fear appeals can be effective in changing behaviours, but the level of fear must be right for each audience. Minimal fear was the most effective with the highest conformity rate to recommended practice.

Issues: Generalisability Social desirability bias Control group Only from one school Social desirability bias Self report Relied on participants being truthful about behaviour change Control group Changes were due to health promotion and not chance Independent measures design Participant variables

Debates: Usefulness Ethnocentrism Showed how a minimal fear appeal is the best option Fear arousal should be tailored to the audience Ethnocentrism All from one school

Health Promotion Task 1: You will be given one of the three methods of health promotion. Your task, in pairs, is to: Choose an issue Design a media campaign/suggest legislation/method of fear arousal for that issue Ext: evaluate your design

Comparison of issues & debates Task 2 Issue/debate Media Legislation Fear Ecological validity Reliability Usefulness Free will/determinism Reduc/holism Nature/nurture Quan/Qual Methods

Exam questions January 2011 How can fear arousal be used as a method of health promotion? (10) Assess the effectiveness of methods of health promotion. (15) June 2011 Describe one piece of research into media campaigning as a method of health promotion. (10) Discuss the ecological validity of research into methods of health promotion. (15) January 2013 How has legislation been used as a method of health promotion? (10) To what extent is research into methods of health promotion limited. (15) June 2014 How can media campaigns be used to promote healthy behaviour? (10) Evaluate strengths and weaknesses of research into methods of health promotion. (15)