Health Communication and Social Marketing: Campaigns That Include Mass Media and Health-Related Product Distribution

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends health communication campaigns that use multiple channels, one of which must be mass media, combined with the distribution of free or reduced-price health-related products.

The specific behaviors promoted in the included studies were the use of products that:

Facilitate adoption and/or maintenance of health-promoting behaviors (i.e., increased physical activity through pedometer distribution combined with walking campaigns).
Facilitate and/or help to sustain cessation of harmful behaviors (i.e., smoking cessation through free or reduced cost over-the-counter nicotine replacement therapy [OTC NRT]).
Protect against behavior-related disease or injury (i.e., condoms, child safety seats, recreational safety helmets, sun-protection products).

Because results were positive across all of the six behaviors evaluated, these findings are likely to apply to a broader range of health-related products that meet the review’s product eligibility criteria in the intervention definition. The effectiveness of interventions promoting the use of health-related products other than those distributed in the reviewed studies should be assessed to ensure applicability.

The systematic review focused only on interventions that included a mass media component; therefore, this recommendation is specific to such interventions. The results may or may not apply to campaigns that do not include a mass media component, which were outside of the scope of the review.

The full CPSTF Finding and Rationale Statement and supporting documents for Health Communication and Social Marketing: Health Communication Campaigns That Include Mass Media and Health-Related Product Distribution are available in The Community Guide Collection on CDC Stacks.

Intervention

This review evaluates the effectiveness of interventions that combine two components to increase the appropriate, repeated use of evidence-based, health-related products:

A health communication campaign that uses messages to increase awareness of, demand for, and appropriate use of the product. The messages must be delivered through multiple channels, one of which must be mass media, to provide multiple opportunities for exposure; and
Distribution of a health-related product, free of charge or at a reduced price (e.g., discount coupons), to reduce cost, access, and convenience-related barriers among targeted users.

Health-related products eligible for this review:

Have been shown through an evidence-based process to improve health-related outcomes
Are tangible
Are not a service (e.g., mammogram)
Are not exclusively available though prescription or administration by a health professional
Require repeated use for desired health promotion and/or disease and injury prevention effects rather than a one-time behavior
Cannot be a specific food product marketed as being “healthful”

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 22 studies (search period 1980 – 2009).

Study Characteristics

Included studies evaluated campaigns to promote use of child safety seats (3 study arms), condoms (6 study arms), recreational safety helmets (10 study arms), pedometers (2 study arms), over-the-counter nicotine replacement therapy (3 study arms), and sun protection products (1 study).
Communication campaigns used several different channels, always with mass media (e.g., TV, radio, newspapers) and nearly always including small media (e.g., brochures, posters, fliers) and interpersonal communication (e.g., peer outreach, hotline numbers), over periods of time that ranged from 1 week to 36 months.
Studies were conducted in a wide range of urban, rural, and suburban settings in the U.S. (20 study arms), Australia (2 study arms), Canada (1 study arm), Belgium (1 study arm), and Israel (1 study arm).

Summary of Results

Twenty-two studies with 25 study arms qualified for the review.

Results from analyses show that effects were favorable for the following outcomes:
- Health promoting behaviors: absolute median change of 8.4 percentage points (Interquartile Interval [IQI]: 2.7 to 14.5 percentage points; 20 study arms)
- Use of child safety seats: absolute median change of 8.6 percentage points (IQI: -9.2 to 9.6 percentage points; 3 study arms)
- Use of condoms: absolute median change of 4.0 percentage points (IQI: -4.0 to 10.8 percentage points; 4 study arms)
- Use of helmets: absolute median change of 8.4 percentage points (IQI: 2.1 to 18.5 percentage points; 10 study arms)
- Smoking cessation: absolute median change of 10.0 percentage points (IQI: 3.1 to 16.9 percentage points; 3 study arms)

Summary of Economic Evidence

An overall conclusion about the economic merits of the intervention cannot be reached because available economic information and analyses were incomplete.

The economic review is based on evidence from 15 studies (search period January 1980 December 2009). There were several limitations to the quality of the cost and benefit estimates including incomplete intervention costs, lack of monetized benefits, and inability to make overall cost-benefit and cost-effectiveness assessments.

Applicability

Results suggest that health communication campaigns that include mass media, and product distribution interventions are applicable to:

A wide variety of broad or narrowly-defined populations provided they are appropriately segmented and targeted.
Products evaluated in this review and products that were not included but meet the criteria. Interventions were shown to be effective for:
- Both free and discounted products
- Single use (e.g., condoms) and reusable (e.g., recreational safety helmets)

Evidence Gaps

The majority of the campaigns researched were short-term; therefore, additional research is needed to assess the sustainability and effectiveness of long-term campaigns.
There is a common research gap related to the explicit efforts made to gather the most information from all targeted individuals. There is a need to increase and improve the collection on different demographic characteristics. This would help explain the differential effect of the campaigns on age, sex, and race/ethnicity.
There is also a need for researchers to design campaigns comparing the intensity of different study arms. Campaign intensity provides informative evidence on how much promotion is necessary for a targeted audience to receive a message in order to help increase the likelihood of a behavior change.
Better reporting on intervention details, including descriptions of the methods used to develop campaigns, combined with the use of more consistent terminology within the field, would improve future research and translation activities.
More complete and high quality economic evaluations of these interventions are necessary.
Most studies evaluated proximal outcomes specific to the interventions. Economic outcomes for healthcare use and workplace productivity and expected QALY saved need to be estimated or modeled to operationalize cost-benefit and cost-effectiveness assessments.

Implementation Considerations and Resources

The review team noted that programs have the potential to positively affect populations outside of the initial target group and also encourage community involvement and partnership. For example, retailers might move products to more accessible areas in response to an increased demand).
One included study reported that targeting condom usage facilitated dialogue between adults and teenagers, and among teenagers themselves, about risky sex behaviors.
Included studies cited lack of community buy-in and failure of partners to meet their commitments (e.g., retailers charging for products that were intended for free distribution) as barriers to implementation.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.