Several decades of research yield lessons for effectively using communications to influence health. For example, a 2006 review article stated:
The literature is beginning to amass evidence that targeted, well-executed health mass media campaigns can have small-to-moderate effects not only on health knowledge, beliefs, and attitudes, but on behaviors as well, which can translate into major public health impact given the wide reach of mass media. Such impact can only be achieved, however, if principles of effective campaign design are carefully followed.1(emphasis added)
However, a progress review of the 2001 National Strategy for Suicide Prevention and an expert panel both noted that these principles are not well-known or followed by the suicide prevention and mental health fields.
The research finds that more successful communications efforts:
- Are intentionally planned.2–5Messages are most effective when they are systematically planned using research so messages are tailored to defined goals, audiences, and contexts.
- While numerous communications planning models exist, each outlines a similar sequence of planning tasks.2,6–9
- It is critical to first analyze the situation and identify what purpose the messages will serve and how they connect to your larger mission and goals. Only then can you choose an audience, create messages and decide how to reach the audience. While it’s tempting to start with a “product” in mind (e.g., Facebook page, poster, speaker’s bureau), it is best to start with strategy. In short, decide “why” before “how.”
- Support broader change goals and work in sync with other programs, resources, or services.3,10
- When pursuing complex behavior changes, communications alone is often insufficient; however, messaging can contribute to such efforts as one part of an overall plan for change.2,11
- Formative research is defined as “Research conducted during the development of your program to help you decide on and describe your target audience, understand the factors which influence their behavior, and determine the best ways to reach them. It looks at behaviors, attitudes and practices of target groups, involves exploring behavioral determinants, and uses a myriad of methods to collect data. Formative research may be used to complement existing epidemiological and behavioral data to assist in program planning and design.” (Source: CDCynergy, Social Marketing Edition Version 2.0)
- Objectives often reflect intermediate changes in knowledge, attitudes, beliefs, perceptions, expectancies, intentions, and other behavioral influences as well as changes in the behavior change itself.
- Many campaigns seek to “raise awareness” of the targeted problem; however, such a vaguely defined objective is too ambiguous and unlikely to advance a specific goal.
- Objectives should be grounded in the formative research, specific, and closely tied to the desired behavior (e.g., “to increase the belief that counseling can be effective”).
- The social marketing literature stresses the importance of highlighting benefits valued by the “customer” (the intended audience) that offset the tangible or intangible costs of taking action.6,14
- Other factors to explore include the audience’s current beliefs and attitudes about the problem and the behavior, their general values and interests, and how they perceive influential individuals and organizations in their lives will view that specific behavior.2,12It is the audience’s current beliefs and perceptions¾whether accurate or inaccurate¾that shape their behavior.
- More effective messaging uses formal behavior change theories as a framework to identify a full range of behavioral influences and decide which ones to address through messages.15–19
- It is also important to learn about the audience’s usual and trusted information sources and media usage.
- When targeting multiple audiences, each audience and behavior should be analyzed separately.
- Are developed using formative research.1,2,12,13
- Set specific and realistic communications objectives: specifically, measurable changes that will occur in the target audience after message exposure.2,13
- Conduct additional audience research as needed to clearly understand the desired changes from the audience’s perspective.
- Include a “call to action” that makes it clear who needs to act and what they need to do, why it is being advocated, and provides information needed to act.20
- Pre-test concepts, messages, and materials with the audience before finalizing them to assess whether they are relevant, credible, culturally appropriate, understandable, and successful in conveying the intended message.1,2,14
- Include a plan for monitoring and assessing whether goals and objectives are achieved.2,5,7,13This is important because evaluation is a particular gap in the research literature on suicide prevention communications.5,21,22
The research on effective communications efforts has become the professional standard for the suicide prevention field.
- All three recommendations from a progress review of the 2001 National Strategy for Suicide Prevention (NSSP) reflect the research on effective communications efforts, including to “increase the proportion of public awareness and education campaigns that reflect…the fundamental principles of health communication….”
- The wording of Goal 2 of the 2012 revised NSSP reflects this literature: “Implement research-informed communication efforts designed to prevent suicide by changing knowledge, attitudes, and behaviors.”
- The literature on suicide- and mental health-related campaigns aligns with these findings, as do the findings from a 2013 Expert Panel on suicide prevention communications.
This literature is the primary foundation for the Strategy component of the Framework. The Strategy section of the site includes the following pages:
- Overview: Strategy
- Principles of Effective Communications
- Key Planning Steps
- Tips for Messaging Strategically
- How Strategy Fits Into the Framework
- Resources: Strategy (includes links to planning guides and other resources)
- Noar SM. A 10-year retrospective of research in health mass media campaigns: where do we go from here? J Health Commun. 2006;11(1):21-42. doi:10.1080/10810730500461059.
- National Cancer Institute. Making Health Communication Programs Work. 2001. Available at: http://pinkbook.cancer.gov. Accessed May 28, 2014.
- DeJong W. The role of mass media campaigns in reducing high-risk drinking among college students. J Stud Alcohol. 2002;suppl 14:182-192.
- Salmon CT, Atkin C. Using media campaigns for health promotion. In: Thompson TL, Dorsey AM, Miller KI, Parrott R, eds. Handbook of Health Communication. Mahwah, NJ: Lawrence Erlbaum; 2003:449-472.
- Chambers DA, Pearson JL, Lubell K, Brandon S, O’Brien K, Zinn J. The science of public messages for suicide prevention: A workshop summary. Suicide Life Threat Behav. 2005;35(2):134-145.
- Grier S, Bryant CA. Social marketing in public health. Annu Rev Public Health. 2005;26(1):319-339. doi:10.1146/annurev.publhealth.26.021304.144610.
- O’Sullivan GA, Yonkler JA, Morgan W, Merritt AP. A Field Guide to Designing a Health Communication Strategy. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs; 2003. Available at: https://www.jhuccp.org/sites/default/files/A%20Field%20Guide%20to%20Designing%20Health%20Comm%20Strategy.pdf. Accessed May 28, 2014.
- Department of Health and Human Services: Center for Disease Control and Prevention. CDCynergy Planning Tool. Available at: http://www.cdc.gov/healthcommunication/CDCynergy/. Accessed May 28, 2014.
- Communications Resource Center, Substance Abuse and Mental Health Services Administration. Strategic Communication Planning: A Workbook for Garrett Lee Smith Memorial Act State, Tribal, and Campus Grantees. 2009. Available at: http://www.sprc.org/sites/sprc.org/files/library/GLSWorkbook.pdf. Accessed May 28, 2014.
- Wallack L, DeJong W. Mass media and public health: Moving the focus from the individual to the environment. In: Martin SE, Mail P, eds. Effects of the Mass Media on the Use and Abuse of Alcohol. Bethesda, MD: NIAAA Research Monograph No. 28, NIH Publication No. 95-3743, National Institute on Alcohol Abuse and Alcoholism; 1995:253-268.
- Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet. 2010;376(9748):1261-1271. doi:10.1016/S0140-6736(10)60809-4.
- Atkin C, Freimuth V. Formative evaluation research in campaign design. In: Rice RE, Atkin CK, eds. Public Communication Campaigns. Thousand Oaks, CA: Sage Publications; 2001.
- Flay BR. Evaluation of the development, dissemination and effectiveness of mass media health programming. Health Educ Res. 1987;2(2):123-129. doi:10.1093/her/2.2.123.
- Gordon R, McDermott L, Stead M, Angus K. The effectiveness of social marketing interventions for health improvement: What’s the evidence? Public Health. 2006;120(12):1133-1139. doi:10.1016/j.puhe.2006.10.008.
- Fishbein M, Cappella JN. The role of theory in developing effective health communications. J Commun. 2006;56(suppl 1):S1-S17. doi:10.1111/j.1460-2466.2006.00280.x.
- Glanz K, Rimer BK, Viswanath K. Health Behavior and Health Education: Theory, Research, and Practice, 4th Edition. San Francisco CA: Jossey-Bass; 2008.
- Wright K, Sparks L, O’Hair D. Health Communication in the 21st Century. Blackwell Publishing; 2008.
- Shemanski Aldrich R, Cerel J. The development of effective message content for suicide intervention: Theory of Planned Behavior. Crisis. 2009;30(4):174-179. doi:10.1027/0227-5910.30.4.174.
- Stecker T, Fortney J, Hamilton F, Sherbourne CD, Ajzen I. Engagement in mental health treatment among veterans returning from Iraq. Patient Prefer Adherence. 4:45-49.
- Murray-Johnson L, Witte K. Looking toward the future: Health message design strategies. In: Thompson TL, Dorsey AM, Miller KI, Parrott R, eds. Handbook of Health Communication. Mahwah, NJ: Lawrence Erlbaum Associates; 2003:473-496.
- Pearson JL. Challenges in US suicide prevention public awareness programmes. In: O’Connor RC, Platt S, Gordon J, eds. International Handbook of Suicide Prevention: Research, Policy and Practice International Handbook of Suicide Prevention: Research, Policy and Practice. John Wiley & Sons, Ltd.; 2011:577-590.
- Dumesnil H, Verger P. Public awareness campaigns about depression and suicide: A review. Psychiatr Serv Wash DC. 2009;60(9):1203-1213. doi:10.1176/appi.ps.60.9.1203.