To be effective, mass media campaigns must be noticed, persuasive and remembered
Australia’s 2008 national campaign Measure Up promoted waist circumference as a way to measure risk
Western Australia’s Go for 2 and 5 increased daily fruit and vegetable intake across the population
LiveLighter’s campaign linking sugary drinks to toxic fat was associated with a short-term reduction in consumption
Mass media campaigns can be effective at changing population health behaviours, including to reduce smoking rates and prevent HIV infection.1 They use existing channels such as television, radio, print media, online and outdoor media (e.g. billboards) to deliver an organised set of communications activities. Such campaigns expose large populations to health messages repeatedly and over time, with the aim of raising awareness, increasing knowledge and changing behaviour.2
Campaigns to prevent obesity are supported by the World Health Organization (WHO) and leading public health bodies.3 The WHO recommends that countries implement mass media campaigns on healthy diets to reduce consumption of fats, sugars and salt and promote the intake of fruit and vegetables.4
If they are to be effective, mass media campaigns must be:
- noticed (using appropriate media channels and placement to reach the target group)
- perceived as persuasive (experienced by the target group as engaging, relevant and/or emotionally affecting), and
- remembered (seen often enough for them to be recalled and acted upon).5
Hierarchy of effects model for mass media campaign
Adapted from Cavill N, Bauman A. Changing the way people think about health-enhancing physical activity: do mass media campaigns have a role? J Sports Sci. 2004;22(8):771–90 and Kite J, Gale J, Grunseit A, Li V, Bellew W & Bauman A. (2018). From awareness to behaviour: Testing a hierarchy of effects model on the Australian Make Healthy Normal campaign using mediation analysis. Preventive Medicine Reports, 12, 140-7
A systematic review of obesity prevention mass media campaigns in Australia and overseas between 2000 and 2017 found they can influence knowledge, attitudes and intentions, especially where campaign awareness is high.6 There is evidence that they can influence some behaviours,1 but researchers have called for future campaign evaluations to assess sustained behaviour change through long-term follow-up.7 They have also recommended the linking of campaigns to broader prevention strategies targeting policy and environmental changes.1
Australia’s national obesity campaign Measure Up was launched in 2008, eight years after obesity was acknowledged as a public health crisis with the publication of a major World Health Organization report.8 Since then, a mix of national and state campaigns have run in Australia to inform the public about the health risks of obesity; and to promote positive attitudes and beliefs towards modifiable behaviours that can help achieve or maintain a healthy weight. Evaluations of LiveLighter campaigns suggest they have not led to increased endorsement of weight-based stereotypes.91011
Further details follow about major Australian mass media campaigns targeting overweight and obesity prevention, at national and state levels, for which published evaluations are available.
Measure Up and Swap it, Don’t Stop It
A major national mass media campaign aimed at encouraging Australians to make healthy changes to diet and physical activity ran between 2008 and 2011. The first phase, Measure Up (2008-09), promoted waist circumference as a new way to measure risk of obesity-related chronic diseases and broadly urged people to make healthy changes. The second phase, Swap It, Don’t Stop It (2011), featured an animated blue balloon character called Eric and encouraged adults to make small, achievable changes by swapping unhealthy behaviours for healthy ones. The campaign used media channels including television, radio, online and outdoor.12
An evaluation of Measure Up in NSW found the campaign increased awareness and knowledge about the link between waistline and chronic disease risk and led to more people measuring their waist. It did not lead to any notable changes in self-reported physical activity or healthy eating behaviours.13
While Measure Up encouraged general behaviour change such as eating more fruit and vegetables and exercising more, the second phase of the national campaign, Swap It, Don’t Stop It, encouraged specific behaviours such as swapping large portions for smaller portions and swapping watching television for going for a walk. Across the population, there was moderate awareness of the Swap It, Don’t Stop It campaign but only 16% of Australians surveyed had made at least one swap in the previous six months.12 Researchers said it was likely that environmental changes were needed to supplement such a mass media campaign, in order to make small behaviour changes easier to implement and sustain.
Go for 2 and 5
The Go for 2 and 5 campaign aimed at increasing awareness of the recommended intake of fruit and vegetables and increasing consumption ran in Western Australia between 2002 and 2005. The campaign featured colourful animated characters made from fruit and vegetables and ran on media channels including television, radio, print and at point-of-sale. The campaign significantly increased correct knowledge of the recommended number of serves of fruit and vegetables and resulted in daily fruit and vegetable intake increasing by 0.8 serves across the WA adult population.14 The campaign had the greatest impact on men who were low consumers of fruit and vegetables, and later ran nationally.
The LiveLighter® toxic fat campaign graphically depicted visceral ‘toxic fat’ around an overweight person’s organs. The aim was to illustrate negative health effects of overweight and obesity and encourage small changes to increase physical activity and eat a healthier diet. The campaign was developed by the Department of Health WA and ran first in WA in 2012 on media channels including television, cinema, radio, print and online.9
The principal advertisement explaining ‘why’ overweight was a problem was more commonly recalled than messages showing ‘how’ to change. The campaign was perceived by almost all adults who recalled it as believable and making a strong argument for reducing weight. Approximately half of adults regarded the campaign as ‘relevant to me’ with adults who were overweight more likely to agree with this.
The proportion of WA adults who reported they would likely meet physical activity recommendations in the immediate term increased significantly from baseline to the second burst of campaign activity. There was no significant increase in intentions to change dietary behaviour, however researchers said the overall findings showed mass media campaigns could lead to a shift in attitudes needed to underpin longer-term behavioural change.
A second phase of the LiveLighter® campaign targeting sugary drinks ran first in WA in 2013, with campaign advertising illustrating the contribution of sugary drinks to the development of visceral ‘toxic fat’ around vital organs. Television advertising was complemented by cinema, radio, print, outdoor and digital advertising.10
The sugary drinks campaign achieved a high level of awareness with about two-thirds of WA adults recalling or recognising it. The campaign led to a significant increase in adults recognising toxic fat build up as a health effect of drinking too many sugary drinks. The campaign was associated with short-term reduction in frequent (4+/week) consumption of sugary drinks among adults.
Piece of String
Cancer Council Victoria’s Piece of String television campaign ran in Victoria for six weeks in 2007, targeting adults aged 30 years and older who were overweight. The advertisement depicted a domestic scene in which a young girl measured pieces of string and tried unsuccessfully to wrap the string around her father’s waist. It cited evidence that being overweight increased your risk of some cancers and specified target waist measurements that men and women should not exceed.15
An evaluation found that the advertisement increased awareness of the link between obesity and cancer. Following exposure to the advertisement, however, respondents were no less likely to classify their weight status as healthy and therefore their perceived risk of cancer did not increase. Researchers said that while the campaign achieved its primary objective of raising awareness of the obesity and cancer link, respondents may have seen the message as more relevant to others, and that barrier was something future campaigns would need to address.
The LiveLighter® campaign targeting sugary drinks, developed in WA and detailed above, ran in Victoria for six weeks in 2015. (The toxic fat campaign ran in Victoria in 2014). Paid television advertising was complemented by radio, cinema and digital advertising. An evaluation of the sugary drinks campaign found it led to a significant reduction in the proportion of frequent sugary drinks consumers among the target population of 25 to 49-year-olds in Victoria.11 Among sugary drink consumers who were overweight, there was also evidence of increased knowledge of the health effects of drinking sugary drinks and increased water intake.
A television advertisement developed by the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) encouraging Aboriginal and Torres Strait Islander people to reduce their intake of sugary drinks ran on the free-to-air channel National Indigenous Television (NITV) in October 2015 with funding from the LiveLighter campaign.16 The advertisement depicted an Aboriginal family watching television, including a girl with a can of sugary drink that turned into a stream of sugar as she went to take a sip. It then showed the whole family devouring spoons of sugar including a girl with rotten teeth, before showing another version of the scene in which the family chose water as a healthy alternative. An evaluation of the campaign found that 52% of Aboriginal and Torres Strait Islander people surveyed had seen the advertisement and of this group, 60% reported cutting down on sugary drinks.16
New South Wales
Make Healthy Normal
The first phase of the Make Healthy Normal campaign targeted adults who were overweight or obese or at risk of developing chronic disease because they did not meet healthy eating or physical activity guidelines. The first phase of the campaign aired in five bursts between November 2015 and June 2016 and centred on two television advertisements, supported by print, outdoor and digital advertising. Campaign messages focused on the ‘problem’ of unhealthy lifestyles becoming normalised and the ‘solution’ of suggested simple lifestyle changes.17 For example, encouraging smaller portions, increased consumption of fruit and vegetables and water, and less sitting.
An evaluation found phase one of the campaign increased knowledge on the risks of being overweight and the benefits of lifestyle changes. Researchers said building on knowledge gains from phase one to influence intentions and behaviour should be a focus of additional phases of the campaign.