Campaigns have increasingly diversified negative incentive strategies to include appeals to include the other undesirable dimensions (e.g., psychological regret, social rejection, monetary cost). Moreover, diversification has increasingly broadened the emphasis on positive incentives (e.g., valued states such as self-esteem, altruism, and efficiency).
Negative Appeals
Health campaigns rely heavily on loss-framed messages focusing on undesirable consequences associated with initiating or continuing an unhealthy practice (Stephenson & Witte, 2001). Instead of primarily emphasizing intense fear appeals, health messages might also pose threats of a less severe nature and present negative incentives beyond the physical health domain. For health topics where there are no compelling consequences (e.g., low probability of a genuinely strong valence), the next best approach is to select a mildly valenced incentive that is highly probable. In the case of drug campaigns, minor negative physical incentives might be loss of stamina, weight gain, and physiological addiction. Other messages might feature negative social incentives (e.g., looking uncool, alienating friends, incurring peer disapproval, losing the trust of parents, or deviating from social norms), negative psychological incentives (e.g., reduced ability to concentrate, low grades, feeling lazy and unmotivated, losing control, and making bad decisions, as well as anxiety about getting caught or experiencing harm, guilt, and loss of self-respect), economic incentives (e.g., diminished job prospects, fines, the cumulative cost of purchasing drugs, and inability to spend money on other needs and desires) and legal incentives (penalties for violating laws and policies, such as incarceration, loss of driver’s license, or suspension from school).
Positive Appeals
Campaigns can also diversify beyond the traditional reliance on fear appeals by presenting a higher proportion of gain-frame incentives. For many of the negative consequences of performing the proscribed practice, there is a mirror-image positive outcome that can be promised for performing the healthy alternative. In the physical health dimension, drug abstinence messages might offer prospects ranging from a longer lifespan to enhanced athletic performance. Similarly, psychological incentives might promise outcomes like gaining control over one’s life, achieving a positive self-image, attaining one’s goals, or feeling secure. Social incentives might include being cool, gaining approval and respect, forming deeper friendships, building trust with parents, and being a good role model. The social norms marketing approach (DeJong & Smith, 2012; Perkins, 2002) is a widely used strategy in promoting responsible drinking on college campuses; messages typically feature statistical evidence to demonstrate that a majority students perform or approve of healthy practices (e.g., use of the designated driver arrangement, or approval of a four-drink limit on celebratory occasions).
Multiple Appeals
There might be dozens of persuasive appeals that are potentially effective on a given health topic, so it is advantageous for campaigners to use a large variety of appeals rather than relying on a handful of incentives. A major campaign’s capacity for conveying multiple appeals allows dissemination of diverse messages; this provides several distinct reasons for the individual to comply or to influence multiple segments of the target audience via media channels where precise targeting is difficult. In identifying incentives to be presented, the key criteria are the salience of the promised or threatened consequences, the malleability of beliefs about the likelihood of experiencing these outcomes, and the potential persuasiveness of the arguments that can be advanced (Cappella et al., 2001). For messages about familiar health subjects, it is important to include novel appeals to complement the standard arguments. Preproduction research can test basic concepts to determine the effectiveness of each one and to examine optimum combinations, and pretesting research can compare the relative influence of executions of various appeals.
Evidence
People tend to be defensive when processing threatening messages about the subject of their personal health, which may be manifested by reactance, counterarguing, or denial of applicability (Stephenson & Witte, 2001). Thus, there is a priority for providing credible evidence to buttress claims about susceptibility, especially concerning risk level of harmful physical consequences. Formative evaluation is helpful in determining which types of individuals are influenced by health messages that use hard information (e.g., citing statistics, offering documentation, and quoting experts), and which segments are more responsive to visual imagery (e.g., exemplars, dramatized specimen cases, and testimonials). Health message designers take care to demonstrate how the evidence is relevant to the situation experienced by the target audience, and are cautious about using extreme claims (e.g., singular cases, implausible statistics, or excessive gore) or contested information. Not only might these elements strain credulity and arouse suspicion, but such content may be challenged by critics on contentious health issues.
One-Sided Versus Two-Sided Campaign Messages
Compliance with behavioral recommendations is impeded by a variety of disadvantages perceived by the audience, notably effort in adopting healthy practices and forsaking the pleasures of unhealthy practices. The strategist is faced with the questions of whether and how to handle these drawbacks. Across major phases of a campaign, the one-sided strategy would consistently ignore the disadvantages and present only the case favoring the healthy behavior or opposing the unhealthy competition; campaigns typically disseminate mostly one-sided messages. The high quantity of campaign messages enables apportionment of some messages to the two-sided strategy.
In a two-sided message, the elements of the opposing case are strategically raised and discounted in order to counteract current misgivings and future challenges, using techniques such as refuting inaccurate information or diminishing the salience of a drawback. The conditions of the typical health campaign context favor a judicious inclusion of two-sided appeals for several reasons: (1) key disadvantages of certain healthy practices are already widely recognized, (2) priority target audience segments are experiencing the benefits of unhealthy practices, (3) media and interpersonal channels frequently convey messages promoting the advantages of unhealthy practices. Formative evaluation is helpful in precisely determining the extent to which the “other side” is familiar to various audiences.
Message Qualities
Designing mediated health campaign messages involves the strategic selection of substantive material and the creative production of stylistic features. In developing the combination of message components, the campaign designer may seek to emphasize up to five influential message qualities. First, credibility is primarily conveyed by the trustworthiness and competence of the source and the provision of convincing evidence. Second, the style and ideas should be presented in an engaging manner via selection of interesting or arousing substantive content combined with attractive and entertaining stylistic execution; this is a key factor because many people regard health topics as inherently dull. The third dimension emphasizes selection of material and stylistic devices that are personally involving and relevant (e.g., portrayals of familiar settings, engrossing narratives, or personally tailored information), so receivers regard the behavioral recommendation as applicable to their own health situation and needs. The fourth element is understandability, with simple, explicit, and detailed presentation of health content that is comprehensive and comprehensible to receivers. For persuasive messages, the fifth factor is motivational incentives, as previously described.
Message Sources
Most health messages prominently depict source messengers, and most identify the campaign’s sponsor as well. The messenger is the model or character in the message that delivers information, demonstrates behavior, or provides a testimonial. Salmon and Atkin (2003) provide a lengthy discussion of the strengths and weaknesses of various types of messengers in health campaigns. Messengers can substantially enhan ce the quality of message content by performing in an engaging manner, imparting trust- or competence-based credibility, and po
ssessing characteristics that are relevant to key audience segments. In the health campaign context, three key contributions of source messengers are (1) increasing breadth of exposure by attracting attention in the cluttered media environment (2) facilitating comprehension through personalization or modeling of unfamiliar or complex health behavior recommendations, and (3) augmenting visibility and memorability of the campaign over sustained periods of time. Zillmann’s (2006) exemplification theory presents a detailed examination of the mechanisms that healthy and unhealthy exemplars appearing in mediated messages use to convey risk perceptions, elicit reactivity, and motivate protective action.
Eight types of messengers are typically featured in campaign messages: celebrities, health experts (e.g., doctors/researchers), professional performers (e.g., models/actors), ordinary people (e.g., blue-collar males), public officials (e.g., political leaders), organizational executives (e.g., hospital administrator), specially experienced individuals (e.g., victims/survivors), or distinctive characters (e.g., animated/costumed figures). Selection of each messenger depends on the predispositions of the target audience, persuasion mechanism underlying the strategy, and type of message. Awareness messages tend to present celebrities, characters, and public officials to draw attention and make a superficial impression; instruction messages are more likely to depict performers and health organization executives to describe or demonstrate how to carry out complex behaviors; and persuasion messages may more often feature ordinary people for purposes of relevance and identification, experts for delivering evidence, and experienced individuals for reinforced or cautionary role modeling.
Each source has its advantages and drawbacks. For example, a researcher or medical authority would strengthen the expertise dimension, but would probably be less engaging due to the delivery of technical information. In contrast, a message that features a popular celebrity can draw great interest to a campaign message, especially if the celebrity conveys experiential competence or relevance as a victim or survivor of the health problem. Indeed, certain celebrities are highly respected and perceived to be trustworthy on various health topics, while other celebrities may engender skepticism, distract from message content, have an unhealthy image, or lose their luster before the campaign concludes. Ordinary people serving as source presenters may be perceived by the audience to be similar and thus relevant and perhaps trustworthy as a role model, but may lack perceived competence or attractiveness. Despite certain drawbacks, the personalized, credible, and engaging qualities of a source figure offer clear advantages over presenting message material without a manifest messenger or only with attribution to an impersonal organization.
The large number of message executions over a lengthy campaign enables the strategist can deploy a substantial collection of source messengers. Multiple messengers have potential for increasing the odds of success, by leveraging the complementary strengths of each type to serve certain functions for diverse audience segments. However, this tactic may increase the risk information overload and undermine continuity across message executions. It should be noted that continuity can still be attained by highlighting the sponsoring organization via prominent name identification, logo, and other symbols. Aside from this provision of branding linkages across disparate campaign stimuli, some widely recognized sponsors can also draw attention to the messages and enhance the credibility or relevance the content.
Mediated Communication Channels
To disseminate messages, health campaigns employ an ever-richer variety of channels encompassing the three basic categories of traditional mass media, conventional minimedia, and interactive technologies. Among mass media, campaigners have customarily relied on television, radio, newspapers, and magazines, specifically broadcast spots, news items, feature stories, and entertainment program inserts. The minimedia play a supplemental role via secondary message vehicles, including billboards, pamphlets, posters, slide shows, direct mailings, and automated phone calls. The importance of new technology channels for health campaigning has rapidly increased, with widespread utilization of web-sites, email listserves, serious games, and social media (notably Facebook), as well as emerging use of mobile phones, tablets, Twitter, and blogs.
In assessing the dozens of options for channeling campaign messages, designers take into consideration advantages and drawbacks along a number of communicative dimensions. Salmon and Atkin (2003) discuss channel differences in terms of reach (proportion of population exposed to the message), specializability (narrowcasting to specific subgroups or tailoring to individuals), interactivity (receiver participation and stimulus adaptation during processing), personalization (human relational nature of source-receiver interaction), decodability (mental effort required for processing stimulus), depth (channel capacity for conveying detailed and complex content), credibility (believability of material conveyed), agenda-setting (potency of channel for raising salience priority of issues), accessibility (ease of placing messages in channel), and economy (low cost for producing and disseminating stimuli).
Channel selection is most often governed by the usage patterns of target audiences and the nature of the message and topic, within the constraints of available resources. Health campaigners find it more practical to stage a pseudo-event that generates irregular news coverage than to raise funds to purchase time or space in the ideal media vehicle, and they will place a PSA on a low-rated mature adult radio station than on a hot teen station due to ready accessibility. Certain topics pertaining to health and safety attain free publicity because they are inherently attractive to reporters and editors working in traditional media, such as newspapers, women’s magazines, radio talk shows, and TV newsrooms.
Indeed, accessibility and economy are major reasons why typically underfunded health campaigners embrace new technologies. Although message production expenses can be substantial for elaborate website features and for sophisticated games, little cost is incurred for many forms of dissemination via digital media. There are several additional compelling reasons for the rise of digital media channels, notably depth capacity, interactivity, and tailoring (Edgar, Noar, & Freimuth, 2007; Parker & Thorson, 2009; Rice & Atkin, 2009). Unlike traditional media vehicles that are limited to a certain number of pages per issue or minutes per day, digital media have remarkable depth capacity for storing information that can be retrieved by website users or experienced by game players. Websites are an especially important channel for people that are highly involved in health topics, such as health opinion leaders seeking to stay well-informed or individuals diagnosed with an illness pursuing treatment information.
Interactivity enables the user and source to use monologue, responsive dialog, mutual discourse and feedback, involving a wide array of specific design features, such as surveys, games, services, email, hyperlinks, and chat rooms (Rice & Atkin, 2009). For example, online health-related support groups provide social support and help boost self-efficacy.
Thousands of health games on computers, consoles, websites, and mobile apps have been developed to teach skills, boost self-efficacy, and simulate role-playing. Lieberman’s (2012) overview of studies and meta-analyses indicates that health games have positive effects on behavior change related to physical activity, nutrition, mental health, safer sex negotiation, disease self-management, and adherence to one’s treatment plan. Health games are especially attractive to the younger population segments that are harder to reach and influence through traditional channels. The interactive, observational, experiential, and absorbing nature of game playing has enormous potential for advanced applications to health, such as utilizing sophisticated avatars and 3-D body model characters.
Digital media facilitate tailoring of individually customized messages that reflect each person’s predispositions and abilities (Noar, Harrington, & Aldrich, 2009; Rimer & Kreuter, 2006). Online screening questionnaires assess factors such as readiness stage, stylistic tastes, knowledge levels, and current beliefs, and then direct them to narrow-cast messages. Not
only does this approach increase the likelihood of learning and persuasion, but it decreases the possibility of boomerang effects. Mobile phone calling and texting are well-suited to offer tailored, wide-reaching, interactive, and continuing campaign interventions (Cole-Lewis & Kershaw, 2010).
There are a number of other ways to utilize new media for health campaigns. Online public service messages include brief banner ads, solicitations to click through to a website, streamed PSA spots, or long-form video messages on You-Tube. Paid health promotion ads on social media sites have greater potential for impact because of more prominent placement and more precise targeting. Blogs link together users with similar information needs and concerns to share their views and experiences, while wikis support collaboration among campaign members. Podcasts can provide relevant audio information to motivated audiences, and Twitter provides updates and protocol reminders to campaign-specific followers.
Messages placed in the mainstream media can attract the attention of many informal influencers, who can then exert an indirect influence on the focal individuals. Health issues gaining visibility in the news media can benefit from the agenda-setting effect (e.g., the obesity epidemic), whereby problems and solutions are perceived as more urgent and significant. This is particularly important in media advocacy strategies targeted at opinion leaders and policy makers.
Entertainment-education, the practice of embedding health-related material in popular entertainment programming or creating entertainment content as a vehicle for health education, attracts large audiences and conveys information in a relevant and credible manner. This approach has proved quite successful in promoting health in less developed countries (Singhal, Cody, Rogers, & Sabido, 2004), and it also has been used in the United States to promote safety belts, use of designated drivers, safe sex, and drug abstinence as well as dealing with youth-oriented topics such as alcohol and obesity prevention.
The SAGE Handbook of Persuasion Page 58