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From awareness to behaviour: Testing a hierarchy of effects model on the Australian Make Healthy Normal campaign using mediation analysis.

ABSTRACT: The Make Healthy Normal mass media campaign was a three-year campaign launched in 2015 in New South Wales (NSW), Australia to address community norms around overweight and obesity. It was underpinned by a hierarchy of effects model; a commonly used framework in campaigns but one that has rarely been tested. The campaign evaluation included a cohort study of NSW adults, surveyed three times over 12?months (n?=?939 at Wave 3). This study tested the campaign's hierarchy of effects model, which theorized that participants would move from recognition to behaviour change via understanding, knowledge, attitude, social norms, self-efficacy, and intention, using these data. We used the moderation and mediation of effects method proposed by Baron and Kenny, adjusting for age and sex, to test for progression through the hierarchy of effects for two outcomes: physical activity and fast food consumption. We found a clear progression through the theorized model, from recognition through to behaviour change, via the intermediate variables for both outcomes. We also found several effects not predicted by the theorized model, with consistently strong associations between understanding and attitude, understanding and self-efficacy, attitude and self-efficacy, and self-efficacy and behaviour change in both outcome models. Our study provides support for the hierarchy of effects as a conceptual model in campaign planning and evaluation of social marketing campaigns. To our knowledge, this is the first study to compare the hierarchy between two behavioural outcomes and the consistency observed between the models adds to the potential usefulness of the hierarchy of effects.

SUBMITTER: Kite J

PROVIDER: S-EPMC6152809 | biostudies-other | 2018 Dec

REPOSITORIES: biostudies-other

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From awareness to behaviour: Testing a hierarchy of effects model on the Australian Make Healthy Normal campaign using mediation analysis.

Kite James J Gale Joanne J Grunseit Anne A Li Vincy V Bellew William W Bauman Adrian A

Preventive medicine reports 20180911

The Make Healthy Normal mass media campaign was a three-year campaign launched in 2015 in New South Wales (NSW), Australia to address community norms around overweight and obesity. It was underpinned by a hierarchy of effects model; a commonly used framework in campaigns but one that has rarely been tested. The campaign evaluation included a cohort study of NSW adults, surveyed three times over 12 months (n = 939 at Wave 3). This study tested the campaign's hierarchy of effects model, which theo ...[more]

PMID: 30258762

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Project description:BackgroundThe rate of overweight and obesity in Australia is among the highest in the world. Yet Australia lags other countries in developing comprehensive educative or regulatory responses to address sugary drink consumption, a key modifiable risk factor that contributes substantial excess sugar to the diet. Measurement of sugary drink consumption is typically sporadic and nutrition focussed and there is limited knowledge of community perceptions and awareness of the health risks associated with excess sugary drink consumption. The aim of this study was to assess the demographic characteristics, behavioural risk factors and attitudes and knowledge associated with sugar-sweetened beverage (SSB) and 100% fruit juice consumption.MethodsA face-to-face household survey was conducted in 2014 using a stratified random sampling strategy to represent the South Australian population aged 15?years and over. The survey contained questions on sugary drinks, with past week SSB consumption and 100% fruit juice consumption used as outcome variables. Associations were examined with demographic characteristics, behavioural risk factors, and sugary drink attitudes and knowledge.ResultsOf the 2732 respondents, 35% had consumed SSBs 1-6 times (moderate consumers) and 16% had consumed SSBs 7 or more times (frequent consumers) in the past week. Furthermore, 35% had consumed 100% fruit juice in the past week, with 10% consuming every day. Rates of SSB consumption were consistently higher among males, younger age groups, and groups with lower education attainment, as well as smokers and frequent consumers of fast food. Awareness of health risks and sugar content of SSBs was low, especially among frequent SSB consumers. Fruit juice consumption was higher among males, younger age groups, the physically active and among those believing that 100% fruit juice did not contain more sugar than SSBs.ConclusionsConsumption of SSBs and 100% fruit juice is common but awareness of health risks and sugar content of these drinks is low. There is a need for greater consumer understanding which could be achieved through educative approaches such as public education campaigns, on-package warning labels and improved nutrition information panels.

Project description:National Eating Disorders Association conducts a NEDAwareness week every year, during which it publishes content on social media and news aimed to raise awareness of eating disorders. Measuring the impact of these actions is vital for maximizing the effectiveness of such interventions. This study is an effort to empirically measure the change in behavior of users who engage with NEDAwareness content, and compare the detected changes between campaigns in two different years. We analyze a total of 35,895 tweets generated during two campaigns of NEDAwareness campaigns in 2019 and 2020. In order to assess the reach of each campaign, we consider the users participating in the campaigns and their number of followers, as well as retweeting engagement. We use the Linguistic Inquiry and Word Count (LIWC) text modeling and causal impact analysis in order to gauge the change in self-expression of users who have interacted with the NEDAwareness content, compared to a baseline group of users. We further enrich our understanding of the users by extracting gender information from their display names. We find that, despite large media corporations (such as MTV and Teen Vogue) participating in the campaign, it is governmental and nonprofit accounts who are among the accounts that attract the most retweets. Whereas the most influential accounts were well-connected in 2019, the 2020 campaign saw little retweeting between such accounts, negatively impacting the reach of the material. Both campaigns engaged women at around 40% and men 17%, supporting previous research showing women to be more likely to share their experiences with eating disorders. Further, women were more likely to mention other health topics within the 15 days of the intervention, including pregnancy and abortion, as well as depression and anxiety, and to discuss the developing COVID pandemic in 2020. Despite the positive message of the campaign, we find that the users who have engaged with this content were more likely to mention the linguistic categories concerning anxiety and risk. Thus, we illustrate the complex, gender-specific effects of NEDAwareness online health intervention campaign on the continued self-expression of its audience and provide actionable insights for potential improvement of such public health efforts.

Project description:OBJECTIVE:In February 2009, the Department of Health in England launched the Face, Arm, Speech, and Time (FAST) mass media campaign, to raise public awareness of stroke symptoms and the need for an emergency response. We aimed to evaluate the impact of three consecutive phases of FAST using population-level measures of behaviour in England. METHODS:Interrupted time series (May 2007 to February 2011) assessed the impact of the campaign on: access to a national stroke charity's information resources (Stroke Association [SA]); emergency hospital admissions with a primary diagnosis of stroke (Hospital Episode Statistics for England); and thrombolysis activity from centres in England contributing data to the Safe Implementation of Thrombolysis in Stroke UK database. RESULTS:Before the campaign, emergency admissions (and patients admitted via accident and emergency [A&E]) and thrombolysis activity was increasing significantly over time, whereas emergency admissions via general practitioners (GPs) were decreasing significantly. SA webpage views, calls to their helpline and information materials dispatched increased significantly after phase one. Website hits/views, and information materials dispatched decreased after phase one; these outcomes increased significantly during phases two and three. After phase one there were significant increases in overall emergency admissions (505, 95% CI = 75 to 935) and patients admitted via A&E (451, 95% CI = 26 to 875). Significantly fewer monthly emergency admissions via GPs were reported after phase three (-19, 95% CI = ?-29 to -9). Thrombolysis activity per month significantly increased after phases one (3, 95% CI = 1 to 6), and three (3, 95% CI = 1 to 4). CONCLUSIONS:Phase one had a statistically significant impact on information seeking behaviour and emergency admissions, with additional impact that may be attributable to subsequent phases on information seeking behaviour, emergency admissions via GPs, and thrombolysis activity. Future campaigns should be accompanied by evaluation of impact on clinical outcomes such as reduced stroke-related morbidity and mortality.

Dataset Information

From awareness to behaviour: Testing a hierarchy of effects model on the Australian Make Healthy Normal campaign using mediation analysis.

Publications

From awareness to behaviour: Testing a hierarchy of effects model on the Australian Make Healthy Normal campaign using mediation analysis.

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