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What We're Reading Archive

Communication (updated with September 2006 reviews)

Audience Analysis (updated with September 2006 reviews)

Evaluation (updated with November 2005 reviews)

Policy Change and Media Advocacy

Planning (updated with August 2006 reviews)

General Health Promotion (updated with July 2006 reviews)

Communication

Fear works, but only if there is a way out
September 2006

A test of two health risk messages about meningitis confirmed previous research showing that even a marginal amount of threat combined with easily implemented solutions may be sufficient to move individuals toward action.

Fore more about fear appeals, check out our Infopack on understanding and using fear appeals: Understanding and Using Fear Appeals for Tobacco Control.

Gore, T., Campanella Bracken, C. (2005). Testing the Theoretical Design of a Health Risk Message: Reexamining the Major Tenets of the Extended Parallel Process Model. Health Education & Behavior 32:1.

Improving health education brochures
September 2006

This article studied professional writers’ use of a series of principles in making editorial changes to brochures. Use of the principles varied widely between editors. Of greater interest to those of us involved in actually writing health communication messages, are the principles themselves, hich include

• Using headings and subheadings to assist with text comprehension;
• Including a brief explanation of the link between new sections and the previous section;
• Repeating key words throughout the text, rather than introducing synonyms that may confuse the reader;
• Replacing ambiguous pronouns (e.g., it, they, this, that, who, etc.) with descriptive nouns or phrases;
• Providing descriptive elaborations, especially for jargon and unusual terms;
• Presenting information in a logical order, starting with information that is already familiar to the audience; and
• Using active, rather than passive sentence structures.

A good checklist for all of us!

Kools, M., Ruiter, RAC., van de Wiel, MWJ., Kok, G. (2004). Increasing Readers’ Comprehension of Health Education Brochures: A Qualitative Study into How Professional Writers Make Texts Coherent. Health Education & Behavior 31:6, 720-740

Reaching the Unhealthy Eater
September 2006

Citing evidence from the 1999 DDB Needham Lifestyle Study, the author argues that although a great deal of money goes into print advertising on the topic of healthy eating, unhealthy eaters tend not to attend to this type of media. Television, radio and Internet, in particular with entertainment education approaches, are suggested as having a higher probability of success.

Dutta-Bergman, MJ. (2004). Reaching Unhealthy Eaters: Applying a Strategic Approach to Media Vehicle Choice. Health Communication 16:4, 493-506

Grossing them out can be effective
September 2006

If you are concerned about the ever safe and "politically correct" often taken with public health ads, you may be on to something.

A test of 50 television ads (tobacco control, pharmaceutical, and tobacco industry ads) with youth in grades 8, 10 or 12 showed that more viscerally negative messaging (for example, one ad shows various shots of diseased body parts and skulls in a scene where a teen puts his head in a toilet bowl) was associated with greater recall, engagement (how much they had thought about the ads and how much they had discussed them with friends and family) and positive appraisals about the ad. Personal testimonials also scored well.

Not surprisingly, these characteristics were found only in the tobacco control ads and not in the pharmaceutical and tobacco industry ads.

Terry-McElrath, Y., Wakefield, M., Ruel, E., Balch, GI., Emery, S., Szczypka, G., Clegg-Smith, K., Flay, B. (2005). The Effect of Antismoking Advertisement Executional Characteristics on Youth Comprehension, Appraisal, Recall and Engagement. Journal of Health Communication 10, 127-143

Pretesting ads--a critical phase, especially with youth
September 2006

After using Web TV to test 3 advertisements with 905 adolescents, between 13 and 18, in their own homes, researchers concluded that

1. Repeated exposure is an important determinant of how well ads are received. In particular, multiple exposures may be more important for complex messages.
2. High-risk youth (for this study, defined as older teens, “sensation-seeking” youth, and those intending to smoke or who have already experimented) do not respond well to directive messaging. They may perceive such messages as “a threat to their freedom to act independently.”
3. Formative and process evaluations are critical for ensuring that psychological reactance, particularly among youth, does not derail a campaign.

Niederheppe, J., Hersey, J., Farrelly, MC., Haviland, L., and Healton, CG. (2005). Comparing Adolescent Reactions to National Tobacco Countermarketing Advertisements Using Web TV. SMQ 11:1.

Using TV effectively
August 2006 Review

In the August 2005 issue of Marketing, Dave Scholz and Jean-Marc Leger report on a pan-Canadian survey completed in June 2005 on TV ad effectiveness. Among their findings was that more Canadians respond (by purchasing) after seeing a newspaper ad than after a television ad. Radio and billboards resulted in a markedly lower response than both newspaper and TV (please note, these are self-report measures).

So what does work on TV? Survey respondents indicated that they

• prefer shorter ads, preferably 30 seconds;
• prefer a product to be revealed at the beginning of a commercial, rather
• than waiting until the end; and
• prefer to see an ad only once during a television program.

Scholz, D., Leger, JM. (2005) Short, sweet and to the point. Marketing. August 15.

Blue but fit
August 2006 Review

Quebec has a new health and fitness promotional campaign. At the heart of it is a blue -- like the Quebec flag -- character named Vasy. For those of you who failed French class, vas-y translates to "Go!"  Vasy is charged with inspiring the public to rediscover the pleasures of exercising and eating well over the next three years.

Despite a few jokes about Vasy’s blueness, the government website assures that he is in excellent shape!

To learn more about the campaign, please visit http://www.vasy.gouv.qc.ca/index_en.html.

Marketing in virtual space
August 2006 Review

Forget billboards, commercials, and magazine ads--reach youth in their virtual world.

Habbo Hotel is a virtual space that simulates a hotel setting.  Visitors create characters that are able to interact with others online as if they were guests in a real hotel.  They are able to explore the hotel, chat, and play games.  Guests are also able to furnish their own virtual rooms by collecting tokens to purchase furniture and other items.

The Canadian Habbo site gets about 300,000 visitors every month. Commercial marketers, such as Sprite, are already building their products into this virtual environment and seeing great increases in sales. Products can be purchased within Habbo and the marketing continues on fan sites, discussion forums, and blogs. 

If commercial marketers can do it, why shouldn't health promoters? Messages can be embedded throughout Habbo Hotel. For one basic example of the potential here, check out this "community news article"-- "Habbo Health, a short guide as written by Ersella."

Project identity – using it the right way
August 2006 Review

An understandably frequent theme in Marketing, branding was addressed again in December 2005. In "Brand 101," Alan Middleton reminds us of some important aspects of brand management. He states that a good brand must be

• relevant and valuable to the target audience,
• continuously improved, and
• integrated into the whole marketing/communication plan.

Though more frequently referred to as project identity in our field, the advice is still relevant.

Middleton, A.  (2005). Brand 101. Marketing, December 5.

Beyond “health” as a benefit
July 2006 Review

We all know that healthy behaviours can be a tough sell. Improved health is simply not enough of a reason to change, particularly when it may take years to see the reward and audiences already have strong feelings about a topic or behaviour.

In this Social Marketing Quarterly article, Bill Smith summarizes the risk communication concept of confirmation bias, noting that when someone already has a strong opinion about something, they deal with new information about that topic in one of four ways:

• If I get some new information, I try to make it fit my previous conception.
• If I get contrary information, I filter it out.
• If I get complex information, I simplify it to fit my previous ideas.
• If I get consistent information, I accept it as positive proof of my original position.

His point is that people are predisposed to remain convinced of a previously held position. This means that we must be very creative about finding ways to associate "less than pleasant" behaviours with something your audience might find more appealing, such as taste, comfort, a loved-one’s well being, adventure, social status, curiosity, or risk.

To help identifying the "ideal" benefits, he suggests completing his Social Marketing Self Audit (found at the end of the article). The audit includes a benefits/barriers analysis matrix:

	Your Product/Service/Behaviour	The Competition
Benefits (e.g., fun, easy, popular)
Barriers (e.g., not fun, difficult, unpopular)

Bill Smith is the Executive Vice President at the Academy for Educational Development (AED) in Washington, DC, where he directs AED activities in behavioural science and social marketing. Additional social marketing tools are at http://www.aed.org/index.cfm.

Smith, B. (2003). Beyond "Health" as a Benefit. SMQ 9:4. 22-30.

Credibility: An essential component of effective messages
July 2006 Review

The idea behind social-norms approaches is that individuals will be more likely to engage in healthy behaviour when they believe "most" others like them are doing so. However, social norms messages must be credible to be effective.

Following a failed drinking social norms campaign, the authors developed a credibility checklist to use before releasing messages. Sample items include

• Are audiences talking about the social norms messages? If not, they may not accept that they are part of the group "norm" portrayed.
• Is the messenger easily identifiable as part of the intended audience?
• Are there sources within the intended audience that will discredit the message? If so, can enough "validating" messages be disseminated to counteract the effect?

Check out THCU’s Health Communication Message Review Criteria (link opens PDF file) for a more complete checklist of message considerations.

Granfield, R. (2002). Can You Believe It? Assessing the Credibility of a Social Norms Campaign. The Report on Social Norms, Working Paper #2. Little Falls, NJ: PaperClip Communications. 1-8.

Correcting false perceptions created by media
July 2006 Review

We all know that the media can knowingly, or unknowingly, spread misperceptions, often through exaggeration or blaming particular groups of people for a situation or lack of action.

In an ideal world, our health communication messages would be supported by media messages. As this is not likely to happen without intervention, the authors in this paper have outlined a media misperceptions detection and correction guide that prescribes antidotes to various types of misperceptions. Examples of misperception and antidote pairs include

• Disproportionately attributing negative qualities to a particular group of people / Giving visibility to positive qualities of the sub-group and recognizing role models
• Overwhelming the public by making the problem too large to solve / Providing skills and suggestions for "baby steps"
• Modeling of false, negative norms by the entertainment industry / Promotion of healthy norms within film and television

This is a nice complement to Larry Hershfield's "Media Voices Model."  Larry, THCUs manager, notes that there are many voices in the media environment. They may come from your immediate circle of friends, the broadest forms of mass media, or anywhere in between (e.g., the workplaces, news). He suggests mapping these voices, which may range from frauds to scientists, for your issue and considering that they vary in weight according to the characteristics of the audience. Once you have a map of the media environment for your issue, develop a strategic response to each "voice," for example

• Support
• Supplement
• Sell (new persuasive messages, social marketing)
• Shape (collaborate with reporters)
• Subvert (e.g., Sdbusters)
• Squash
• Shame (denormalization strategies)

In this way, you can add value to the media environment instead of developing yet another independent campaign from scratch, which may get lost in the "mix."

Linkenbach, J. (2001). Cultural Cataracts: Identifying and Correcting Misperceptions in the Media. The Report on Social Norms, Working Paper #1. Little Falls, NJ: PaperClip Communications. 1-8.

The strength of a brand
July 2006 Review

In case you need more evidence to convince you of the importance of having a strong project identity/brand, this article explains that the Truth Brand not only strengthened anti-tobacco commitment but also warded off other tobacco industry marketing campaigns.

Evans, W., Price, S., and Blahut, S. (2005). Evaluating the Truth Brand. Journal of Health Communication 10, 181-92.

Using Fear Appeals Effectively
November 2005 Review

In our 2000 Infopack, Fear Appeals for Tobacco Control (scroll down to General Resources), we summarized the Extended Parallel Process Model of Kim Witte. One of the most important principles of this model is that scaring people can be useful but only if you provide them with a clear, concrete and easy way to alleviate the fear. Fear alone can cause audiences to block out the message and even do the opposite of what you are recommending. This article reports on a study of meningitis messages that confirms this principle. They found that fear messages were effective, even if they generated only marginal amounts of fear, when combined with high efficacy messages that provided all of the information needed for audiences to act in a way that would alleviate the threat.

Gore, T., Campanella Bracken, C. (2005). Testing the Theoretical Design of a Health Risk Message: Reexamining the Major Tenets of the Extended Parallel Process Model. Health Education and Behaviour, 32:1, 27-41.

Beauty Salons – An Innovative Health Promotion Setting
November 2005 Review

If you’re familiar with THCU’s 12 steps to developing a health communication campaign, you may recall that we recommend setting objectives at some or all of four levels: individual, network, organizational, and societal. In our work, we find that one of the most overlooked levels is the network level.

If you’ve heard of the concept of diffusion of innovations or the recent bestseller The Tipping Point, by Malcolm Gladwell, then you are already aware of the power of discussion among informal social networks to influence health behaviour.

These two papers explored the use of beauty salon staff and the beauty salon setting itself for communicating messages about health – specifically cancer and smoking. They found that in addition to displays and client reading material, by giving staff the information and tools to supplement their natural helping and conversational abilities they were able to affect client changes in behaviour through the provision of

• emotional support (showing empathy, love, trust, caring),
• instrumental support (tangible aid or service),
• informational support (advice, suggestions), and
• appraisal support (information that assists with self-appraisal).

What a great channel to consider for your next campaign!

Solomom, F., Linnan, L., Wasilewski, Y., Lee, A. M., Katz, M., & Yang, J. (2004). Observational Study in Ten Beauty Salons: Results Informing Development of the North Carolina BEAUTY and Health Project. Health Education and Behaviour, 31:6, 790-806.

Linnan, L., Ferguson, Y., Wasilewski, Y., Lee, A.M., Yang, J., Solomon, F., and Katz, M. (2005). Using Community-Based Participatory Research Methods to Reach Women With Health Messages: Results From the North Carolina BEAUTY and Health Pilot Project. Health Promotion Practice, 6:2, 164-73.

Behavioural Branding – An Essential Component of a Health Communication Campaign
November 2005 Review

In the June 2005 edition of What We’re Reading, we reported on a brand evaluation scale that was used for the Truth anti-tobacco social marketing campaign. This follow-up article reports on the finding that an increased association with the Truth brand not only strengthened anti-tobacco commitment but also warded off other tobacco industry marketing campaigns. This further emphasizes the importance of behavioural branding as a public health communication strategy.

Evans, W., Price, S., and Blahut, S. (2005) Evaluating the Truth Brand. Journal of Health Communication, 10:2, 181-92.

Message Testing – Asking the Right Questions
November 2005 Review

Common message-testing questions for focus groups include ‘Do you like it?’ or ‘Which one do you like the most?” We encourage our clients to avoid questions about likeability and instead focus on issues such as comprehension of the message or ability to attract attention. This article is a good example of how questions about likeability can lead you astray.

Though the "Done 4" social norms campaign used a concept ranked as a "favorite" in focus groups, this campaign failed to reach its objectives. Post-campaign analysis revealed that the targeted students did not see the connection between the campaign image and the key message.

For more information on message testing, please see our Message Review Tool.

Russell, C., Clapp, J., & DeJong, W. (2005). Done 4: Analysis of a Failed Social Norms Marketing Campaign. Health Communication 17:1, 57-65.

Effectiveness of Health Fairs
June 2005 Review

Questions about the effectiveness of health fairs and displays come to THCU on a fairly regular basis. Last summer I pulled together a briefing (scroll down to Effectiveness of Health Fairs, Displays and Posters) summarizing what the published (and unpublished) literature says about health fairs and displays. This article focuses mainly on the logistics of developing and managing a successful health fair, but there is a portion of the article that outlines some pre-planning steps, namely setting goals and audiences. This section has the greatest interest for me because doesn’t effectiveness always depend on what your goals are in the first place?

Let’s start with the authors’ definition of a health fair. There are seven components to their definition, but what struck me as most important was that fairs are “part of a strategically planned community health intervention.” They go on to suggest some health fair goals:

• To provide information to a specific population segment
• To provide screenings to a specific population segment
• To trigger specific health actions or behaviour change in a specific population segment
• To increase organizational visibility within a community
• To promote collaboration with key community agencies
• To meet requirement of funders

They then emphasize the importance of being very clear on the audience, including their basic demographics, current health concerns, attitudes toward the topic, and preferred methods of communication.

The rest of the article is about organizational logistics. This isn’t rocket science, but it’s an excellent reminder that displays/health fairs must be strategic and focused, just like any other health communication activity.

Goldman, K., & Schmalz, K. (2004). Top Grade Health Fair: An “A” Fair to Remember. Health Promotion Practice, 5:3, 217–221.

Health Communication and Social Capital
June 2005 Review

Another popular THCU consultation request is how to work the social determinants of health into health communication campaigns (instead of focusing on individual responsibility). Here’s an article that does just that, with social capital – defined as “features of social life – networks, norms, and trust – that enable participants to act together more effectively to pursue shared objectives” (Putnam, 1995).

The point of this campaign was to stimulate behaviours that would provide a more supportive social environment for children and youth. The actual campaign included stories and ads in newspaper and on television over two years. Their rigorous evaluation plan is too complex to describe here, but in general, after years one and two they measured

• recall of the stories and ads,
• number of interpersonal discussions about youth,
• individual levels of awareness about the importance of attention to youth,
• attitudes toward youth,
• opinions on levels of neighbourhood trust in various youth-related situations (attachment to community),
• perceptions about one’s community as a place to raise youth, and
• behaviour toward youth.

They found significant changes in awareness and attitude after year two of the campaign. They found that the television coverage had a direct effect on people but the newspaper coverage affected people indirectly by increasing interpersonal discussion about the topic. They also found that it was the newspaper coverage that drove the rise in attention to youth, attachment to community, and attitude toward youth. They conclude that social capital can be increased through media efforts. The evaluation survey questions are provided at the end of the article.

Thorson E., & Beaudoin, C. (2004). The Impact of a Health Campaign on Health Social Capita. Journal of Health Communication, 9, 167–194.

Writing Well
June 2005 Review

Writing is a large part of my professional work as well as a hobby of mine (well, it was prior to the birth of my young son anyway – I hope it will be again someday soon!) so I am always interested in articles about writing well. This one describes a process used to assess and then rewrite a federally mandated report to consumers about the quality of the water. It is a great case study with many tips and lessons for health promotion practitioners. I especially like their table with plain language suggestions for complex terms that we are all guilty of using. Some suggestions include replacing "annual" with "yearly," "evaluated" with "tested," "minimize" with "reduce," and "assistance" with "help." Bigger is not always better!

Rudd, R., Kaphingst, K., Colton, T., Gregoire, J., & Hyde, J. (2004) Rewriting Public Health Information in Plain Language. Journal of Health Communication, 9, 195–206.

TruthSM anti-tobacco campaign
June 2005 Review

Many of you are probably aware of the American TruthSM anti-tobacco campaign. One of the goals of the campaign was to invent a “truthsm brand that would potentially compete for market share with tobacco industry brands...The strategy was to present a brand associated with a smoke-free lifestyle rather than presenting educational public health messages.” To evaluate the brand, the authors developed a scale that is a variant of Aaker’s (1996) Brand Equity Ten. Youth were asked to rate each of the following items on a scale of 1 (strongly agree) to 4 (strongly disagree).

Brand Loyalty

• I’d like to help truthsm get the word out.
• I’d defend truthsm if someone were putting it down.
• I’d wear a truthsm T-shirt.
• If I had the chance, I would tell other kids my age to watch the truthsm ads.

Leadership/Popularity

• Truthsm ads are becoming more popular with kids like me.
• Truthsm ads are for people like me.

Brand Personality

• Would you say that the young people in truthsm ads generally take control of their lives
• Would you say that the young people in truthsm ads generally take risks.
• Would you say that the young people in truthsm ads generally rebel against authority
• Would you say that the young people in truthsm ads generally act independently.
• The kids in truthsm ads are just like me
• The kids in truthsm ads are like the kids I hang out with.

Brand Awareness

• When you think of the truthsm ads, you think: It’s dumb to smoke cigarettes.
• When you think of the truthsm ads, you think: Tobacco companies are trying to get young people to smoke.
• When you think of the truthsm ads, you think: Smoking is not cool.
• When you think of the truthsm ads, you think: Young people have better things to do than smoke.
• When you think of the truthsm ads, youth think: Young people can take action against tobacco companies.

Results showed that the brand did a very good job of communicating these things. I think this testing/evaluation framework has the potential to really spice up the identity development process and move it away from simply developing yet another logo.

Blahut, S.A., Evans, W.D., Price, S., & Ulasevich, A. (2004). A Confirmatory Test of a Higher Order Factor Structure: Brand Equity and the TruthSM Campaign. Social Marketing Quarterly, 10:1, 3–15.

Direct Marketing
September 2004 Review

It’s no secret that tobacco companies are on the cutting edge in terms of audience analysis research. And that includes knowing just what vehicles and channels will engage and influence people. This article outlines the marketing practices of tobacco companies in the US following the Master Settlement Agreement in 1998, which banned billboard advertising, use of cartoon characters, merchandise displaying brand logos, and any advertising or promotions that directly or indirectly target youth. It notes that many of their current strategies “operate out of sight of public health professionals and most of the public, and so go unchecked by either tobacco control advocates or public opinion.” Examples of promotional materials that are sent by direct mail include coupons, slick magazines that look like other mainstream fashion and entertainment magazines but are loaded with tobacco ads, announcements of sweepstakes and sponsored events, free samples, and CDs with music and activities embedded with tobacco logos and messages.

The article suggests that “a first step in countering these practices is to increase awareness and understanding of them, followed by development of strategies to address them and to limit or eliminate their use in tobacco marketing.” I certainly agree, however it also occurs to me that we might also borrow some of their techniques for our own health communication campaigns. Imagine: coupons for $1.00 off broccoli or sweet potatoes, CDs with music by popular Canadian artists with interactive quizzes and tools about physical activity. What do you think?

Lewis, M.J., Yulis, S., Delnevo, C., & Hrywna, M. (2004). Tobacco Industry Direct Marketing After the Master Settlement Agreement. Health Promotion Practice, 5:3, 75S-83S.

TiVo data confirms worst fears
February 2004 Review

We know most of you can’t afford to buy prime time television ad space for your campaigns, and now you don’t have to wish you could! New U.S data, cited in Brendan Christie’s article "TiVo data confirms worst fears" for Strategy Media Magazine, September 2003, shows that ads embedded in the most desirable television time slots are most likely to be skipped because they are being watched on tape where commercials can be fast forwarded. In contrast, time-sensitive programming such as news, sports, event programming, and reality shows tend to be watched live. Only 17% of viewers skipped commercials for these shows compared to 60% of other prime time shows.

The September issue also provided a short demographic and mediagraphic profile of Toronto in comparison with the rest of Canada. Variables discussed included age, income levels, occupation, education, languages spoken at home, radio listenership, local television viewership, and newspaper readership--highly recommended!

Christie, B. (2003). TiVo data confirms worst fears. Strategy Magazine, September. <http://www.strategymag.com/articles/media/20030922/tivo.html> Accessed February 2004.

Social Marketing and Public Health, Lessons from the Field
November 2003 Review

This rich resource from the Turning Point Program analyzes social marketing campaigns on a wide variety of topics (alcohol use, sexual abuse, HIV, nutrition, etc.), determining how well they follow basic social marketing principles (audience segmentation and analysis, the 5 Ps, etc.).  The two-page list of criteria alone is enough reason to have a look at this resource--it's an excellent checklist for anyone working on a communication campaign.  Alas, the case studies are U.S. based, but Canadian organizations have been included in the resources/organizations section.  Click here to access the pdf (717kb). 

Social Marketing National Excellence Collaborative. (2003). Social Marketing and Public Health, Lessons from the Field. Washington: Turning Point National Program Office, University of Washington.

1001 Ways to Wow the Media and Speaking Audiences
November 2003 Review

What else is there to say about this?  Check it out by clicking here.

Walker, T.J. "1001 Ways to Wow the Media and Speaking Audiences." <http://www.tjwalker.com/1001Ways to Wow.htm>. Acessed November 2003.

A Goodman Online -- Communication Resources
November 2003 Review

Andy Goodman publishes a free monthly newsletter called Free Range Thinking. The March 2002 issue contains a great little article called "Creative, Convincing and Cheap" on low budget communication vehicles.

Goodman, A. (2002) Creative, Convincing and Cheap. Free Range Thinking, March. <http://www.agoodmanonline.com/newsletter/archive/2002_03.htm>. Accessed November 2003.

Environmental Education & Communication for a Sustainable World: Media Campaigns
September 2003 Review

In Chapter 11 of this book from the Academy for Educational Development, Peter Sandman describes his environmental communication model, which combines two older models - the educator's model and the advertiser's model for behaviour change.  In his model, behaviour change efforts should start by getting people to perform one initial small behaviour in the right direction - like visiting a recycling depot once.  This might be accomplished by an incentive or superficial motivator of some sort, like money, a social event, or to stop your child from nagging you!  After the initial small step, it is time to introduce the real reasons for the behaviour.  They weren't interested before, but now that they've taken some action, a window of opportunity opens up to reinforce the behaviour.  This is because people feel the need to justify to themselves (and others) why they took action that one time (cognitive dissonance).  Carefully targeted messages can move the audience to longer term behaviour change.  An interesting theory!

Sandman, P. (2000). Media Campaigns. In Environmental Education & Communication for a Sustainable World. Eds. B. A. Day and M. C. Monroe. Washington, DC: Academy for Educational Development. <http://www.greencom.org/greencom/books/eec_handbook.asp>. Accessed September 2003.

Amnesty International Radio Campaign
September 2003 Review

In the July 14 issue of Marketing magazine (sorry, I'm a bit behind on the reading!), there is a brief write up by Pat Pirisi on page 20 about a new Amnesty International (Ottawa) radio campaign designed to "Put Human Rights Back on the Radar for Canadians."  I found the ad online.  In case you don't have the right software to hear it - here's the text:

[Voice with exotic accent]" This is Natal Vorenc, President of Rutakia.  My government would like to express its gratitude to Canadians.  Without your silence, it would be difficult to violate my people's basic human rights.  Thanks to your apathy, I can imprison, torture or kill anyone who attempts to express their religious or political beliefs.  I count on your continued support. [Announcer]: Speak out for human rights.  Join Amnesty International.

The ad was developed by Axmith McIntyre Wicht in Toronto.  I'll be on the lookout for an evaluation!

Marketing Social Marketing in the Social Change Marketplace
September 2003 Review

This article proposes a specific social marketing brand campaign to advance the field of social marketing - using the field's own tools.  After providing a good reminder of the essential components of social marketing and an analysis of the current  barriers to widespread acceptance of the field among health promoters, Andreasen proposes a marketing strategy.  His strategy includes, among other things, positioning social marketing as being complementary to, rather than competitive with community and structural approaches.  He suggests that if barriers to change are at the individual level, then a social marketing approach can play a role in creating awareness and promoting benefits of the behaviour.  If the barriers to change are at the community level, then social marketing can be used to influence key opinion leaders who might then mobilize the community.  If the barriers to change are structural, then social marketing can be used to influence legislators to change policies.  Overall, it is an interesting paper that exemplifies the social marketing process. The article is available online (link opens PDF file, 220kb) via Turning Point.

Andreasen, A.R. Marketing Social Marketing in the Social Change Marketplace. Journal of Public Policy and Marketing, 21(1), 3-13. Available online (link opens PDF file, 220kb) via Turning Point. Accessed September 2003.

Demographic and Psychographic Antecedents of Community Participation: Applying a Social Marketing Model
September 2003 Review

This article proposes the use of demographic and psychographic variables to increase community participation in health promotion initiatives.  In-depth profiles of involved and less involved individuals are developed and include factors such as consumerism, health consciousness, gender, innovativeness, conservatism, opinion leadership, etc. The profiles suggest that communication campaigns intended to increase community participation are not likely to succeed by focusing on the notion of responsibility.  Rather, positioning community engagement as a new way of having fun might draw the attention of previously uninvolved audiences. 

Dutta-Bergmen, M.J. (2003). Demographic and Psychographic Antecedents of Community Participation: Applying a Social Marketing Model. Social Marketing Quarterly, 9(2), 17-31. 

The Truth Campaign's Branding Strategy
September 2003 Review

If you work in the area of tobacco, you may have heard about the American Legacy Foundation's truth campaign - the largest national media campaign every designed to reduce smoking among youth.  They have gone to great lengths to create a truth brand that could compete with tobacco industry brands.  In the fall 2002 edition of Social Marketing Quarterly (pp 17-30) there is a great little article (Evans, Wasserman, Bertolotti and Martino) about how truth's branding strategy works within the context of social psychological theory of attitude and belief formation, and behaviour change.  In the article, they describe the development of a health-related 'brand equity' scale based on a widely used traditional marketing and advertising version.  The authors have evaluated (with youth respondents), the truth brand using this scale.  Results and implications for campaigns on other health-related behaviours is discussed.  This is a keeper!

If the branding topic interests you, I recommend that you also check out the June 2001 issue of Social Marketing Quarterly, as it is entirely on the topic of branding.  Included is a good article on how to develop a brand and an article describing the U.S. Centres for Disease Control identity re-vamping process (2000).  It has many practical insights about audience perceptions of public health work, that can be applied to any organization working on a health promotion issue.

Evans, W.D., Wasserman, J., Bertolotti, E., Martino, S. (2002). Branding Behavior: The Strategy Behind the Truth Campaign. Social Marketing Quarterly, 8:3, 17-30.

Exposure: Theory and Evidence About All the Ways It Matters
September 2003 Review

"There is good evidence that failure and success in public health communication is better predicted by variation in exposure to messages achieved than it in in variation in quality of messages."  In this short article, Hornik backs up this comment with evidence from some of the largest health communication campaigns of the 80's and 90's.  He goes on to explain that there are different ways that exposure may work: increased opportunity for learning specific messages; increases in perception that an issue is important to take into account; increases in the likelihood that social discussion of messages will be stimulated; and increases in the perception that a new behaviour is socially expected.  It may also work by making politicians believe that the high exposure means it has caught public attention and requires money and policy changes.  But how does one get the kind of exposure that is necessary?  Well, if you don't have the money, you either have to beg for it or earn it!  For ideas on earning it, check out our media advocacy workbook or workshops.

Hornik. R. (2002). Exposure: Theory and Evidence About All the Ways It Matters. Social Marketing Quarterly, 3:3, 31-37.

Marketing the Echo Hatchback
August 2003 Review

The July 28/August 4 issue of Marketing magazine has a little article by Chris Powell on page four about Toyota's advertising plan for their new Echo Hatchback.  They will be putting ads on ice machines near gas bars, using Flashmedia posters at convenience stores and installing Floormedia displays inside convenience stores.  These Gallop & Gallop Media Products are apparently ideal to reach the 18-34 demographic which, according to the Print Measurement Bureau, makes 8.9 trips to convenience stores every 30 days.

Powell, C. (2003). Convenient location for Toyota ads. Marketing, July 28/August 4.

Do Pre-Movie Ads Work?
August 2003 Review

THCU clients have been asking us lately about the effectiveness of pre-movie ads.  Well, it's not exactly peer reviewed research, but interestingly the National Cinema Network took out a full page ad in the July 28/August 4 edition of Marketing magazine claiming that 8 out of 10 movie goers, aged 18-49, will remember pre-movie ads the next day.  I'll keep an eye out for any journal articles on the topic!

Media Lions Award Winners
August 2003 Review

The July 28 edition of Strategy Magazine includes a short article by Kristen Vinakmens on the winners of the Media Lions awards at the 50th International Advertising Festival in Cannes (June 2003).  Two of the winners she highlighted are health related.

First was New Zealand's "Bruised Ambassadors" fundraising stunt (for Women's Refuge Annual Appeal).  Prominent women (e.g., mayors) were made up to appear as if they had large bruises on their faces.  They went to work as usual and were told to answer inquiries with comments like "I walked into a door."  At the end of the day emails were sent out to staff telling them about the stunt.  It made the evening news and resulted in 20% more donations over the previous year. Information on their campaigns is archived online.

Second was a Chilean effort to promote seatbelt use.  Disabled people were hired to handout flyers reading "I didn't buckle my seatbelt either" - "Just buckle it."  Apparently 9 out of 10 drivers who received the flyers buckled up right away.  Previous campaigns to promote seat belt use in the area have failed.  Hmmm.  Guess they haven't read Guttman's health communication book on values and ethical dilemmas!

Strategy Magazine didn't report on it, but I found one other health-related winner.  Alabama Tobacco Free Families won in the Best Use of Mixed Media category for an anti-smoking campaign.  The organization is online, but there doesn't appear to be any information about the campaign on the site.  I'm looking into it!

Vinakmens, K. (2003). They Put Ads Where? Strategy Magazine. July 28.

New Media Research
August 2003 Review

I haven't looked into the prices of these reports yet, but the July 28 issue of Strategy Media makes note of some interesting media research which is already available, or soon to be available.  The ones that caught my eye include

• a report by the Print Measurement Bureau on the readership by physicians and specialists of 38 medical publications (call Lina Di Santo/Tosha Haskell at 416-961-3205); 
• a report by ComBase on readership of multi-issue, multi-publication frequency community newspapers (call Elena Dunn at 604-669-0209); and 
• the Summer 2003 Radio Survey by BBM radio on current audience ratings, share and listening location data.

Okalow, S. (2003). New channels poised to cool hot market. Strategy Magazine. July 28.

The "Doublemint" Factor: Issues and Challenges in Marketing Nutrition and Physical Activity Behaviours in One Program
June 2003 Review

So can you cover two "birds" with one campaign?  This article suggests that while it's theoretically possible, it is extremely difficult and generally not advised. In the case of nutrition and physical activity, challenges include the fact that the barriers to, benefits of, and skills required to change can be very different.  In addition, any given audience may be at different stages of change for each behaviour.  If you do decide to try to tackle both at once, the authors recommend (among other things) that you use a clear logic model in the planning phase, to clearly show the path of influence for each, so that you can focus only on common areas.

Fridinger, F., Kirby, S. (2002). The "Doublemint" Factor: Issues and Challenges in Marketing Nutrition and Physical Activity Behaviours in One Program. Social Marketing Quarterly, 3:4, 40-52.

Audience Analysis

Tweens need personal success
September 2006

In order to help “youth develop habits that foster good health over a lifetime, including appropriate behaviors related to diet, physical activity, and avoidance of illicit drugs, tobacco and alcohol,” the United States Congress designated the Centers for Disease Control and Prevention (CDC) to plan, implement, and evaluate a national Youth Media Campaign (YMC). Their formative research with tweens (9-13 years), parents, adult and teen influencers, and industry professionals/prospective partners revealed the following findings:

• Messages for tweens should help them discover their passion. Both involved and uninvolved youth are attracted to messages about self-discovery.
• Intervention strategies should address tweens’ self-esteem by showing the connection between participating in activities and achieving success. “All intervention efforts should be grounded in the theme that participating in activities can help tweens feel good about themselves.”
• Messages targeting parents should focus on how they can help their tweens discover their passion.
• In order to ensure continued relevant to the tween audience, planners should continuously monitor tweens’ needs and expectations, possibly through as many as 250-300 focus groups per year!

Aeeffect Inc. (2005). Excerpts from Research to Support Development of the Youth Media Campaign: Revealing Target Audience Receptiveness to Potential Message Concepts. SMQ 11:1.

In search of young men
August 2006 Review

Wondering where all the men have gone? You must work in public health! (Just kidding).  Seriously, if you are trying to reach males aged 18-35, don’t use TV because they aren’t watching. For ideas on alternatives, check out the “Reaching the Unreachables" in the October issue of Business 2.0 for free for ideas on where to place ads. Entrepreneurs are now offering ad time/space at events (e.g., car shows) and in other vehicles (e.g., online games) designed specifically for this demographic.

Levine, R. (2005). Reaching the Unreachables. Business 2.0. October 1.

Talking to Tweens – What Messages Work?
November 2005 Review

As we’ve previously reported, there is an endless stream of useful research being generated through the U.S. National Youth Media Campaign (YMC) evaluation. This article summarizes the results of formative focus group research with tweens (aged 9-13 years), parents, adult and teen influencers, and industry professional/prospective partners. Researcher conclusions included the following:

• Messages for tweens should help them discover their passion. Both involved and uninvolved youth are attracted to messages about self-discovery.
• ntervention strategies should address tweens self-esteem by showing the connection between participating in activities and achieving success. “All intervention efforts should be grounded in the theme that participating in activities can help tweens feel good about themselves.” Additionally, the idea that everyone is good at something is important for youth with lower self-esteem.
• Messages targeting parents should focus on how they can help their tweens discover their passion.

Experts cited in this paper noted that it is important to continuously monitor tween needs and expectations. They estimate the need for as many as 250-300 focus groups per year to do this properly!

For more information on tweens, please check out our audience analysis profile.

National Center for Chronic Disease Prevention and Health Promotion. (2001). Message Strategy Research to Support Development of the Youth Media Campaign (YMC) Revealing Target Audience Receptiveness to Potential YMC Message Concepts.

Defining the Pink Consumers
September 2004 Review

For those of you struggling to capture useful demographic information in your surveys, the following may be of interest to you.

In the April 19, 2004, issue of Marketing, Andrea Zoe Aster reports that The Print Measurement Bureau (PMB) has added a question about partnership to their questionnaires. Options include traditional married, same-sex married, and, for singles, preferred partnership – same sex married. Aster writes that the most recent sample of 12,000 indicates that there are approximately 274,000 gay or lesbian Canadians – or 1.1% of Canadian individuals. She notes that the most recent data from Statistics Canada estimates 0.5%. Most respondents to the survey were in the 25-34 age bracket. The survey collected data on a variety of media habits and product preferences.

Aster, A.Z. (2004). Defining pink consumers. Marketing. April 19.

Audit Bureau of Circulations
February 2004 Review

Last August we mentioned some noted some mediagraphic sources that appeared in Strategy Magazine. In addition to the reports mentioned there, you might want to check the Audit Bureau of Circulations for a report on Canadian magazine readership trends and the circulation data for all Canadian daily newspapers (membership may be required).

Canada’s Teens: Today, Yesterday and Tomorrow
February 2004 Review

If you are working on a youth project of any kind, this book can help you understand your audience. Though it is not possible to summarize all of the information presented in the book in this small space, here are a few key findings:

• There is nothing that teens value more highly than friendship and freedom (p 11), though they also value being loved, having choices, a comfortable life, success in what they do, concern for others, family life, and excitement (in that order) (p 13).
• Teens also feel that honesty and humour are very important (p 16).
• Their primary sources of enjoyment include friends, music, and their own room (p 24). In terms of other sources of enjoyment (year 2000), television (60%) still holds a wide lead over computers (47%), the Internet (42%) and email (33%).
• Even though 80% have access to a computer at home, on an average day they spend more time watching TV than sitting at those computers (p 26).
• On a daily basis 92% watch TV, 86% listen to music, 60% spend time with friends (p 28) and 41% use a computer daily.
• When asked about key influences in their lives, 91% say the way they were brought up, 89% willpower, 81% mother, 78% friends, and 71% the characteristics they were born with. Fathers are in fifth place, noted by 70% of teens.
• When asked about their primary personal concerns, teens most often mention pressure to do well at school, what they are going to do when they finish school, and how they never seem to have enough time.

Information is also presented on teens from days gone by, including the grandparents of current teens, and a chapter is devoted to what to expect from the next cohort. Also of interest is chapter three, which explores teen perceptions, concerns and attitudes about violence, sexuality, drugs, and other issues.

Bibby, R.W. (2001). Canada’s Teens: Today, Yesterday and Tomorrow. Toronto: Stoddart.

Advertising on Egg Shells
February 2004 Review

Looking for ideas on vehicles to reach your target audience? How about eggshells? The Aug 25, 2003, issue of Strategy Magazine reports that Montreal-based Egg Ads Media has partnered with Ovale Industries to make advertising space available on 30 million eggs! The first ad campaign using eggs as a vehicle started last May. It was a child health-care fundraiser called Operation Enfant Soleil . Campaign messages were printed on 2 million eggs.

Vinakmens, K. (2003). They put ads where? Strategy Magazine. August 25.

Time for a Closer Look at the Aboriginal market
February 2004 Review

In the September 22, 2003 issue of Marketing, Deanie Kolybabi raises some interesting points about Canadian Aboriginals as a target audience. Following are some highlights:

• The 1996 Statistics Canada census found the Aboriginal population is expanding nearly four times faster than any other segment.
• The fastest growing segment of Canada’s urban population is Aboriginal youth.
• 50% of the Aboriginal population is under 25 and that percentage continues to rise each year.
• 42% of identified Aboriginal peoples live off-reserve.
• First Nations, Inuit, or Metis enterprises are represented in all the major economic industries in Canada, with more than 20,000 Aboriginal-owned business.
• Canadian media channels that focus on this group include Aboriginal Peoples Television Network, Aboriginal Voices Radio, CHUM Television, and Ontario-based Spirit Magazine.

She also recommends (as we would!) carefully analyzing and segmenting, as there are big differences within the populations, and NOT to just repackage messages (and products) that were designed for other populations.

Kolybabi, D. (2003). Time for a closer look at the Aboriginal market. Marketing. September 2003.

Unweaving the Web: An Exploratory Study of Low-Literate Adults' Navigation Skills on the World Wide Web
August 2003 Review

We seem to do a lot of talking about the 'hard-to-reach' these days, but when it comes down to designing our communication materials, who is walking the talk?  In this article, the authors study how low literacy audiences, one important hard-to-reach group, use the Internet.  Their findings lead them to make 9 recommendations that we should all take to heart when designing our own websites, particularly those that are geared toward the so-called 'general public'.  I don't have room to reprint all of them here, but they include keeping all information in the browser window and not requiring the user to scroll down for more information; including clear, simple instructions with hot-linked graphics, and displaying a user's path history on each page so that they can retrace their steps after unsuccessful searches.

Zarcadoolas, C., Blanco, M. and Boyer, J.  (2002). Unweaving the Web: An Exploratory Study of Low-Literate Adults' Navigation Skills on the World Wide Web. Journal of Health Communication 7, 309-324.

Evaluation

Top Ten Misperceptions of Focus Group Research
November 2005 Review

Focus groups are a popular choice for collecting formative, process, and outcome evaluation data in the health promotion world – often because they are viewed as being easy and cheap. But don’t rush into a focus group! Why? This paper gives an overview of ten important focus group myths that may give you reason to reconsider your methods next time you need to check in with your target audience.

Ten Focus Group Myths

1. Focus groups are easy. In fact, it takes considerable time and effort to collect valuable focus group data.
2. Focus groups are quick. One focus group is not enough. Researchers should conduct as many as it takes to get to the point where new information is no longer emerging. It takes at least a month to plan a series of focus groups.
3. Focus groups are cheap. Try telling this to someone who has spent money on room rental, equipment purchase or rental, fees for moderators and scribes, transportation and babysitters, and incentives for participants!
4. Any five people make a focus group. The people you recruit for your focus group should precisely match the audience you want to work with. Basically, no wizards if you want to talk to hobbits! Six to eight focus group participants is ideal.
5. Focus group facilitators can play the discussion by ear. A good focus group facilitator does not ad lib. The facilitator is a part of the research team and must be suitably trained to steer the discussion in order to obtain important and relevant results for the researchers.
6. Focus group data can be used to replace surveys. Surveys explore “how much” or “to what extent” while focus groups explore “how” or “why.” They meet very different objectives.
7. You can generalize what you learn from a focus group to your population. Results from a focus group do not reflect attitudes and behaviours of the entire population. They simply provide a guide for questions you should ask in a quantitative survey.
8. Qualitative data produced in focus groups are better than quantitative data. Qualitative and quantitative research answer different questions. Their relevance depends on the situation (see point six above).
9. Focus group results can be easily compiled and reported. Analyzing participant responses involves a detailed, time-consuming process of transcribing and coding responses. A complete transcript-based analysis is recommended to reduce the degree of subjectivity in the analysis.
10. Focus groups pose no risk to participants. Focus group participants should know why they are being asked to participate and how the information will be used. Participants should be complete strangers in order to avoid compromising their privacy.

Fabiano, P. & Lederman, L.C. (2002). Top Ten Misperceptions of Focus Group Research. The Report on Social Norms Working Paper #3. Garfield, NJ: PaperClip Communications.

Web vs. Mail Surveys
November 2005 Review

Web surveys seem to have almost completely replaced the traditional mail survey. But are they as effective? This American Journal of Evaluation article compares the effectiveness of a web survey and a mail survey that were used to evaluate a professional development program. Here’s what the researchers found:

1. Web-survey participants had a higher response rate than mail-survey participants, especially when they were solicited by email, possibly because web surveys can be completed around the clock.
2. Web surveys were as effective as mail surveys in the completion of closed-ended questions. In addition, web surveys garnered longer open-ended answers as many people now find typing easier than writing.
3. Web-survey participants may be worried about confidentiality.
4. There were no differences between the web and print formats in overall perceptions about the program being evaluated, thus the format does not appear to bias results.

The above findings paint a rosy picture of web surveys, however when weighing your options, don’t forget about the disadvantages! Because there is no physical presence, web surveys require frequent reminders. In addition, inadequate computer skills, access, and equipment can still be barriers, even in this high-tech world.

Kiernan, N., Kiernan, M., Oyler, M., & Gilles, C. (2005). Is a Web Survey As Effective As a Mail Survey? A Field Experiment Among Computer Users. American Journal of Evaluation 26:2, 245-52.

Evaluation Methods from the American Journal of Evaluation, Spring 2004
September 2004 Review

It seems that all health promoters search continually for evaluation processes that are easy and cheap. Here, from the spring 2004 issue of the American Journal of Evaluation, are two noteworthy methods.

SAFAR

Gajda describes Strategic Alliance Formative Assessment Rubric (SAFAR), an assessment tool and process that can help program managers gauge the strength of their collaborative endeavour over time. The rubric describes the purpose, types of strategies and tasks, types of leadership and decision making, and style of interpersonal communication for five levels of integration: networking, co-operating, partnering, merging, and unifying.

Gajda suggests convening a focus group to determine the key stakeholders for a given project then mapping them onto a matrix. Project representatives then look at the relationship between every combination of stakeholders and identify their current and desired levels of integration. Participants are then asked to describe the steps needed to move toward their desired level of integration and identify the evidence that would indicate that they have reached it. This process can be repeated.

Gadja notes that partners may realize that while it may be considered politically correct to form a collaborative, many goals can be achieved with well developed cooperation or partnering. This can be a relief because resources that would have been targeted for building the structure to support higher levels of integration can be used for other purposes.

Gajda, R. (2004). Utilizing Collaboration Theory to Evaluate Strategic Alliances. The American Journal of Evaluation, 25:1, 65-77.

Low-Cost Quality Monitoring

Barth describes a low-cost way to monitor the quality of sites in a multi-site project, beginning with selecting a number of people who are extensively involved with one or more project sites. These individuals are then asked to complete the sentence “A specific characteristic that contributes to the success of the project/site is...” Respondents note as many characteristics as they desire.

Responses are then reviewed for redundancy and collapsed into one list. Next raters are asked to identify the importance of each characteristic on the list, by rating them from 1 (slight importance) to 5 (critical importance). Raters sort the characteristics into groups that “make sense.” Statistical software then generates a short list of rating factors and their relative importance to success.* Barth’s results were By-In (5), Champion/Leadership (5), Communication (4), Teamwork (4), Staff Specialist (2), Program Implementation (2), Program Readiness (2), Parent Involvement (1), Practice Support (1).

Finally, raters are asked to rate each site with which they are familiar on the rating factors/clusters. Using the weighting system, each site is then assigned a rating between 1 and 100 for comparison. The last step in the rating system can be repeated over time to monitor progress.

*The software is available for free online. I have downloaded it but not yet tried it. It appears to work in conjunction with Access 97 or 2000.

Barth, M.C. (2004). A Low-Cost, Post Hoc Method to Rate Overall Site Quality in a Multi-Site Demonstration.The American Journal of Evaluation , 25:1, 79-97.

Youth Participation in Community Evaluation Research
February 2004 Review

The article makes the case that youth participation in evaluation is desirable because it develops knowledge for social action, enables young people to exercise their political rights, allows them to share in the democratization of knowledge, and prepares young people for active participation in a democratic society and strengthens social development. I think the most useful part of the article is a matrix showing the potential roles youth can play in defining questions, creating instruments, collecting information, analyzing information, and disseminating findings. Roles are outlined for each of the above evaluation stages depending on whether the youth are acting as subjects, consultants, partners or directors.

Checkoway, B., & Richards-Schuster, K. (2003). Youth Participation in Community Evaluation Research. American Journal of Evaluation , 24:1, 21-33.

Getting to Outcomes: Methods and Tools for Planning, Self-Evaluation and Accountability
February 2004 Review

This manual that leads you through an empowerment evaluation model by asking ten questions that incorporate the basic elements of program planning, implementation, evaluation, and sustainability:

• What are the underlying needs and conditions that must be addressed?
• What are the goals, priority populations, and objectives (i.e., desired outcomes)?
• What science - (evidence-) based models and best practice programs can be useful in reaching the goals?
• What actions need to be taken so the selected program fits the community context?
• What organizational capacities are needed to implement the program?
• What is the plan for this program?
• How will the quality of program and/or initiative implementation be assessed?
• How well did the program work?
• How will continuous quality improvement strategies be incorporated?
• If the program is successful, how will it be sustained?

Each chapter defines the element, discusses its importance, addresses the action steps needed, and provides a checklist for each question. It is useful at any stage of the planning, implementation, or evaluation process as it is not a linear model. Cultural competence is promoted throughout. A good companion piece to THCU’s program planning, evaluation and sustainability workbooks!

Wandersman, A., Imm, P., Chinman, M., & Kaftarian, S. (2000). Getting to Outcomes: Methods and Tools for Planning, Self-Evaluation and Accountability. 2 vols. Santa Monica: RAND Corporation.

Associations Between Message Features and Subjective Evaluations of the Sensation Value of Anti-drug Public Service Announcements
February 2004 Review

The authors of this article suggest that the effective targeting of high sensation seeking adolescents, who are most at risk for drug abuse and other high risk behaviours, requires the creation of high sensation value messages. They provide background information on sensation seeking as a psychographic characteristic then reveal the results of their study, which identifies the structural and content features of messages that are most likely to evoke sensory, affective, and arousal responses. Their findings show that these features include intense images, sound saturation, unexpected format, a surprise or twist ending, and acting out of consequences. Less important elements include the number of cuts/edits, visual effects, unusual images, music, sound effects, and slow motion.

Morgan, S., Palmgreen, P., Stephenson, M., Hoyle, R., & Lorch, E. (2000). Associations Between Message Features and Subjective Evaluations of the Sensation Value of Anti-drug Public Service Announcements. Journal of Communication , 52:3, 512-526.

Addressing Attribution Through Contribution Analysis: Using Performance Measures Sensibly
February 2004 Review

In this article, Mr. Mayne notes that public servants are usually assessed on the outputs they produce (e.g., number of products, programs), rather than on outcomes (e.g., community or behaviour changes). He suggests that it is possible to move to outcome-based performance measures without expensive program evaluation strategies. A contribution-analysis model, which explores ‘plausible association’ between program activities and intended outcomes, is his proposed solution.

I like the model he suggests, not for its performance-assessment implications but because I think it is a good planning tool that can help reduce uncertainty about program impacts, particularly when few resources are available for evaluation.

At the heart of his idea is the “results chain,” which describes how the program is supposed to work. The links in the chain connect program activities to outcomes in small increments. A results chain might, for example, consist of the following:

• a tent card advertising a healthy eating initiative on a restaurant table
• prompts a customer to ask a waitress what it means
• which leads to the waitress listing healthy side dish options
• which leads to the customer ordering a baked potato instead of French fries
• which leads to a change in the customer’s overall eating habits
• which leads to reduced risk of heart disease

Once a results chain is proposed, he recommends considering the credibility of each link. Weak links (lacking in evidence or plausibility) should be re-worked or targeted for future evaluation. In the above example, it may not be clear (from literature or past evaluations) how many people will actually ask a waitress for suggestions or how many might actually act on the suggestions. His model also considers external factors that may affect outcomes and includes regular revisions of the chain as new information becomes available.

Similar processes are a part of most well-accepted planning models but, in my experience, are frequently skipped in practice. This article simply serves as a good reminder to health promotion practitioners to spend a bit more time considering the finer details of how they expect their program to have an impact.

Mayne, J. (2001). Addressing Attribution Through Contribution Analysis: Using Performance Measures Sensibly. The Canadian Journal of Program Evaluation, 16:1, 1-24.

A Framework for Evaluating Comprehensive Community Initiatives
February 2004 Review

This article describes a model and design for evaluating comprehensive community health promotion initiatives. The focus is on a healthy youth initiative that helps communities build a foundation for 40 assets that contribute positively to a young person’s development, but the information provided is useful for any large community project. I found the comprehensive menu of desired outcomes and indicators at the community, institutional, individual, and administrative levels to be the most useful part of the article, though the table showing specific evaluation questions, with a description of the theories on which they are based, was also handy. Worth checking out if you are struggling with how to demonstrate the impact of your community initiative!

Lafferty, C.K.,& Mahoney, C. (2003). ,A Framework for Evaluating Comprehensive Community Initiatives. Health Promotion Practice, 4:1, 31-44.

Evaluation of the National Youth Anti-Drug Media Campaign
August 2003 Review

The three goals of this multi-million dollar U.S. media campaign are to educate and enable America's youth to reject illegal drugs; prevent youth from initiating use of drugs, especially marijuana and inhalants; and convince occasional users of these and other drugs to stop using drugs. Five years of campaigning has not resulted in significant changes in youth beliefs, attitudes or behaviours, though it has had significant effects on parents.  However disappointing the results, the rigorous, theory-based campaign development, implementation and evaluation processes are an extremely rich source of information for health communicators working on any topic.  The fact that campaign development and evaluation is being led by a team of highly skilled researchers should not hinder readers from at least browsing through this report.  Among the interesting lessons are the way clear models of potential campaign effectiveness were designed prior to implementing the campaign and the way effects are being measured at both the individual and network (e.g. number and type of conversations among friends and parents) levels.  Many of these lessons have potential for application at the community level, even with minimal funding.

Hornik, R., et al. (2002). Fourth Semi-Annual Report: Evaluation of the National Youth Anti-Drug Media Campaign. Report prepared for the National Institute on Drug Abuse. Washington, DC: Westat.

Evaluating the California Wellness Foundation's Health Improvement Initiative: A Logic Model Approach
June 2003 Review

The difficulties of evaluating community-based initiatives have led some researchers to argue in favour of a case study "logic model" approach to evaluation.  This article describes such an approach.  The basic premise is that positive community outcomes are only attributed to the program if the steps in the logic model occurred in the sequence predicted.  For example, "a decrease in disease morbidity will be attributed to the program only if it occurs following the successful achievement of the process and intermediate outcomes specified in the logic model."  An excellent case for planning with logic models!  If this interests you, you may want to check out our logic model workbook too! 

Cheadle, A., Beery, W., Greenwald, H., Nelson, G., Pearson, D., and Senter, S. (2003). Evaluating the California Wellness Foundation's Health Improvement Initiative: A Logic Model Approach. Health Promotion Practice 4:2, 146-156.

Policy Change & Media Advocacy

Advocacy 101: Getting Started in Health Education Advocacy
June 2005 Review

The term health education advocacy is not one that we normally use in Canada but most of us are familiar with advocacy in general and media advocacy in particular. The first part of this article focuses on concerns professionals may have about getting involved with advocacy efforts. They include lack of time, lack of skills, difficulty selling health promotion, fear that it won’t make a difference, and fear of employment-related repercussions. Certainly we’ve encountered these barriers before.

My favourite part of the article, however, is the practical strategies section. I frequently find myself consulting with organizations that are trying to figure out how to get their community members more involved with the policy-development process. That’s why I really like the "Good, Better, Best " Advocacy Strategy Table these authors have created.

For six advocacy strategies they provide three levels of involvement: a nice, baby-step model! For example, for the strategy voting they suggest it’s "good" to register and vote, "better" to encourage others to register and vote, and "best" to register others to vote (is that allowed in Canada?). For use of the Internet they suggest it's "good" to use the Internet to access information related to health issues; "better" to build a web page that calls attention to a specific health issue, policy, or legislative proposal; and "better" to teach others to use the Internet for advocacy activities. You get the idea. I can see how these baby steps could be developed and promoted in a community for all kinds of advocacy activities. Let us know if you’d like to try it!

Galer-Unti, R., Tappe, M., & Lachenmayr, S. (2004). Advocacy 101: Getting Started in Health Education Advocacy. Health Promotion Practice , 5:3, 280–288.

Planning

Using Formative Research to Plan Health Promotion Programs
August 2006 Review

In-depth formative research is an important step in the development of health promotion programs. For the Trial of Activity for Adolescent Girls (TAAG), a variety of formative research was conducted including

• 80 qualitative interviews with girls,
• focus groups with boys and focus groups with girls,
• school surveys, and
• parent surveys.

Findings included the following:

• Both sexes described physically active girls as being tomboys or too aggressive.
• Both sexes listed boys, girls themselves, and family as physical activity barriers for girls.
• Family was described as the most influential factor in a girls’ decision to be physically active, followed by positive peer influence.

All findings were passed on to intervention planners through multiple channels. Unfortunately, although there were two full years available for program development, timelines were such that some planning had to take place prior to the completion of research. Thus the extensive formative research was sometimes a step behind the development process.

Ideally, intervention planning should not begin until formative research is complete:  “When insufficient time is allowed between collecting formative research data and intervention planning, there is a risk of sharing incomplete data that do not hold up in final analyses” (Young, D., Johnson, C., Steckler, A., et al, 2006). 

Of course time is a luxury that we often don’t have in public health. However, the lessons learned from this large-scale, well-resourced initiative show that although formative research is critical it must be collected well before implementation begins to be truly useful. To that end, in some cases it may be wiser to sacrifice some rigour or depth in formative research processes and instead focus on a process that can be completed before planning begins.

Vu, B., Murrie, D., Gonzalez, V., & Jobe, J. (2006). Listening to Girls and Boys Talk About Girls’ Physical Activity Behaviors. Health Education & Behavior 33(1): 81-96

Young, D., Johnson, C., Steckler, A., et al. (2006). Data to Action: Using Formative Research to Develop Intervention Programs to Increase Physical Activity in Adolescent Girls. Health Education & Behavior 33(1): 97-111

To Replicate or Not to Replicate: That Is the (Programmatic) Question
September 2004 Review

Here’s one more for your best practices file. A nice, two-page list of 40 questions to ask yourself to determine whether a program that you’ve heard about should be replicated. Examples of questions include Which elements of the program are critical to its success? How do you know that the program will have an impact? Have you surveyed the field of programs that serve a similar purpose?

Goldman, K., and Schmalz, K. (2004). To Replicate or Not to Replicate: That Is the (Programmatic) Question! Health Promotion Practice, 5:2, 105-107.

Health Education Leadership Development: A Conceptual Model and Competency Framework
February 2004 Review

This article presents a list of competencies that should be covered in public health leadership training programs. The list is too long to include here, but it could be applied to job descriptions and professional development plans.

Wright, K., Hann, N., McLeroy, K.R., Steckler, A., Matulionis, R.M., Auld, M.E., Lancaster, B.,& Weber, D.L. (2003). Health Education Leadership Development: A Conceptual Model and Competency Framework. Health Promotion Practice, 4:3, 293-302.

General Health Promotion

"Commonsense" behaviour change theory
July 2006 Review

At THCU, we aim to develop tools that simplify sometimes-intimidating behavior change theories (for example, Changing Behaviours: A Practical Framework). This article provides a nice "commonsense" interpretation of behaviour change theory. The authors encourage practitioners to consider five domains when developing interventions:

1. Risk Appraisal—an individual’s awareness, perception and sense of vulnerability to the risk
2. Self-Perception—the extent to which an individual feels capable of doing a recommended action
3. Emotion and Arousal—an individual’s feelings about a particular behaviour
4. Relationships and Social Domain—cultural influences, interpersonal communications, peer pressure, social support, etc., that may impact on behaviour
5. Environmental and Structural Factors—such as public policy, racism, socio-economic dynamics, political climate, etc., that support or restrict behavioural change

Dolcini, M., Canin, L., Gandelman, A., and Skolnik, H. (2004). Theoretical Domains: A Heuristic for Teaching Behavioural Theory in HIV/STD Prevention Courses. Health Promotion Practice 5:4, 404-17.

The Go-Kit
June 2005 Review

This may be a bit off topic, but have you heard of a Go-Kit? I just read about them in Marketing (July 12/19, 2004, by Rebecca Harris). A Go-Kit includes a surgical mask, gloves and thermometer, anti-microbial wipes, and antiseptic hand-wash – described by the makers as "bacteria protection in a bag." Bob Weir, creative partner at Toronto-based Promotivation, which markets the products warms, “The plague is coming.”

Harris, R. (2004). Plague protection. Marketing. July 12/19.

American Journal of Health Promotion Interactive Database
September 2004 Review

The American Journal of Health Promotion has recently launched an interactive database search. Over 350 peer-reviewed studies addressing the following health promotion research questions are indexed.

Users can perform a search using any combination of six variables including type of dependent measure, topic, research design rating, internal validity rating, unit of analysis, and research question. The research questions are as follows.

1. What behaviors, health signs, and health conditions are associated with positive underlying health conditions, productivity, health care costs, and other positive outcomes?
2. What behaviors, health signs, and health conditions are associated with negative underlying health conditions, productivity, health care costs, and other negative outcomes?
3. To what extent do changes in behaviors, health signs, and symptoms occur after health promotion programs are provided? Are the changes correlation or causal?
4. To what extent do people who change their behaviors, health signs, and symptoms as a result of being involved in health promotion programs also change their underlying health conditions, productivity, health care costs, and other positive outcomes?
5. How long lasting are the changes in behaviors, health signs, and symptoms that result from health promotion programs?
6. How long lasting are the changes in underlying health conditions, productivity, health care costs, and other positive outcomes that result from health promotion programs?
7. What are the characteristics of health promotion programs that produce the behaviors, health signs, and symptoms that produce positive outcomes?

The history of the development of this database can be found in the March/April 2004 issue of the American Journal of Health Promotion (18:4, 326-327). The database was originally the vision of Canada’s own Dr. Lawrence Green.

Confused About Healthy Eating?
September 2004 Review

In the March 22, 2004, issue of Strategy Magazine, Patti Summerfield reports the results of a recent Decima poll showing that 43% of Canadians say that they are actively restricting carbs. Two pages later, Okalow notes that Krispy Kreme is ramping up their office delivery service in Toronto.

Summerfield, P. (2004). Almost half of Canadians cutting carbs. Strategy Magazine. March 22.

American Journal of Health Promotion
December 2003 Review

This special issue on health-promoting community design is loaded with practical articles, including

• theories and frameworks to explain the impact of community design on health;
• tools to assess walking and bicycling suitability of local sidewalks and roads;
• ideas for how transportation decision making can better support public health objectives, including reduced crashes, pollution and increased physical activity;
• opportunities for integrating public health and urban planning approaches to promote active communities; and much more!

On page 13 there is a large list of related weblinks. Some that caught my attention are Active Living by Design; Center for Health Design; Creating Defensible Space (Crime Prevention through Environmental Design); Environmental Research Design Association and Institute on Aging and Environment.

(2003). American Journal of Health Promotion, 18:11.

New York Academy of Medicine Grey Report
November 2003 Review

There is often a gold mine of information to be found in non-commercially published grey literature--reports, conference, proceedings, theses, etc.  But how to find this literature?  One place is the New York Academy of Medicine's Grey Report. This is a quarterly, online publication (you can sign up to receive notification of new issues if you are interested).  Though U.S. based, there is a significant amount of health promotion material here.  You can link to the documents directly and there is also a search engine.

Interview Questions that Really Work!
November 2003 Review

Are you looking to fill that vacant health promotion position?  Check out this article on Charity Village.  There are some great ideas here!

Howe, T. Interview questions that really work! CharityVillage. <http://www.charityvillage.com/cv/research/rhr9.html>. Accessed November 2003.

Keeping up to date on Health Promotion Literature
November 2003 Review

This eight-page, user-friendly summary of recent health promotion literature is published by the New Zealand Health Promotion Forum.  It is published on-line and also distributed as an insert with their Newsletter (also available online) at least twice a year. It is intended to help increase access to the health promotion literature, increase awareness of some of the current thinking and latest research findings in the health promotion field, and increase use of this information in practice.

Emerging Theories in Health Promotion Practice and Research: Strategies for Improving Public Health
August 2003 Review

While researchers toil away updating old theories to incorporate new knowledge, it is the job of practitioners to base their work on the most current theoretical frameworks.  This book is an excellent reminder about how and why this is important.  

Information from the book that struck me as particularly interesting, included the chapter on The Elaboration Liklihood Model of Persuasion.  This model acknowledges that there are two routes to attitude change.  A central route when people are relatively thoughtful in their consideration of the information being presented to them, and a peripheral route which requires relatively little thought about issue-relevant information.  An exploration of which route your target audience is most likely to use should be an important factor in message design on any topic, as different message characteristics increase effectiveness in each situation.  

Chapter 9 on Social Capital Theory includes some interesting insights on the mixed results of community development approaches, and some intriguing ideas about how to apply the Stages of Change model to increasing community levels of social capital.

Finally, I think chapter 11 on Conservation of Resources Theory is worth a look, as a reminder that "Poverty, low social status, racism, unavailability of health care, and other fundamental resources should remain foremost in our minds, both because they are primary in the potential success of any program and because failing to refer to them opens the risk of blaming the victim" (page 289).

DiClemente, R., Crosby, R.A., Kegler, M. (Eds). (2002). Emerging Theories in Health Promotion Practice and Research: Strategies for Improving Public Health. San Francisco: Jossey Bass.

Achieving Cultural Appropriateness in Health Promotion Programs: Targeted and Tailored Approaches
June 2003 Review

This article briefly describes five strategies commonly used to target programs to culturally defined groups.  They include

• Peripheral strategies which give materials the appearance of cultural appropriateness.
• Evidential strategies which enhance the perceived relevance of a health issue for a given group by presenting evidence of its impact on that group.
• Lingustic strategies which make programs and materials more accessible by providing them in the dominant or native language of the group.
• Constituent-involving strategies that draw directly on the experience of the group by using them in consultant or training roles.
• Sociocultural strategies that discuss health-related issues in the context of broader social and/or cultural values and characteristics of the intended audience.

It then explains how a sixth approach, cultural tailoring, might extend these strategies and enhance our ability to develop effective programs for cultural groups.

Krueter, M., Lukwago, S., Bucholtz, D., Clark, E., and Sanders-Thomson, V.  (2002). Achieving Cultural Appropriateness in Health Promotion Programs: Targeted and Tailored Approaches. Health Education and Behaviour. 30:2, 133-146.