Theoretical Background and research questions/hypothesis: The Dietary Guidelines for Americans (DGA) recommend a diet rich in whole grains, fruits and vegetables, and lean meats or plant-based proteins to promote a healthy weight and reduce risk of non-communicable diseases. Marketing and media campaigns implemented by public- and private-sector entities have used various integrated marketing communications strategies and media platforms to promote a healthy diet in the United States. Cross-cutting insights from many of these campaigns have not yet been formally published. This study’s research question was: What lessons can be learned from 12 U.S. campaigns implemented during the past 25 years to inform future efforts to promote a healthy diet? We examined evidence available for the sales and consumption of these campaigns related to nutrient-dense food groups (i.e., fruits and vegetables, whole grains and legumes); healthy beverages (i.e., milk and water); and to reduce meat consumption.
Methods: We used a mixed-methods research approach to collect evidence through a comprehensive literature review and key informant interviews (n=11). Eight electronic databases and relevant gray literature and media releases were reviewed for articles published between January 1990 and October 2016. Evidence selection was guided by the National Academy of Medicine’s LEAD principles (i.e., locate, evaluate, and assemble evidence to inform decisions), five qualitative-research criteria, and validated by data and investigator triangulation. Selected data sources (n=60) were categorized and analyzed using an adapted health-branding framework (i.e., brand development, marketing execution, and monitoring and evaluation metrics) with 29 components. Key informant interviews were analyzed using NVivo 11.0 software to identify themes, organized by the health-branding framework, to complement the literature review findings.
Results: Brand development for nine campaigns used either health behavior (n=4) or communication (n=3) theories, or marketing concepts (n=2). Nine of 12 campaigns conducted formative research; and all campaigns used taglines, images, or logos to convey dietary messages. Marketing execution included: use of paid (n=10) or unpaid (n=12) mass media, earned media (n=12), audience segmentation (n=8), and integrated marketing communications (n=10). Communications targeted towards consumers conveyed diet-related messages that emphasized health, convenience, relevance, and environmental benefits. Nine campaigns were monitored and/or used evaluation metrics that examined changes in awareness (n=5), attitudes (n=3), consumption (n=5) and product sales (n=6).
Conclusions: The campaigns reviewed employed a variety of health-branding components in different manners, but no campaign used all 29 components related to brand development, marketing execution, and monitoring and evaluation. Leveraging public- and private-sector assets and expertise through commercial and public health sector collaboration may improve the design of marketing and media campaigns and contribute to their expansion, scaling up and sustainability to promote a healthy diet that aligns with the DGA.
Implications for research and/or practice: Rigorous formative, process and outcomes evaluations are needed to inform the design of U.S. marketing and media campaigns to promote a healthy diet. Recommendations are provided to assist public health practitioners to use integrated marketing communications to design effective campaigns, select appropriate metrics to evaluate campaigns, and share findings to inform future marketing and media campaigns.