The SAGE Handbook of Persuasion

by James Price Dillard

  There are tens of thousands of websites offering a wide variety of health materials; in addition to prepackaged pages and video clips, the interactive capacity enables campaign message tailoring. Tailored messages are constructed via diagnostic questionnaires that gather each individual’s background information (e.g., capabilities, stage of readiness, stylistic taste, knowledge level, and current beliefs) and translate the data into individually customized messages (Noar et al., 2009; Rimer & Kreuter, 2006). Not only does this approach increase the likelihood of learning and persuasion, but it decreases the possibility of boomerang effects.

  Quantitative Dissemination Factors

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  Five major aspects of strategic message dissemination are the total volume of messages, the amount of repetition, the prominence of placement, the scheduling of message presentation, and temporal length of the campaign. A substantial volume of stimuli helps attain adequate reach and frequency of exposure, as well as comprehension, recognition, and image formation. Message saturation also conveys the significance of the problem addressed in the campaign, which heightens agenda setting and salience. A certain level of repetition of specific executions facilitates message comprehension and positive affect toward the product, but high repetition eventually produces wear-out and diminishing returns.

  Placement prominence of messages in conspicuous positions within media vehicles (e.g., newspaper front page, heavily traveled billboard locations, or high-rank search engine websites) serves to enhance both exposure levels and perceived significance. Another quantitative consideration involves the scheduling of a fixed number of presentations; depending on the situation, campaign messages may be most effectively concentrated over a short duration, dispersed thinly over a lengthy period, or distributed in intermittent bursts of “flighting” or “pulsing.” In terms of the calendar, there are critical “timing points” when the audience is more likely to be attentive or active in information-seeking.

  Regarding the overall length of the campaign, the challenging task of gaining audience attention and compliance often requires exceptional persistence of effort over long periods of time to attain a critical mass of exposures to produce impact. In many cases, perpetual campaigning is necessary because focal segments of the population are in constant need of influence as newcomers enter the priority audience, backsliders revert to prior misbehavior, evolvers gradually adopt practices at a slow pace, and vacillators need regular reinforcement.

  To maximize quantity, campaigners seek to gain media access via monetary support from government and industry (to fund paid placements and leveraged media slots), aggressive lobbying for free public service time or space, skillful use of public relations techniques for generating entertainment and journalistic coverage, and reliance on low-cost channels of communication, such as websites and social media. The Ad Council creates more PSA messages that address health issues than for any other topic. Finally, the reach of a campaign is often boosted by sensitizing audiences to appropriate content already available in the media and by stimulating information-seeking from specialty sources.

  Campaign Effectiveness

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  Researchers have assessed the impact of media-based health campaigns using survey and field experimental designs over the past several decades. The findings from many empirical studies have been summarized in literature reviews and meta-analyses, the most recent of which include Lundgren and McMakin (2009), Rice and Atkin (2009), Atkin and Salmon (2010), Green and Tones (2010), Webb, Joseph, Yardley, and Michie (2010), Rice and Atkin (2011), Silk et al. (2011), Phillips, Ulleberg, and Vaa (2011), Snyder and LaCroix (2012), and Paisley and Atkin (2012). The preponderance of evidence shows that conventional campaigns typically have limited direct effects on most health behaviors; specifically, campaigns are capable of exerting moderate to powerful influence on cognitive outcomes, but less influence on attitudinal behavioral outcomes. Further, the degree of impact on behavior tends to occur in proportion to such factors as dose of information, duration of campaign activities, integration of mass and interpersonal communication systems, and supplementation of social-change strategies, such as enforcement and engineering. Societal level outcomes in the form of policy changes have also been attained, but isolating the campaign input is difficult.

  A campaign may not attain a strong impact for many reasons. Audience resistance barriers arise at each stage of response, from exposure to behavioral implementation. A major problem is simply reaching the audience and attaining attention to the messages (Hornik, 2002). Exposed audience members are lost at each subsequent response stage, due to defensive responses, such as misperception of susceptibility to threatened consequences, denial of applicability of message incentives to self, defensive counterarguing against persuasive appeals, rejection of unappealing behavioral recommendations, and sheer inertial lethargy. Public communication campaign outcomes tends to diminish when receivers regard messages as offensive, boring, preachy, confusing, irritating, misleading, irrelevant, uninformative, unbelievable, or unmotivating.

  Salmon and Murray-Johnson (2001) make distinctions among various types of campaign effectiveness, including definitional effectiveness (e.g., getting a social phenomenon defined as a social problem or elevating it on the public agenda), contextual effectiveness (e.g., impact within particular contexts, such as education vs. enforcement vs. engineering), cost-effectiveness comparison (e.g., prevention vs. treatment, addressing certain problems over others), and programmatic effectiveness (e.g., testing campaign outcomes relative to stated goals and objectives).

  Rather than being defined in absolute terms, campaign effectiveness is often defined relative to pre-campaign expectations. Although campaign planners may be tempted to set readily attained goals, lowering the bar does not necessarily improve campaign performance. Nevertheless, Fishbein (1996) advances the pragmatic argument that realistically small effect sizes should be set for media campaign so that obtaining effects is achievable.

  Future Research Agenda

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  Fortunately for the next wave of campaign scholars, numerous theoretical and practical challenges remain to be addressed if health campaigns are to be more successful. Investigations are needed answer the following questions pertaining to campaign design and implementation.

  What is the optimum mix of message content themes? Health campaigns typically use multiple persuasive strategies, but what is the most effective ratio of gain-frame versus loss-frame messages, one-sided versus two-sided appeals, and physical health versus nonhealth incentives? Second, what is the most effective balance of direct versus indirect strategies in health contexts? Campaigns increasingly rely on messages targeted to interpersonal influencers and on media advocacy approaches aimed at the general public and policy makers, but what is the appropriate way for these approaches to be intermingled? Third, how can campaigns communicate effectively with young people, who exhibit fundamentally different appraisals of risk and future consequences, who are using radically different interactive and personal media, and who are deeply embedded in peer networks?

  Fourth, what is the impact of various quantities of campaign messages? What is the critical mass of stimuli needed to achieve meaningful effects on key outcomes, and what is the optimum frequency of repetition for a particular message execution? Fifth, what is the relative impact of various channels for disseminating messages? Specifically, what are the appropriate roles to be played by traditional media versus new technologies, and which of dozens of digital media devices can make meaningful contributions to health? Sixth, how can strategists reduce counterproductive effects at the individual and society levels? Promotion of cancer screening may lead to a rise in detrimental tests and treatments, recommending sunscreen use may produce a false sense of protection, fear appeals may create anxiety rather than coping responses, and depicting drugs as forbidden fruit may arouse curiosity. Finally, how can campaigns effectively overcome the unhealthy influences of entertainment, news, an
d advertising messages on high-profile health issues, such as drinking, smoking, safe sex, and violence?

  Conclusion

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  Most experts conclude that contemporary public communication campaigns attain a modest rather than strong impact. This appears to be the case for health campaigns, which are characterized by limited effects on the health behaviors in most cases. The inability to attain strong impact can be traced to meager dissemination budgets, unsophisticated application of theory and models, and poorly conceived strategic approaches. It is also due to the difficulty of the task facing the health campaigner in surmounting the challenge of influencing resistant people to adopt difficult practices or sacrifice pleasurable activities.

  In these situations, the pragmatic strategy may be to emphasize relatively attainable impacts: aiming at the more receptive focal segments, promoting more palatable positive products perceived to have a favorable benefit-cost ratio, creatively generating free publicity, and shifting campaign resources to indirect pathways that facilitate and control behavior of the focal segment via interpersonal, network, organizational, and societal influences. These emphases are not playing the expectations game, but can lead to substantive improvements in effectiveness. More generally, the degree of campaign success can be enhanced via greater diversification of influence pathways, of recommended behaviors, and of persuasive appeals beyond the approaches conventionally used in health campaigns. In addition, campaign strategists should realize that the optimum campaign mix incorporates elements to supplement persuasive appeals for influencing attitudes and behaviors; there are important roles for messages that simply impart new knowledge, enhance salience, deliver educational lessons, provide reminders to act, and stimulate information seeking.

  Despite the array of barriers that diminish campaign effectiveness, the research literature shows important success stories over the past several decades. Health campaigns have made significant contributions to the progress in addressing pressing problems, such as smoking, seat belt use, drunk driving, AIDS, drug use, and heart disease. These effective campaigns tend to be characterized by theoretical guidance and rigorous evaluation, substantial quantity of message dissemination over sustained periods, widespread receptivity to the advocated action and accompanying persuasive incentives, and supplementation of mediated messages by campaign-stimulated factors, such as informal interpersonal influences and social engineering policy initiatives.

  With the increasing implementation of increasingly sophisticated strategies and the rising societal priority of healthier behavior, there is a sound basis for optimism that campaigns can produce stronger impacts in the future. The ideas outlined in this chapter offer some promising approaches for scholars and practitioners to consider in developing the next generation of health campaigns.

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