Motivating Behavior Change: A Content Analysis of Public Service Announcements From the "Let's Move!" Campaign

I. Introduction

Children in the United States are growing, and although we may want them to grow taller, they are also growing wider. Over the past 30 years, childhood obesity prevalence has tripled in the United States (Yaqubi, 2011). According to the National Health and Nutrition Examination Survey taken in 2008, approximately half (50.1%) of our youth ages 2-19 were considered obese (Yaqubi, 2011). These alarming numbers are due in part to an overall decrease in physical activity and an increase in unhealthy eating habits. Children spend countless sedentary hours consuming entertainment media and eating more than ever before. Childhood obesity is an important problem to address because adolescent obesity can lead to serious health and self-esteem problems later in life.

In 2010, the United States government launched the Let's Move! campaign, a program developed by First Lady Michelle Obama "dedicated to solving the problem of obesity within a generation, so that children born today will grow up healthier and able to pursue their dreams" ("First Lady Michelle Obama launches Let's Move"). To mark the one-year anniversary of the campaign, Let's Move! joined forces with the U.S.

Department of Health and Human Service, the U.S. Department of Agriculture and The Ad Council to develop TV, radio, print, outdoor and web public service advertisements. These ads aim to educate parents and children about healthy eating and physical activity to ultimately motivate behavior change. This study analyzed television and print public service advertisements for the Let's Move! campaign with the goal of discovering how health messages are communicated to motivate behavior change. This research also aimed to evaluate the health communication theory and practices used in these campaign advertisements.

II. Literature Review

No specific studies have analyzed how health messages are communicated in the Let's Move! campaign public service advertisements to motivate behavior change. For the purpose of this study, academic literature was reviewed about public health communications campaigns, the effectiveness of public service advertisements in yielding behavior change and health communication theory. A case study about the success of the VERB campaign to increase physical activity among children was also reviewed.

Public Health Communication Campaigns

Public health communication campaigns are implemented to address health problems such as poor diet, inactivity, tobacco use and AIDS prevention. These campaigns use a variety of communication tactics and channels to reach publics and influence health behavior including in-school presentations, handouts, public service announcements and discussion groups (Snyder, 2007). Studies published about the effectiveness of health communication campaigns found that utilizing an appropriate channel and targeting a specific audience are helpful in motivating behavior change among publics. Abroms, Schiavo and Lefebvre conducted a study evaluating the successfulness of various heath campaigns and found that by integrating new media such as the Internet, computer games, digital television and cell phones into public health campaigns, a larger number of people were reached and the length of the campaign was expanded (2007). Many of the tools that distribute new media are free via the Internet, which makes dissemination even easier and more cost-efficient, thus exposing the campaign to more people and overall increasing the motivation to change the requested health behavior (Abroms et al., 2008; Snyder, 2007). Although mass media campaigns reach a wide breath of people, when interventions were specifically targeted to a group of publics, they were even more effective in yielding behavior change (Marcus, Owen, Forsyth, Cavill, & Fridinger, 1998).

Health communications campaigns are faced with the constant challenge of reaching publics from a variety of socio-economic backgrounds. A study analyzing media-based physical activity interventions conducted by Marcus, Owen, Forsyth, Cavill, and Fridinger found publics who were socially disadvantaged were harder to reach with a media-based intervention campaign than those who were not socially disadvantaged (1998). Furthermore, in an assessment of an adolescent physical activity campaign, Faulkner, Kwan, MacNeil and Brownrigg found that children from low-income families recalled less information about the campaign than children from high-income families (2011).

Social Cognitive Theory and Health Belief Model

Communications and public health theory are used to develop effective communications that drive behavior change in public health campaigns. The social cognitive theory and health belief model are useful in explaining behavior change among publics. For the purpose of this study, research about certain aspects of these theories was explored. The social cognitive theory is a learning theory developed by psychologist Albert Bandura, which explains how certain behavioral patterns are adopted. People are influenced by personal factors and environmental factors, which in turn affect the individual's behavior (2001). According to Bandura, the most important pre-requisite for a person to change their behavior is the existence of self–efficacy, which is the internal belief that the individual is able to implement the proposed behavior change (2001). With self-efficacy, one can make a behavior change even when obstacles are in the way.

Bandura's social learning theory asserts that individuals learn from observing the actions of others and the benefits of those actions (Bandura, 2001). The social lerning theory evolved from the social cognitive theory, which is explained above. According to Bandura, individuals can learn through observing actions of others in three ways: when an actual person demonstrates the desired behavior, when a person verbally instructs them how to make the desired behavior change, and when they models themselves for a real or fictional character who demonstrates the desired behavior in the media (1977). Although they learn through observing, it is not guaranteed they will make a behavior change (1977).

The health belief model is from the public health discipline, and attempts to explain why people make a health behavior change. The health belief model asserts that in order for individuals to think about making a behavior change, they must first recognize they are susceptible to the condition or disease. Next, the individuals must believe this is a serious condition, and they can reduce their risk if they take the advised action. The individuals also needs to receive cues to action, such as how-to information, so they can initiate behavior change. Lastly, they must have self-efficacy in order to take action (Champion & Skinner, 2008). According to Champion and Skinner, self-efficacy can be achieved through verbal reinforcement and guidance in the recommended action (2008). It is important health campaign messages utilize the above theories by showing and telling the how-to and when to in order to help drive behavior change (Snyder, 2007).

Childhood Obesity Campaigns

Public health campaigns that were designed to increase physical activity and educate about nutrition began to appear in the mid-1980s due to an increase in overweight and obesity (Huhman, Potter, Duke, Judkins, Heitzler & Wong, 2007). In the 1990s, campaigns became more intently focused on nutrition, particularly "increasing consumption of fruit, vegetables and low-fat milk" (Huhman et al., 2007). Because of the recent increase in the prevalence of childhood obesity, many public health advocates see the promotion of youth physical activity as an even more pressing priority (Huhman et al., 2007). According to a survey conducted by the Pew Research Center, more than half of adults believe the government should play a significant role in helping to reduce childhood obesity (2011). This is why the government has launched two childhood obesity campaigns within the past 10 years: The VERB campaign and the Let's Move! campaign.

In 2002, the U.S. Center for Disease Control and Prevention launched the VERB campaign, which used commercial marketing techniques to "sell" physical activity to tweens ages 9-13. Results found that this physical activity campaign had the largest effect on behavior change (Snyder, 2007). The campaign's chief strategy was to create a brand, "VERB: It's what you do." In order to make the brand known, the VERB campaign associated "with popular kids' brands, athletes and celebrities, and activities and products that are cool, fun, and motivating" (Parvanta, 2011). The VERB campaign used atypical messages to communicate to tweens about physical activity. Instead of presenting facts, the campaign showed tweens how to take action by using visuals in public service advertisements on TV and in print. Tweens featured in the advertisements were of various ethnic backgrounds, body weights and ability levels so they were easily identifiable for a large number of publics. Furthermore, communication tactics were targeted separately at parents and children so tweens would still associate VERB with a cool and young brand (Parvanta, 2011).

A study conducted by Wakefield, Loken, and Hornik found that campaigns using mass media to prevent childhood obesity showed significant improvements in weight loss (2010). Because the VERB campaign was mass media based, interventions reached a large number of target publics (Hihman et. al.,2007). Although these improvements were significant, long-term changes are difficult to maintain after a campaign ends (Wakefield et al., 2010). Therefore, in 2010 First Lady Michelle Obama launched the Let's Move! campaign. This ongoing campaign promotes better nutrition information, increased physical activity, easier access to healthy foods, and personal responsibility. For the purpose of this study, public service advertisements from the Let's Move! campaign were analyzed for communication tactics.

Public Service Advertisements

Mass media campaigns use public service advertisements to raise awareness and educate publics about an issue at hand with the goal of shifting attitudes and ultimately motivating behavior change (Atkin, 2001). PSAs communicate about health topics or social issues including alcohol awareness, environmental protection, obesity prevention and gun control (Atkin, 2001). Charles Atkin conducted a study in which he reviewed major health campaign PSAs, and analyzed their value in yielding behavior change. Atkin found "the effectiveness of public service advertising depends not only on the quantity and quality of campaign messages, but on the difficulty of achieving the intended outcome and the receptivity of the audience to the health behavior being promoted" (2001). Drawn from theory and research, Atkin proposes a PSA should contain three types of messages to motivate behavior change: Awareness, instruction, and persuasion. To generate awareness, campaign messages must inform publics about the health topic. Instruction messages should tell publics what to do and how to do it, and persuasion messages should give reasons why publics should adopt this particular health behavior. Atkin also discusses how to increase the effectiveness of PSAs by adding credibility, communicating in an engaging style to gain the attention of publics, creating a simple understandable message, and making the message personally involving and relevant (2001). Atkin advises it is important to choose a messenger that is influential to target audiences. Through these strategies, public service advertisements will influence target publics to a greater extent and ultimately result in the desired health behavior.

Research Questions

RQ1: What types of communication messages are presented in the Let's Move! campaign to motivate target audiences to change their behavior and reduce obesity?

RQ2: To what extent do these messages follow health communication theories (Health belief model, social cognitive theory)?Continued on Next Page »