This glossary collects the key concepts, people, and ideas you will meet in this lesson. Use it as a reference while you work through the material, or as a review before assessments. Type in the search box to filter entries.

Why the media matter for behaviour

This is an application lesson. It takes the theories from earlier lessons and asks how they are used in one of the most familiar forms of health promotion: the communications campaign. Before the lesson gets to campaigns, it pauses on a prior question. Why should messages in the public media change what anyone does? This section takes up that question. It covers the argument that humans are symbolic creatures, the way media figures act as models, the technologies that have reshaped communication since the 1990s, and the shift from a single line between sender and receiver to a web of reactions.

Creatures of communication and symbol

The argument starts from a claim about the species. As human beings, we are highly sophisticated creatures of communication and symbol, processors of symbolic information. Communication is our primary tool in the basic process of interacting with other people, as it is for every social species, but the argument presses further. Human life is inseparable from the complex world that is represented, stored, transmitted, and altered through the range of communication processes we use. We live a life built around shared, and conflicting, meanings, ongoing social interaction, and group-related behaviour, much of which is encoded and acted on through the ways we communicate.

A deliberately small example makes the point. How do you know what clothing to wear at any given time? How do you know what is fashionable? Much of what you know comes through the communication of images in the media and through all the talk that occurs about clothing and dress. You know what it means to wear one thing versus another, and in which situations a particular kind of clothing will mean one thing versus another, or at least you know what it means for the social group you belong to. A behaviour that feels like personal taste turns out to be built from communicated meanings.

That is why the mass media, meaning television, film, video, DVDs, cable, the Internet, social media, radio, and print, have taken on such importance in contemporary society. What you see, read, and hear in the public media becomes a major storehouse of information influencing how you act, look, sound, and think about things. The language you hear, the patterns of social interaction you see, the way situations are presented and characterized, and the way symbols are used all shape your understanding of the world. People and characters in the media provide models for behaviour. The communication scholar Sheila McNamee says the same thing in a sentence: with a flip of the channel or a turn of the page, we have at our disposal an enormous array of possible identity models.

Observational learning, revisited

If you remember your theory from Lesson 4, the phenomenon of media models has a name. Social Learning Theory, and later Social Cognitive Theory, described observational learning, in which people model their own behaviour on the behaviour of others and on what happens to those others when they engage in the behaviour. Models in the media help people develop an understanding of, for example, when it might be appropriate to use violence, or whether smoking is an attractive thing to do. The mass media, especially the Internet in its many applications, can also be seen as a playing field for representing oneself and interacting with others. A person is a viewer of models and also, increasingly, a model for other viewers.

A theme that runs through the whole course applies here. Behaviour is action infused with intent and meaning, interconnected with the social and environmental spheres. The mass media are a major component of that social environment, and they affect the health of people in both intended and unintended ways. A drama that makes smoking look sophisticated has a health effect nobody planned. A public service announcement has one that somebody did. The question this lesson sets out to explore is how the media can be intentionally used to promote the public's health.

Canadian policy has long treated the media as part of the environment that shapes behaviour. Quebec's Consumer Protection Act has banned commercial advertising directed at children under thirteen since 1980, and the federal Tobacco Act of 1997 sharply restricted tobacco advertising and sponsorship. Both rest on the premise laid out above: images in the media act as models, so limiting the models is a health intervention. The same premise runs the other way. If media models can make a product attractive, deliberately placed models can make a healthy behaviour attractive, which is the wager every campaign makes.

Recent technologies and their emerging roles

By the early 2010s the traditional media, television, newspapers, magazines, and radio, remained important but no longer dominated. Four technologies were taking on new roles. Click each card for a description.

Two of these observations deserve emphasis because they matter for every campaign that follows. First, the constant exchange of information through mobile devices is the primary communications channel for young people who have grown up with it. A campaign that wants to reach youth through the evening news is reaching their parents. Second, an abundance of channels cuts both ways. Cable and satellite gave people around the world access to shared cultural symbols, language, and behaviour, and the same abundance lets people retreat into enclosed worlds. That observation was first made about hundreds of cable channels. It applies with more force to feeds that are assembled for each viewer, where two people in the same household can live in different media environments.

From a line to a web

Communications theory, covered in Lesson 5, traditionally described a path from a sender who encodes a message through a channel to a receiver who decodes it. The point about social media is that this path is now potentially a much more complex interaction among multiple senders and receivers. A message is posted, commented on, shared with commentary, answered, and reshaped, and each of those reactions reaches people the original sender never addressed. The diagram contrasts the two pictures.

Use the interactive below to watch a single post become a web. Each wave adds the reactions described above, and the counter tracks how many people are now sending as well as receiving.

A threat, a tool, or both

Everything in this section can be read two ways. The media are a source of unintended health effects, because the models they supply were chosen by advertisers, producers, and other users for reasons that have nothing to do with health. They are also the largest set of channels a health program will ever have. The case below asks you to hold both readings at once.

The reflection at the end of this section picks up that question. Carry two ideas into the next section, where the lesson gets to campaigns proper. The media matter because they supply models and meanings that people act on. And the channels that carry those models now form a web rather than a line, which is one reason a campaign must know exactly which channels its audience actually uses.

A planned process of disseminating messages

This section covers the core of the lesson: what a communications campaign is and how one is built. It works through a hypothetical obesity campaign to show how two audiences become four segments, how formative research reveals the channels and tone each segment responds to, and how the pieces are sequenced. It closes with branding, a four-stage planning approach, and the communications plan.

What a communications campaign is

A communications campaign is a planned process of disseminating messages to influence behaviour in a particular group or population, typically called a target audience, through a coordinated process with five elements. Open each one.

Two points frame the definition. Campaigns usually, and most effectively, combine channels, including public events and interpersonal communication alongside the mass media. And campaigns are most effective when they are heard and remembered against the din of competing messages, of which there are a great many.

The problem of exposure

That din leads to one of the most practical claims in this lesson. A major difficulty for campaigns is that they often do not adequately expose the target audience to the message: they are less than effective because they do not reach their audience, and the fault lies there rather than in message design. The claim, from Hornik's review of the evidence, reverses the instinct of planners who polish the message and give little thought to how many people will see it often enough to remember it. The slider makes the arithmetic visible; the numbers are illustrative, the shape of the result is the point.

The obesity hypothetical: two audiences become four

Here is an assignment: a campaign in a metropolitan area that will raise awareness among adults and young people about the need for exercise and better eating to address obesity, and convince them to adopt better habits. Is it sufficient to think of two target audiences? Probably not. Adults who are parents think of their children as well as themselves and want to be good examples, so messages for parents should help with that. Single adults may have more time to exercise, cook, or eat out, and their focus is on themselves and the quality of their personal lives. Among youth, eating patterns differ between a nine-year-old and a sixteen-year-old, and sixteen-year-olds care about how they look in ways nine-year-olds do not yet grasp. Geography matters too: suburban and rural youth may have parks, urban youth a school playground. Even this simple exercise yields four segments: single adults, adults who are parents, youth about 12 and younger, and youth about 13 and older. Other splits, by cultural background, language, or region, are possible.

Formative research

Which channels suit each segment? That is a question for formative research: interviews, focus groups (something like a group interview), or surveys with members of the target audience. The findings identify channels, the best tone for a message, themes to emphasize or avoid, potential spokespersons or influential social models, and the audience's knowledge and attitudes. Pause on the phrase influential social models and ask which theory it refers to: Social Cognitive Theory, since a spokesperson is a model for observational learning. The tabs collect what the research might plausibly find for each segment, and the pitch that follows from it.

Notice the pattern: some overlap within the adult groups and within the youth groups, very little between youth and adult channels. Every segment's list combines mass media, authority or admired figures, and interpersonal sources.

Sequence and strategy

With the research in hand, you work with experts in social media, print, community events, news, and television advertising to design a package of messages and materials that fits the needs identified. Then you think strategy. Should there be a general kickoff event? Based on the research, perhaps not: older youth might be alerted that this is a health campaign, and younger youth might not pay attention, so a kickoff would serve only adults. For youth, a better opening is messages on websites or during sports broadcasts. When the sequencing is worked out, you have a campaign.

Branding

A big issue in applying communications theory is how to present the messages and the behaviour so that they represent something attractive and coherent across channels and segments. One approach from social marketing that has gained currency is branding. An advertiser links a product to an appeal attractive to a segment of consumers by creating a brand image that captures the appeal in a tagline, symbol, or personality. The brand is a shortcut: a consumer grasps what the product stands for without wading through the details. Treat a health behaviour as a product and the task is the same: a brand that links the behaviour to an appealing idea, so the population of focus can understand and take it up more easily, with the motivation of what it represents attached.

The four-stage planning approach

Thinking more systematically, the National Cancer Institute's guide Making Health Communication Programs Work, the pink book, describes a four-stage process. It is very much like PRECEDE-PROCEED, from Lesson 6, applied to communications.

Stage 3 deserves a second look: tracking exposure during implementation is how a campaign discovers, while there is still time to adjust, that its messages are not reaching a segment.

The communications plan

All of these decisions are documented in a communications plan, which summarizes the rationale for, elements of, and timetable for a campaign: campaign name; agency; health problem; overall health objective; communications campaign objectives; primary and secondary target audiences; formative research activities, purpose, and results; messages by segment; materials; dissemination, meaning channels, materials by channel, and the rationale; timeline; staff and resources; partners; and the evaluation plan. Two entries are easy to skip and costly to omit. The distinction between the health objective and the communications objective keeps a campaign honest about what messages alone can achieve, and the evaluation plan, written at the start, is what allows anyone to say later whether the campaign worked. The next section turns to the theories that guide the messages, and to a kind of campaign whose target is policy rather than personal behaviour.

Changing policy, and choosing the theory behind the message

The previous section built a campaign aimed at what individuals eat and how much they move. This section adds two things. The first is media advocacy, a communications activity whose target is a policy rather than a person. The second is the theory question the whole course has been building toward: which theories should guide a campaign's messages, and how do you tell? The answer comes in three parts: Hornik's three types of theoretical models, a mapping of familiar theories onto the obesity campaign, and a worked example in which theory is selected, rejected, and replaced as the audience changes.

Media advocacy

Media advocacy is the strategic use of mass media to apply pressure to advance healthy public policy. Its primary purposes are to influence public opinion, policymakers, and policy. Such campaigns aim at health behaviour change indirectly: they seek to change social institutions and their policies, and in doing so reach the environment that surrounds behaviour. Well-known examples of effective advocacy are smoking regulations such as clean indoor air ordinances and increased funding for HIV/AIDS research and prevention. Like any communications effort, media advocacy begins with a goal, but the goal is the behaviour change of policymakers in a school, a city, or a state, on matters such as alcohol sales to minors, secondhand smoke, access to healthcare facilities in an urban neighbourhood, or the cleanup of polluted water.

Media advocacy can be a full-scale mass media campaign, with advertising to build public support for a policy or to move a vote. It can also work through access to the news media, which is called news outreach. The first step is to gain media access and adequate coverage, so that the public and policymakers know about the issue. The second, equally important, is to make sure the topic is covered in a particular way, shaped so that it advances public health. The story you supply should make your point: that, for example, there are no healthcare facilities in certain sections of the city and the council is doing nothing about it. Open the items below for the strategies and materials involved.

Canada's tobacco control record is largely a record of media advocacy. Groups such as the Non-Smokers' Rights Association and the Canadian Cancer Society spent decades supplying journalists with stories, human faces, and policy asks, and the policies followed: the Tobacco Act of 1997, picture warnings on cigarette packages from 2001, provincial bans on smoking in vehicles carrying children beginning in 2008, and plain packaging regulations in 2019. None of these was a message to smokers. Each changed the environment around smoking by changing the behaviour of legislators, the indirect route described above.

Three kinds of theoretical models

By this point in the course you may have guessed that much of the health behaviour theory it has covered is useful in communications and mass media campaigns. This lesson organizes that theory using Hornik's three general types of theoretical models, and then proposes a fourth. Click each card.

The three models are three routes to the same destination, individual behaviour. The diagram draws them side by side. Notice that the further right you move, the longer the chain between the message and the behaviour, and the larger the number of people whose behaviour eventually changes if the chain holds.

Mapping theories onto the obesity campaign

A wide variety of theoretical approaches can be mapped onto those general models, using the obesity campaign as the example. The table gathers the mapping. The last column notes the model type each theory serves.

New communications technologies are ripe for the application of theory. Email counselling had been used to change behaviours including weight loss and smoking. Internet support groups for women with breast cancer had been shown to reduce negative emotions, increase participation in health care, and increase information competence. Text messaging had potential to help people stay on track and quit smoking, which the Text2Quit example in the next section develops. Canadian quit services have followed the same path: QuitNow in British Columbia and the Canadian Cancer Society's Smokers' Helpline offer text and online support alongside telephone counselling.

Theory and the development of messages

What information should you communicate, and how should you package or encode it? These questions are informed by theory as it pertains to the situations and characteristics of particular populations. If you hope to influence behaviour in a group, your messages must have meaning for that group, which is what finding the right pitch meant in the previous section. Here is an example every student should be able to reproduce.

Recall the older youth. They will not attend to messages that seem to ask them, or scare them, into conforming to what adults think is right. Now suppose formative research shows that this age group does not think itself susceptible to obesity or its consequences. That sounds like the Health Belief Model. All you have to do is write a message that increases their perceived susceptibility. The answer is no, or at least not yet.

So what is developmentally relevant? Adolescents and young adults in the United States look to peers for guidance on how to behave, so Social Cognitive Theory and its vicarious learning component fit. A message that employs a peer social role model to create value for exercise and healthy eating, without dwelling on scare tactics for the moment, may be more effective. Notice that this is still consistent with the Health Belief Model, because it plays up the benefits of the behaviour as young adults understand them. The construct has changed from susceptibility to benefits, and the mechanism from a warning to a model.

Now change the population once more. Suppose the messages are for young adults from another country or culture, where the peer emphasis common in the United States is less important. In some cultures great respect is given to older adults. Culture theory tells us that people live and behave in subjective worlds of meaning, where behaviour and meaning are linked. If age-respect is important, and if young people are viewed as representing their family rather than asserting individuality, a common sentiment in many Asian cultures, then a message associating exercise and good eating with approval from elders and representing one's family well may be much more effective than a peer appeal. Three audiences, three theories, one behaviour. The workbench below lets you run the same reasoning for yourself.

The workbench is a teaching device rather than a formula. What it should leave you with is the habit this lesson models: name the audience, ask what formative research says they believe and whom they listen to, and only then choose the construct and the channel. The next section asks whether that habit predicts which real campaigns worked.

Three campaigns and what their evaluations showed

The lesson closes with program examples: two national youth campaigns whose evaluations point in opposite directions, and a pilot of a text messaging program built directly from Social Cognitive Theory. A question follows the first two, and it is left to you: why did one campaign succeed with youth and the other not? This section lays out what the evaluations reported, works through candidate answers using the tools from earlier sections, and then turns the same lens on four Canadian campaigns. Throughout, the section reports what the evaluations found about effects and marks where a claim goes beyond the evidence it cites.

Three program examples

The table places the two youth campaigns side by side on the dimensions this lesson has used: audience, the appeal of the message, the theory implied, the channels, and what the evaluation measured.

Why did one succeed with youth and the other not?

The question is left open here, but the earlier sections supply candidate explanations. None is proven by the evaluations cited above; the exercise is to reason from theory to a testable hypothesis.

Canadian campaigns through the same lens

Each case below is a real Canadian communications effort described in general terms. For each, identify the audiences, the appeal, the theory implied, the channels, and what an evaluation would need to show. Where a case makes no claim about effects, that is deliberate.

Spot the construct

The last interactive of the lesson asks you to do quickly what this lesson has done slowly: read a campaign message or approach and name the construct or model it acts on. Each item describes a real campaign's central move, in general terms.

You have now seen the whole arc of the lesson: why the media matter, how a campaign is planned, which theories guide its messages and its advocacy, and what evaluations of real campaigns have found. The final review brings the pieces together around a single design task.

Bringing It All Together

This lesson moved from the media to the message and back to the evidence. It began with a claim about people: we are creatures of communication and symbol, and what we see, read, and hear in the public media becomes a storehouse of information that shapes how we act, look, sound, and think. People and characters in the media are identity models, and the mechanism by which they influence behaviour is the observational learning of Social Learning Theory and Social Cognitive Theory. The media affect health in intended and unintended ways, and the Internet, mobile devices, social media, and cable and satellite broadcasting have multiplied the channels while turning the sender-receiver path into a web of many senders and receivers.

A communications campaign is the intentional use of that mechanism: a planned process of disseminating messages to influence behaviour in a target audience through a coordinated process of identifying audiences and segments, choosing channels, determining messages and their format, sequencing activities, and conducting formative research. The obesity hypothetical showed two audiences becoming four segments with different channels, different concerns, and different tolerances for tone, and showed why the obvious sequence, a public kickoff, can be wrong. Branding, the four-stage planning approach, and the communications plan give the effort coherence; media advocacy extends it to policy by changing the behaviour of policymakers rather than of individuals. The most practical warning in the lesson is that campaigns most often fail on exposure, because they never reach their audience against the din of competing messages.

Theory enters at the level of the message. Hornik's individual, social diffusion, and institutional diffusion models, plus the newer virtual dissemination models, organize the routes from a message to behaviour, and the familiar theories map onto them: the Health Belief Model and the Transtheoretical Model for individuals, diffusion of innovations, social marketing, communications theory, culture theory, and social networks for norms, and elite opinion through media advocacy for institutions. The worked example of older youth showed theory being chosen, rejected at a developmental brick wall, and replaced by a peer model and then by cultural meaning. The program examples closed the loop: a well-exposed antidrug campaign that did not move youth, a Truth Campaign that fit their need for independence and changed beliefs in proportion to exposure, and a text messaging pilot that put Social Cognitive Theory into a new channel. Canadian campaigns on tobacco and vaping, impaired driving, COVID-19 vaccination, and mental health can be read with the same lens, and every evaluation claim should be read by the link in the chain it concerns.

Final Knowledge Assessment

This assessment covers all material from this lesson. You must score 100% to complete the lesson. Review the feedback for any incorrect answers and try again.