In Western cultures, it is common to treat health as both an individual responsibility and a personal freedom. From the COVID-19 pandemic to secondhand smoke, public health issues have been framed as matters of personal choice, often focusing on how individuals’ behaviors affect them specifically, rather than their community as a whole. However, as the term public health indicates, health challenges are far more communal than one might initially assume. This article provides an introduction to communication research on health campaigns and is designed for prospective graduate students interested in health communication.
Health campaigns are communication-centered initiatives that attempt to alter popular health behaviors in the service of promoting public health. Many public health campaigns are undertaken by federal, state, or city government agencies, while others are conducted by non-governmental organizations (NGOs), health providers, health insurance companies, mass media institutions, social movement groups, community organizations, and other groups attempting to promote better public health. After providing a brief history of health campaigns, the following sections examine how communication scholars envision the research and design of health campaigns, explore some key theories that inform health campaign initiatives, and discuss the contemporary state of research in the field.
A Brief History of Health Campaigns
Health campaigns emerged at the turn of the 20th century as a method for combatting the spread of infectious diseases due to a constellation of factors. The pandemics of the previous centuries had demonstrated the importance of public behaviors, such as hygiene, in mediating the transmission of disease. In turn, public health became a greater area of concern for nations around the world. This time of cultural, economic and technological change also led to the rise of print advertising – a mode of mass media that would be critical to early public health campaigns.
One early example from this period is an advertisement that circulated through popular periodicals in England, aimed at promoting vaccination and infant hygiene, which depicts monstrous flies assailing a defenseless child. The use of media to promote popular health behaviors gained more traction during World War II in media initiatives to promote popular lifestyle changes in light of the need to ration resources. These early efforts drew on the tactics of advertising and primarily resorted to fear appeals to sway popular behaviors.
As Amy Lauren Fairchild et al. (2018) observes, from the 1950s to the 1970s, health campaign researchers and practitioners came to reject the efficacy of fear-based appeals. During this period, social psychological research on human behavior becomes an increasingly important contributor to considerations of how to design health campaigns. Drawing from these models, health communication researchers began to generate more nuanced strategies of promoting changes in the public health’s behaviors – for example, by bolstering an individual’s perception that they can effectively participate in the target behavior and overcome potential obstacles (Bandera 2009).
Today, the use of fear in health campaigns remains a matter of contention, while the close relationship between health campaigns, advertising, and social psychology has endured. Contemporary health communication research most commonly draws from social scientific theories based in marketing, advertising, and social psychology to devise communicative strategies to guide campaigns meant to promote public health issues, with some of the most successful targeting tobacco use and HIV/AIDS prevention.
At the same time, health campaigns are an important target for critical health communication scholars, who argue that health campaigns often function as a mechanism of Western colonialism and depend on racist, sexist, and cis-normative and heteronormative assumptions. Designing campaigns in engaged work with communities to help ameliorate these harms has become an important part of this research (Dutta-Bergman 2005). To learn more, see our Guide to Critical Perspectives in Health Communication.
Spotlight on Scholarship: Featured Scholars Researching Health Campaigns
Explore contemporary scholars conducting research on health campaigns and designing public health interventions today, from research on preventing opioid misuse to encouraging organ donation.
Dr. Katharine Head is Associate Professor in the Department of Communication at Indiana University Indianapolis, where she serves as the Director of the Health Communication Ph.D. Program. She is also an affiliate faculty member of the Fairbanks Center for Medical Ethics, and an adjunct faculty member for the Medical Humanities and Health Sciences Program. Dr. Head has published numerous single and co-authored research articles in journals like Health Communication. Her research has focused on HPV vaccination, COVID-19, and the use of social media in health campaigns. Dr. Head also holds leadership positions in the Indiana Immunization Coalition and the Health Communication Working Group at the American Public Health Association. Explore more of her work on health campaigns in our Interview with Dr. Head.
Dr. Nicky Lewis is Associate Professor in the Media School at Indiana University Bloomington where her research specializes in media psychology and media effects. Dr. Lewis, a prolific scholar in a number of areas, has applied this expertise to the study of health campaigns through her work on the HEALING Communities Study, funded by a grant from the National Institute of Health, which aims at reducing opioid misuse and overdoses through local interventions. This research has produced two co-authored studies: "The HEALing communities Study: Protocol For a Cluster Randomized Trial at the Community Level to Reduce Opioid Overdose Deaths through Implementation of an Integrated Set of Evidence-Based Practices" and "Health Communication Campaigns to Drive Demand for Evidence-Based Practices and Reduce Stigma in the HEALing Communities Study," both published in Drug and Alcohol Dependence.
Dr. Susan E. Morgan is Full Professor in the Department of Communication Studies at the University of Miami. Dr. Morgan's research on health campaigns focuses on issues of technology and health promotion in culturally diverse settings, with a special emphasis on organ donation campaigns. Her essays have appeared in leading publications, such as Health Communication, Communication Theory, and Journal of Applied Social Psychology. Dr. Morgan is the author of the book, From Numbers to Words: Reporting Statistical Results for the Social Sciences, and her research has been funded by organizations like the National Institute on Drug Abuse and the Department of Health and Human Services. Read our Interview with Dr. Morgan to learn more about her work.
Dr. Erika L. Thompson is Associate Professor at The University of Texas Health Science Center at San Antonio. Previously, she served as Program Director for the Maternal and Child Health Master's in Public Health Program at the University of North Texas Health Science Center at Fort Worth. Dr. Thompson's research and applied work on health campaigns focuses on HPV vaccination and prevention. Her work has appeared in medical research journals, health education journals like Cancer Education, and communication journals like the Journal of Health Communication. Dr. Thompson's research has been recognized by the American Academy of Health behavior with the 2020 Judy K. Black Early Career Research Award, and she is co-representative of the Women's Caucus for the American Public Health Association.
Dr. Marco Yzer is Professor in the Hubbard School of Journalism and Mass Communication at the University of Minnesota, where his research focuses on media effects and social media in the context of health campaign communication. His work on health campaigns, including the co-authored piece "Does Perceived Message Effectiveness Predict the Actual Effectiveness of Tobacco Education Messages? A Systematic Review," has appeared in top journals like Health Communication and Journal of Health Communication, and as chapters in several collected volumes. Dr. Yzer's doctoral dissertation, Mass Media Campaigns to Promote Safe Sex: An Evaluation of Public Campaigns in the Netherlands (1999) was also published as a book.
Key Theories in Health Campaign Research
Health communication researchers tend to base their recommendations for health campaigns on two different strains of scholarly literature: those based on advertising and marketing, and those based in research on communication and persuasion. The former set of approaches, sometimes called “social marketing,” applies principles like audience analysis, branding, cost/benefit analysis, and competition. For example, social marketing-based health campaigns are likely to focus on particular target audiences, identified by socioeconomic, cultural or behavioral demographics. They are also more likely to use branding, and other forms of commercially-derived messaging, operating under the perception they must compete with other health-related messages that the public is exposed to.
The latter set of approaches draws from communicative theories of persuasion, such as McGuire’s “Communication-Persuasion Matrix,” a modified version of the Shannon-Weaver communication model that argues that messages are “inputs,” whereas the factors involved in audience response (exposure to the message, learning, and yielding to attitude change) dictate the end behavior. Other communicative theories are derived from media and technology studies, mass communication research on media effects, and political communication. These include agenda setting, which argues campaigns are at their most effective when aligned with topics that are prominent in the media and other public discourse, and framing, which argues that the appeals of messages imply certain frameworks for understanding public health decisions (e.g., emphasizing gains from health behaviors, or emphasizing losses from not participating in them).
While there are important differences between these two main sets of influence, in practice health campaigns often synthesize the concerns and methodologies of the two fields in their efforts to design strategically effective messaging. A focus on adapting messaging to the audience, for example, is a key concern throughout health campaign research. Moreover, social marketing and communication-centered approaches frequently draw on similar theoretical constructs, with the most popular being social-psychological theories of behavior. The social psychological models inspiring health campaign designs include theories like the Health Belief Model, the Theory of Planned Behavior, and Social Cognitive Theory, discussed in detail in their respective articles .
These theories work to explain how individuals translate their perceptions (their knowledge, attitudes, and beliefs) into action or behavior. Scholars and health campaign workers draw from them to guide the communicative interventions of campaigns, targeting those constructs these models identify as likely to promote constructive health behaviors. For example, according to the Health Belief Model, the perceived benefits and consequences of taking a health-related action contribute to whether individuals will take that action, so campaigns routinely highlight the positive aspects of participating in that behavior and dramatize negative consequences of nonparticipation.
These are not the only theoretical influences on health campaigns. Research perspectives in interpersonal, family, organizational, and intercultural communication are also important influences on understanding campaign design, and, as noted below, critical perspectives that urge attention to how health campaigns can be designed equitably and to promote social justice have become an important as well.
Designing and Evaluating Health Campaigns
Rather than producing division in the field, the diverse intellectual foundations of health campaigns have been developed into a few primary campaign strategies. These different approaches are often employed together, though particular campaigns will often have particular emphases. Snyder and Hamilton (2004) identify these categories as information, enforcement, services, role modeling, and exposure.
Many early campaigns were informational in nature, based on the presumption that if individuals understood the consequences of their actions, they would engage in behaviors that directly benefited their health. Information on its own, however, frequently proves insufficient to inspire behavioral change. For many communication campaigns, messaging strategies that emphasize the negative consequences of certain behaviors (e.g., fear campaigns) or illustrate the social consequences of participation come to supplement their traditional provision of information. Other theory-based informational campaigns focus on an individual’s sense of self-efficacy by focusing on the how to participate in the desired health behavior.
Similar to informational campaigns, campaigns focused on exposure work on normalizing a health behavior and instilling its importance in the audience through repetition. The strategy of role modeling employs mass media or social communication to represent health behaviors to their target audiences to encourage them to adopt those practices. These campaigns draw from Albert Bandura’s Social Learning Theory and Theory of Planned Behavior in supposing that individuals learn from observing others practice a behavior and seeing its consequences.
These first three strategies are communicative. Some campaigns, however, go beyond communication to make use of more material interventions, like enforcement and the provision of services. Seat belt laws, for instance, are an example of an enforcement campaign that saw a great deal of success. The provision of services is also a central way of combatting perceived obstacles and increasing individual self-efficacy, which are both found to increase the likelihood that individuals engage in desirable health behaviors.
If the primary goal of health communication research in its collaboration with health campaigns is to incentivize behaviors conducive to public health, determining the efficacy of campaign strategies in reaching these goals is a critical task for researchers. However, as Seth Noar (2009) argues, many campaigns still suffer because the strategies that they adopt do not correspond with the recommendations of research. According to Noar (2012), health campaigns are most successful when they are grounded in theory and conduct research at every stage of the campaign process: from selecting the audience and the channels to be used for the communicative aspects of the campaign, to designing their messages. Similarly, researchers ought to thoroughly evaluate each stage of the design and the campaign process, in addition to its outcomes, which tend to be the exclusive focus of research evaluating the efficacy of campaigns.
Health Campaigns Today
Health campaigns have been an important means of combatting some of the most pressing public health problems that we have been confronted with over the last century. Research shows that, in many cases, campaigns have had measurable, positive effects on health promotion. Still, there are individuals and groups that questions the efficacy of health campaigns. As a result, many health communication researchers now dedicate their efforts to determining which theoretical models work best to guide campaigns, while advocating for more rigorously constructed health care messaging and interventions.
Other limitations stem from the paternalist and colonial mindset that has historically characterized health campaigns and how they relate to Black, Indigenous, and queer communities, as well as cisgender women. Campaigns have been shown to lack positive impact for members of marginalized groups when they are not outright harmful (Dutta-Bergman 2005). As a result, contemporary research on health campaigns often advocates for community-based initiatives that are designed to “go beyond individuals and include the family, social and cultural contexts (Bracht and Rice 2013).”
Despite these limitations, health campaigns are a central part of public health promotion, and a large part of health communication research is currently dedicated to informing the practices of public health campaigns. In recent decades, research on health campaigns has started to engage with health communication’s deeply rooted political, cultural, and theoretical shortcomings. It has also taken on new dimensions in seeking to understand social media as a resource for health campaigns and a challenge to public health alike. Today’s health campaign researchers are more determined than ever to designing efficacious means of promoting public health, while more often recognizing that respecting individual and cultural differences and promoting equity are central parts of that process.
Sources and Additional Resources
To learn more about current campaigns or dig deeper into the background of health communication campaigns, check out the following resources, as well as our exclusive Health Communication Research Interviews:
- Atkin, Charles and Ronald E. Rice. 2014. “Theory and Principles of Public Communication Campaigns.” In Public Communication Campaigns, Fourth Edition. Charles Atkin and Ronald E. Rice, editors.
- Borden, Neil H. 1964. “The Concept of the Marketing Mix.” In Science in Marketing, George Schwartz, editor. John Wiley, 1964.Bracht, Neil and Ronald E. Rice. 2014. “Community Partnerships in Health Campaigns.” In Public Communication Campaigns, Fourth Edition. Charles Atkin and Ronald E. Rice, editors.
- Bracht, Neil and Ronald E. Rice. 2014. “Community Partnership Strategies in Health Campaigns.” In Public Communication Campaigns, Fourth Edition. Charles Atkin and Ronald E. Rice, editors.
- Campo, Shelly, Kenzie A. Cameron, Dominique Brossard, and M. Somjen Frazer. 2004. “Social Norms and Expectancy Violation Theories: Assessing the Effectiveness of Health Communication Campaigns.” Communication Monographs 71 (4): 448–70. https://www.tandfonline.com/doi/abs/10.1080/0363452042000307498.
- Cho, Hyunyi, and Charles T. Salmon. 2007. “Unintended Effects of Health Communication Campaigns.” Journal of Communication 57 (2): 293–317. https://academic.oup.com/joc/article-abstract/57/2/293/4102644?redirectedFrom=fulltext.
- Douglas Evans, W. 2006. “How Social Marketing Works in Health Care.” Business Management Journal 332 (7551): 1207-1210.
Dutta-Bergman, Mohan J. 2005. “Theory and Practice in Health Communication Campaigns: A Critical Interrogation.” Health Communication 18 (2): 103–22. https://www.tandfonline.com/doi/abs/10.1207/s15327027hc1802_1. - Evans, W. Douglas, Jennifer Uhrig, Kevin Davis, and Lauren McCormack. 2009. “Efficacy Methods to Evaluate Health Communication and Marketing Campaigns.” Journal of Health Communication 14 (4): 315–30. https://www.tandfonline.com/doi/abs/10.1080/10810730902872234.
- Fairchild, Amy Lauren, Ronald Bayer, Sharon H. Green, James Colgrove, Elizabeth Kilgore, Monica Sweeney, and Jay K. Varma. 2018. “The Two Faces of Fear: A History of Hard-Hitting Public Health Campaigns Against Tobacco and AIDS.” American Journal of Public Health 108 (9): 1180–86. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2018.304516?journalCode=ajph.
- McGuire, William J. 2014. “McGuire’s Classic Input–Output Framework for Constructing Persuasive Messages.” In Public Communication Campaigns, Fourth Edition. Charles Atkin and Ronald E. Rice, editors.
- Noar, Seth M. 2009. “Challenges in Evaluating Health Communication Campaigns: Defining the Issues.” Communication Methods and Measures 3 (1–2): 1–11. https://www.tandfonline.com/doi/full/10.1080/19312450902809367.
- Noar, Seth M. 2012. “An Audience–Channel–Message–Evaluation (ACME) Framework for Health Communication Campaigns.” Health Promotion Practice 13 (4): 481–88. https://journals.sagepub.com/doi/10.1177/1524839910386901.
- Noar, Seth M., Philip Palmgreen, and Rick S. Zimmerman. 2009. “Reflections on Evaluating Health Communication Campaigns.” Communication Methods and Measures 3 (1–2): 105–14. https://www.tandfonline.com/doi/abs/10.1080/19312450902809730.
- Paisley, William and Charles Atkin. 2014. “Public Communication Campaigns—the American Experience.” In Public Communication Campaigns, Fourth Edition. Charles Atkin and Ronald E. Rice, editors.
- Robinson, Maren N., Kristin A. Tansil, Randy W. Elder, Robin E. Soler, Magdala P. Labre, Shawna L. Mercer, Dogan Eroglu, et al. 2014. “Mass Media Health Communication Campaigns Combined with Health-Related Product Distribution.” American Journal of Preventive Medicine 47 (3): 360–71. https://www.ajpmonline.org/article/S0749-3797(14)00254-2/abstract.
- Shi, Jingyuan, Thanomwong Poorisat, and Charles T. Salmon. 2018. “The Use of Social Networking Sites (SNSs) in Health Communication Campaigns: Review and Recommendations.” Health Communication 33 (1): 49–56. https://www.tandfonline.com/doi/full/10.1080/10410236.2016.1242035.
- Snyder, Leslie B. and Mark A. Hamilton. 2002. “A Meta-Analysis of U.S. Health Campaign Effects on Behavior: Emphasize Enforcement, Exposure, and New Information, and Beware the Secular Trend.” In Public Health Communication Evidence for Behavior Change. Robert C. Hornick, editor. Lawrence Erlbaum Associates.
- Snyder, Leslie B., Mark A. Hamilton, Elizabeth W. Mitchell, James Kiwanuka-Tondo, Fran Fleming-Milici, and Dwayne Proctor. 2004. “A Meta-Analysis of the Effect of Mediated Health Communication Campaigns on Behavior Change in the United States.” Journal of Health Communication 9 (1): 71–96. https://www.tandfonline.com/doi/abs/10.1080/10810730490271548.
- Sood, Suruchi, Corrinne Shefner-Rogers, and Joanna Skinner. 2014. “Health Communication Campaigns in Developing Countries.” Journal of Creative Communications 9 (1): 67–84. https://journals.sagepub.com/doi/10.1177/0973258613517440.
- Wang, Xiao. 2009. “Integrating the Theory of Planned Behavior and Attitude Functions: Implications for Health Campaign Design.” Health Communication 24 (5): 426–34. https://www.tandfonline.com/doi/abs/10.1080/10410230903023477.
- Yzer, Marco C., Brian G. Southwell and Michael T. Stephenson. 2014. “Inducing Fear as a Public Communication Campaign Strategy.” In Public Communication Campaigns, Fourth Edition. Charles Atkin and Ronald E. Rice, editors.
Additional Topics on Research in Health Communication
This guide details the central theories governing health communication research, including social cognitive theory and the theory of planned behavior, while examining the different types of health communication such as patient-provider discussions and health campaigns.
Explore Social Cognitive Theory and its applications in health communication. Learn about the theory’s history and key constructs, as well as its applications in health campaigns and health promotion initiatives, and the current state of research using the SCT.
Explore the definition and history of the Health Belief Model, its application in health communication research and public health initiatives, and its limitations, as well as contemporary research on the Health Belief Model and its effects.
Learn about the Theory of Planned Behavior in health communication research. Explore the history of the Theory of Planned Behavior, its key constructs, the model’s applications in health campaigns and health education, and the state of contemporary research in the field.
