The Framework for a Public Health Campaign Targeting Childhood Obesity
Public relations campaigns remain one of the mostly widely used tools in the arsenal of authorities who want to influence the behaviour of the public. Public relations strategies play a crucial role in advocating public health priorities, continuing to produce innovative and thoughtful campaigns that powerfully shift the population’s attitudes and behaviours.
Childhood obesity is a current health issue which experts agree is a significant issue for Australia, in both health and economic terms, and yet there has not been an integrated, national campaign that has successfully lowered childhood obesity rates. An opportunity exists to influence the younger generation’s attitude to healthy choices.
Public communication campaigns can be defined as “purposeful attempts to inform or influence behaviours in large audiences, using an organised set of communication activities using multiple channels to produce benefit to individuals and societies” (Atkin & Rice 2013, p. 3). This describes the type of communication plan typically used in public health promotion activities, which are developed to improve the health of individuals and reduce the burden of disease on society.
The problem that exists is that childhood obesity rates have risen to such an extent that it’s considered a public health crisis. Childhood obesity rates have risen sharply in the past two decades and it’s estimated that 1 in every 4 schoolchildren is affected by obesity (Gill,
Storlien, Brand-Miller, Colagiuri, Caterson, Baur, Singh, Bauman, & Steinbeck 2009, p. 146). Mihrshahi, Gow & Baur (2018, p. 269) suggest that in order to influence behaviour change among children and young people, strategies involving family involvement and school-based intervention with support from health professionals should be considered. In addition, parents aren’t always aware of their child’s weight status or the risk factors of childhood obesity (GreenMills, Davison, Gordon, Li & Jurkowski 2013, p. 25).
Thus, the problem a public health campaign could address is:
Broadly, the communication objective of the public health campaign is to raise awareness among children and their families about the health implications of obesity, modify their behaviour to make healthy choices, and encourage them to seek medical support. This will be achieved by running a large scale, national campaign over a time period of least twelve months aimed at children at risk for obesity and their families, with support from school communities and medical practitioners. Evaluation of the campaign will examine whether attitudes towards obesity have changed, whether healthier choices are being adopted, and whether rates of accessing medical help have increased - all of which are behavioural objectives (Hayes, Hendrix & Kumar 2013, p. 28).
Preliminary research indicates that an effective campaign would include the following:
There is a significant body of research that childhood obesity results in both immediate and long-term health consequences, including Type 2 diabetes, cardiovascular risk factors and psychosocial problems (Gill et al 2009, p. 146). Furthermore, the health consequences of childhood obesity persist in the long term. Must and Strauss (1999, p. 8) found that long term consequences of childhood obesity are of “significant public health importance.” A research review conducted by Reilly (2005, p. 336) found that long term social and economic consequences, such as income, educational attainment and lost economic productivity, could be attributed to childhood obesity along with higher health care expenses (Black, Hughes & Jones 2018, p. 1).
The organisation who will undertake this campaign is the Australian Medical Association. The Australian Medical Association (AMA) commenced operations formally in 1962 and performs an advocacy role to “promote and protect the health care needs of patients and communities” (AMA, 2020). In 2012, the AMA made a submission to the National Health and Medical Research Council which advocated the development of resources to prevent childhood obesity, including multimedia videos and fact sheets that can support medical practitioners and patients (AMA, 2012). The AMA publishes the well-regarded Medical
Journal of Australia, Australia’s “leading peer-reviewed general medical journal”, which has published more than sixty research articles on obesity over the past two decades, establishing itself as a front-runner in clinical research…on the subject of obesity (AMA, 2020). With a well-established history and a trusted reputation among both medical professionals and communities they serve, the AMA is considered a credible source to disseminate health promotion campaigns.
The key publics targeted for addressing childhood obesity include children and teenagers, in the age bracket of 8 – 15, their families and school communities. Identifying these key publics and their characteristics and social traits means that the public health campaign will be more efficient, audience receptivity will increase and message effectiveness will improve
(Atkin & Rice 2020, p. 5).
Publics have five key characteristics: they are distinguishable, homogenous, important, large and accessible (Smith 2017, p. 66). The key public can be easily distinguished as Generation Z, children born between 1996 – 2010, and who share homogenous traits such as age, school attendance and technological expertise. They are one of the largest publics in Australia, as Generation Z comprises around 20% of Australia’s population (McCrindle, 2020). They are easily accessible due to their ability to use technology, described as being the most technologically saturated generation, and engaged through social media (McCrindle, 2020). Families and school communities, described by Smith (2017, p. 68) as secondary customers, are also key publics. A third type of public are the medical professionals who are ready to support children and families, and who are considered an enabling public, a group with some influence over the primary publics (Smith 2017, p. 69).
Health campaigns using public relations methods and campaigns targeting obesity are not new and there are opportunities to review and inform future campaigns. An evaluation of a childhood obesity awareness campaign conducted in 2017 (GreenMills, Davison, Gordon, Kaigang & Jurkowski, p. 25) found that few public health interventions engaged families as a whole. Another study focused on whether public health campaigns should use social media as part of their communications, and found that social media is “highly effective in motivating participants to take small, concrete actions” (Freeman, Potente, Rock & McIver 2015, p. 1). Reviewing public health promotions, Vine, Hargreaves, Briefel & Orfield (2013, p. 13) concluded that the integration of primary care is important to accelerating progress in preventing childhood obesity. Based on this research, the campaign should be careful to involve families as key publics, rather than focusing exclusively on children. It’s important to include a participatory and technologically advanced approach and it’s critical to enlist the support of schools and physicians in any public health campaign to support children and families.
The childhood obesity health campaign is considered to be a proactive campaign, long range and strategic in nature (Hayes, Hendrix & Kumar 2013, p. 14). If one of the campaign objectives is to encourage children and families to make healthier choices in the long term, it is critical to equip them with the means and motivation to do so. A campaign based on social cognitive theory will achieve this.
Social cognitive theory emphasizes “the processes by which source role models, explicitly demonstrated behaviours, and depiction of vicarious reinforcement enhance the impact of messages” (Atkin & Rice 2020, p. 5). Beliefs of efficacy is a significant cause of action, according to Bandura (1998, p. 624) who argues that unless “people can produce desired effects by their actions, they have little incentive to act”. Bandura (1998, p. 624) offers two ways to effectively achieve this: through mastery experiences, where success builds the target public’s belief efficacy; and vicarious experiences, where people similar to the target publics are seen to succeed and model comparable activities.
With regard to children and young people, Bandura (1998, p. 643) argues that “health habits are rooted in familial practices” and that schools play a critical role in health promotion. However, rather than requiring schools to assume the role of health educator, Bandura (1998, p. 643)suggests that schools can assist by equipping children with skills and beliefs that enable them to regulate their own behaviour.
A review of health promotion campaigns which used social cognitive theory as a basis for the campaign found that the theory was used where the goals of the campaigns where to raise awareness of a health issue, influence attitudes, and impart self-help skills such as seeking medical help or making positive lifestyle choices and were successful in influencing behaviours (Randolph & Viswanath 2004, p. 428).
The proposed campaign uses gamification through social media to achieve beliefs of efficacy. As young people play games that encourage healthy choices, they’re learning self-help skills to modify their attitudes and behaviours about diet and exercise. Through winning levels and unlocking achievements in the game, children and young people can win sporting equipment for their schools which involves this critical community, as well as providing the means for students to increase their physical activity. A supporting role played by key role models in a media campaign provide the necessary influence.
The relationship management perspective holds that public relations balances the interests of organisations and publics and is defined as “effectively managing organisational-public relationships around common interests and shared goals, over time, results in mutual understanding and benefit for interacting organisations and publics” (Ledingham 2003, p. 190). Moreover, Broom and Dozier (in Ledingham 2003, p. 183) ) argue that the relational perspective shifts the validation of public relations initiatives from measuring communication outputs to that of behavioural outcomes, which is the objective of the proposed health promotion campaign.
Relationship management theory shifts communication methods from message manipulation to cultivating mutually productive relationships, which in turn shifts evaluation to determining the perception and behaviour change in key publics (Bruning & Ledingham 2000, p. 87). Where organisations wish to influence the attitude and behaviour of key publics, Grunig (in Bruning & Ledingham 2000, p. 87) noted that “organisations must engage in behavioural relationships, then communicate about those activities to affect the long-term behaviour of key public members.”
Given that one of the key objectives of the childhood obesity campaign is to achieve longterm behaviour and attitude changes, basing the campaign on building relationships is key.
Research has shown that childhood obesity is a problem with no quick solutions; therefore, the public health promotion must assume the same perspective. Springston and Lariscy (2005, p. 227) agree that building and maintaining positive relationships with the organisation's various stakeholders is a major element of effective public relations in public health and that public health efforts require a great deal of collaboration between a variety of organisations and individuals.
The framing model of media effects assumes that how an issue is characterised in the media can have an influence on how it is understood by audiences (Scheufele & Tewksbury 2007, p. 11). Framing theory is useful in health promotion efforts due to the fact that it is able to “make aspects of an issue more salient through different modes of presentation and therefore, shift people’s attitudes” (Scheufele & Tewksbury 2007, p. 15). Rothman & Salovey (1997, p. 4) suggest that nearly all health-related information can be construed in terms of either benefits or costs, and that behavioural responses to framed information is a function of both the framed message and the pre-existing perception of the health issue. The health behaviours a public relations campaign seek to influence are preventative; that is, the campaign asks key publics to act, such as eating healthy food or taking up exercise, to prevent the development of a health problem. To adopt a preventative behaviour is seen as less risky, and therefore gain-framed information should promote prevention-oriented health behaviours most effectively (Rothman & Salovey 1997, p. 11). This informs the proposed childhood obesity campaign to be gain-framed through encouraging certain behaviours, such as making healthier food choices and taking up physical activity.
Rothman & Salovey (1997, p. 15) also assert that the ultimate goal of any framed message is to promote a particular behaviour. The likelihood of a person accepting a message sufficiently to act on it relies in large part on their ability to perform the behaviour successfully as explained by social cognitive theory. When researching and designing a health promotion campaign, Scheufele (1999, p. 116) asserts that the perceived importance of the frame setting plays a key role in an effective strategy.
The proposed childhood obesity campaign uses social cognitive theory, relationship management theory and framing theory to create an effective strategic framework through improving beliefs of efficacy, influencing using role models, building strong stakeholder relationships and using gain-framed messaging. This framework for the campaign has the ultimate goal of changing attitudes and behaviours in the key publics, which all three theories advocate. It is from this framework that a large-scale public health campaign can be designed to improve the health of children, their families and their communities.
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