Health Communication Campaigns That Include Mass Media and Health-Related Product Distribution: A Review of Effectiveness From the Task Force On Community Preventive Services

Theoretical Background and research questions/hypothesis: To address knowledge gaps related to social marketing within the Guide to Community Preventive Services (the Community Guide), a review team of experts in social marketing, health communication, health literacy and systematic reviews evaluated the effectiveness of interventions for improving a range of important health behaviors. To arrive at a clearly defined intervention that would be feasible for a Community Guide systematic review, the team scanned the available research literature and determined that the only common elements of social marketing campaigns that could explicitly and reliably be identified in the published studies were product distribution combined with health promotion messages (e.g., effectiveness of condoms for preventing STIs). To attain further conceptual clarity regarding the scope of interventions of interest, the campaigns were required to use mass media as at least one channel for message delivery. 

Methods: Studies of campaigns promoting use of various products were systematically reviewed, using Community Guide methods (http://www.thecommunityguide.org/about/methods.html) to assess overall effectiveness and whether results differed by key variables, such as whether the campaign explicitly used social marketing principles. The specific review definition included two components: 1) Promotion of behavior change through multiple channels, one of which must be mass media, and 2) Distribution of a product that facilitates adoption and maintenance of health-promoting behaviors, sustains cessation of harmful behaviors, and protects against behavior-related disease or injury. Products were distributed, free of charge or at a reduced price, to reduce cost, access, and convenience-related barriers among targeted users.

Results: Outcomes were increased use of the health-related products distributed and promoted in the campaigns, and improved health behaviors or outcomes related to product-use. Of 22 studies that met review criteria, the 17 that assessed the proportion of people engaging in a healthful product-related behavior (e.g., bicycle helmet use) found a median improvement of 8.4 percentage points (IQI: 2.7, 14.5). The remaining 5 studies used different metrics, (e.g., odds ratios) but had similar results. Evidence also suggested that product distribution increased the effectiveness of health communication campaigns.  

Conclusions: According to Community Guide rules of evidence, the Task Force recommended these interventions based on strong evidence on effectiveness.  In addition, the available evidence on effectiveness suggests that these interventions should be applicable across demographic groups (e.g., race/ethnicity) when they are appropriately selected and targeted. Future studies should include: 1) important intervention details, such as methods used to develop the campaigns, 2) characteristics of the targeted populations and, 3) information on costs of these interventions

Implications for research and/or practice: This review provides guidance to the broad range of public health practitioners, researchers and other decision-makers who use the Community Guide as a source for evidence-based recommendations and findings about what works to improve public health. Although this review successfully demonstrated the effectiveness of integrating product distribution and health promotion messages, the ability to draw more specific conclusions about other important social marketing practices was hampered by limited descriptive information in the studies reviewed. Improved reporting of specific practices used in campaign development and implementation would build a more robust evidence base.