Monday 17 February 2014

Media Advocacy Optimization Tips

I want to know the specifics of how to design a media message so as to maximize its impact. Despite the somewhat large quantities of writing on health communication, social marketing, entertainment-education, the psychology of fiction, narrative persuasion, advertising, and so on, it is still difficult to find concrete tips that media producers should be aware of. As far as I know, the available information on effective communication has never been packed into the same place anywhere on the internet. This is an ongoing list of concrete tips for optimizing persuasive media messages aimed at changing behaviour. I will update this post whenever I discover a new one. At the moment, it is almost certainly lacking huge amounts of important information. Please leave a comment if you have more resources.


  • Messages tailored to individuals are more effective than generic appeals to the broader population.
  • Gender, race, ethnicity, and other participant characteristics have no effect on the impact of tailored communication messages.
  • Theoretical plus cultural tailoring works better than theoretical tailoring alone.
  • In terms of print media advocacy, pamphlets, newsletters, and magazines appear to work better than letters, manuals, or booklets.
  • Attractive visual design and layout increase engagement. This could include infographics and images.
  • The longest pamphlets are the least effective.
  • Perceived susceptibility significantly reduces persuasion, while perceived self-efficacy facilitates persuasion.
  • People are more likely to take up a loan if only one term and size is offered than if there are multiple options.
  • Men are significantly more likely to take up a loan when a picture of a woman is on the corner of the message.
  • Loss framed appeals are more effective than gain framed appeals.
  • Fear appeals in high-efficacy messages have the strongest rates of behaviour change, while fear appeals in low-efficacy messages have the highest rates of reactance.
  • Fear appeals should target either the individual or the group depending on whether it is disseminated in an individualist or a collectivist culture.
  • Fear appeals work best when combined with messages about how to control the danger and relieve anxiety. 
  • Different genders can require different advice based on the nature of the issue (e.g. regarding condom use).
  • Reading materials targeted at Americans should be kept at a 7th or 8th grade reading level.
  • The use of exemplars in news articles and other appeals is effective, as it increases narrative engagement, which leads to increased persuasion and behavioural intent.
  • In terms of emotional engagement, persuasiveness, grabbing attention, and next-day recall, television is the most effective advertising medium.
  • Offering an additional free prize with your product can reduce interest in your product if the prize is uninteresting.
  • Getting people to imagine themselves performing a behaviour makes them more likely to perform that behaviour.
  • When using fiction as a vehicle for persuasive messages, do not let your messages distract from the narrative or reduce the entertainment value of the program.
  • Campaigns including threats of enforcement of laws and regulations are more effective at influencing behaviour.
  • Campaigns that present new information are more successful than campaigns that repackage already known information.
  • Messages about attitudes, expectancies and behavioural skills were more effective than messages about disease prevention, transmission, or threats.
  • Targeting ethnic minorities and people with lower socioeconomic status results in larger effect sizes.
  • Parasocial interaction and general involvement with characters reduces counterarguing, as well as psychological reactance.
  • Identification with a vulnerable character will reduce perceived invulnerability thus increase the viewer's odds of changing behaviours.
  • Parasocial interaction with a character displaying counternormative behaviour is likely to enhance the persuasive effects of entertainment-education by altering perceived norms.


A number of narrative reviews of the tailored health communication literature have, in fact, examined the issue of impact of tailored messages on health behavior change. Skinner et al. (1999) reviewed 13 health behavior intervention trials testing the efficacy of tailored print messages versus nontailored comparison or control conditions. They concluded that tailored messages are indeed more effective in influencing health behavior change as compared with the other conditions tested, noting that 6 of 8 studies com- paring tailored messages to similar but nontailored messages resulted in significant findings. Rimer and Glassman (1999) reviewed 17 cancer communication intervention trials testing the efficacy of tailored print communications and similarly concluded that evidence suggests behavioral outcomes are more positive than they are null or negative. Kroeze, Werkman, and Brug (2006) reviewed 30 studies on computer-tailored materials for physical activity and dietary behavior change and described the evidence supporting the effectiveness of dietary computer-tailored interventions as “quite strong” (p. 208). They also concluded that too few studies existed in the physical activity domain to draw conclusions. Revere and Dunbar (2001) reviewed 37 health behavior intervention trials, including those utilizing print materials, automated telephone, computers, and mobile communications. They found that 34 of the 37 trials had statistically significant or improved outcomes and thus concluded that tailored interventions are effective. Other reviewers of this literature have similarly concluded or suggested that tailoring appears to “work” (Brug, Campbell, & van Assema, 1999; Kreuter, Farrell, et al., 2000; Strecher, 1999; Velicer, Prochaska, & Redding, 2006).”
In addition, narrative reviews of the tailored message literature have consistently remarked that we need to learn a great deal more about the mechanisms underlying effective tailoring and tailored interventions, or the so called “black box” of tailoring (Abrams et al., 1999; Kroeze et al., 2006; Skinner et al., 1999). Thus, another major aim of the current study was to examine which features of tailored interventions related to larger effect sizes, which was achieved through the examination of a number of potentially important moderating variables. Results indicated that participant characteristics (e.g., gender, race, education level) were generally unrelated to effect size. This result is not surprising, as the over- riding concept of tailoring is one of customization of a message to a particular individual. Thus, whether participants are men or women, African-American or Caucasian, a carefully tailored message should be relevant and potentially effective with the individual for whom it was created. These findings suggest that tailoring is an appropriate health communication strategy for numerous target populations.”

Analysis of the type of print materials that were used in interventions suggested that the most successful print tailored materials have been pamphlets, newsletters, or magazines, rather than letters, manuals, or booklets. Why might this be the case? Although few study authors provided details on the layout of print materials, it may be that pamphlets, newsletters, and magazines were more likely to include pictures and graphics and to have superior layout characteristics that may have helped to garner and perhaps retain the attention of participants. Donohew, Lorch, and Palmgreen (1998) argue that capturing attention is a prerequisite to persuasion with regard to health education messages. If materials are not sufficiently stimulating to attract and keep the attention of an individual, that individual may lose interest, and the content of the message will not have had an opportunity to be persuasive (Donohew et al., 1998). One empirical study of tailored print materials found evidence to support this proposition. Namely, participants who found the materials to be “attractive” were significantly more likely to pay attention to, like, and understand the health information, or what the authors referred to as “preliminary steps to behavior change” (Bull, Holt, Kreuter, Clark, & Scharff, 2001, p. 275). Others have additionally made the case that the layout of health education materials can have an effect on whether individuals pay attention to, read, and ultimately process health information (e.g., Kreuter, Farrell, et al., 2000; National Cancer Institute, 2001). In fact, in their book on tailored health messages, Kreuter, Farrell, et al. (2000) go as far as to state that with regard to tailored materials, “Good visual design can be as important to the success of a tailored communication piece as the message content itself” (p. 105). Visual design and layout includes a number of considerations, and developers of tailored interventions and other health promotion materials should seek guidance when developing such materials (see Kreuter, Farrell, et al., 2000). In addition, it should also be noted that the type of print material with the smallest effective size (i.e., manuals) also tends to be the longest in length. Length of print materials is also an important consideration when it comes to creating tailored messages, as those that are too lengthy may not be read by participants.”
For instance, Kreuter et al. (2005) examined the impact of tailored health magazines on African American women’s mammography and dietary behaviors, comparing theoretical tailoring only, cultural tailoring only, and theoretical plus cultural tailoring. Results indicated that the theoretical plus cultural tailoring condition significantly outperformed the theoretical tailoring only condition on both mammography and dietary behavioral change. Although few additional studies have examined the “value added” of other tailoring strategies over and above theoretical tailoring, the current meta-analysis suggests that carefully tailoring on demographic characteristics (e.g., gender, race, age) and giving feedback on the behavior itself may enhance the effectiveness of theoretical tailoring.“
The only theoretical concept found to be associated with significantly decreased effect sizes was perceived susceptibility. Why was this the case? It may be that in a number of health domains, messages that focus on increasing positive views and feelings toward a health behavior (i.e., attitudes) and those that increase one’s confidence in performing the behavior (i.e., self-efficacy) are more motivating to health behavior change than messages that raise the threat of a disease. In fact, a recent meta-analysis examining the impact of theoretical strategies in persuasive health communications found just that result (Albarracin et al., 2003). Namely, messages that presented attitudinal information and/or modeled behavioral skills (i.e., raised self-efficacy) were found to affect condom use, whereas messages aimed at raising the threat of HIV/AIDS had no such effect. The literature on perceptions of risk and their relation to health behavior remains mixed, with some meta-analyses finding no association (Gerrard, Gibbons, & Bushman, 1996), others finding a modest association (Harrison, Mullen, & Green, 1992), and still others finding a stronger association (Brewer et al., 2007).”
For example, the lender varied the description of the offer, showing the monthly payment either for one typical loan or for a variety of loan terms and sizes. In all cases, it was specified that this was only a sample term and loan size and that other terms and loan sizes were available. This particular manipulation aimed to contrast the economic truism that having more options is always good with the psychological perspective that a greater number of alternatives can increase decisional conflict and overload decision makers. Other randomizations included whether and how the offered interest rate compared with a “market” benchmark, the inclusion of a photo in a corner of the letter that differed on race and gender, the expiration date of the offer, whether the offer included a promotional giveaway, and whether suggested uses for the loan were included in the offer letter. The lender also performed several telephone calls either to remind consumers of the offer or to prime them through suggestion (we explain this further subsequently). Use of administrative data from the lender allowed for the measurement of how actual take-up of the loan corresponds with the interest rate and the various psychological factors.

As economic models predict, the interest rate strongly affects take-up. There appears to be a robust, negatively sloping demand curve in this market. Yet some of the psychological factors also strongly affect demand in ways that are difficult to reconcile with the rational choice model. For example, consumers are more likely to take up a loan if only one term and size are described in the offer letter than if many examples are provided. As another example, male customers’ take-up increases substantially with the inclusion of a woman’s photo in a corner of the offer letter. Although not all of the psychological factors had a significant effect on take-up, many did, and their impact was large. On average, any one “positive” feature increased take-up by almost as much as a one percentage point drop in the monthly interest rate.”

In one field experiment conducted as part of a workplace health-promotion program at a large telephone company, women were encouraged to take mammograms (Banks et al.1995). Women (N = 133) who had obtained fewer than 50% of the mammograms they should have at their age were invited to view a 15-minute videotape on breast cancer and mammography. They were randomly assigned to two conditions: Half viewed a video called “The Benefits of Mammography,” which was a gain-framed presentation that emphasized the potential benefits of getting a mammogram. The other half viewed a video called “The Risks of Neglecting Mammography,” which was a loss-framed presentation that pointed out the potential costs borne by women who neglect to get a mammogram. Women who viewed the gainor loss-framed video did not differ in their liking for the video or in what they learned from it; these responses were measured immediately afterward. However, 12 months later, 66.2% of the women who viewed the loss-framed video had obtained a mammogram, compared with 51.5% of the women who had viewed the gain-framed version. Similar results have been replicated with larger samples, again showing the power of the loss-framed messages to spur behavior. In a recent intervention addressing the take-up of flexible-spending accounts, an increased take-up was observed under a loss compared with a gain frame (Schwartz et al. 2006).

The framing of messages can be altered in other ways as well. For example, framing outcomes in aggregate (yearly income) as opposed to segregated (weekly income) formats can have an impact, as can mere labeling (e.g., 3% mortality versus 97% survival rates). However, decision frames are often chosen inadvertently and as if they mattered little. If the results from other domains generalize to social program take-up, far greater care should be taken in designing the optimally framed message.”

The meta-analysis suggests that strong fear appeals produce high levels of perceived severity and susceptibility, and are more persuasive than low or weak fear appeals. The results also indicate that fear appeals motivate adaptive danger control actions such as message acceptance and maladaptive fear control actions such as defensive avoidance or reactance. It appears that strong fear appeals and high-efficacy messages produce the greatest behavior change, whereas strong fear appeals with low-efficacy messages produce the greatest levels of defensive responses. Future directions and practical implications are provided.

Fear appeals threatening the individual have been shown to be powerful persuasive devices in the cultures where they have been studied. However, most fear appeal research has been conducted with members of individualist cultures. Individualist cultures place self-needs above group concerns, while collectivist cultures place group needs above self-concerns. Little is known about the effectiveness of fear appeals (or other persuasive strategies) in collectivist cultures. Two studies assessed the effectiveness of AIDS-prevention fear appeals threatening the self versus fear appeals threatening the group (i.e., family) on members of individualist and collectivist cultures. The first study focuses on African American and Mexican immigrant junior high school youth. The second study focuses on U.S. and Taiwanese college undergraduates. The results indicated that fear appeals should address cultural orientation (i.e., individualist versus collectivist orientation) to achieve maximum effectiveness. The results also indicate that one cannot assume cultural orientation based on ethnicity.”

The most significant correlates of consistent condom use for men included perceived self-efficacy for correct condom use, discussing condom use with friends, and perceived self-efficacy for using condoms with a long-term partner. Discussing condom use with a sex partner and the perceived self-efficacy to refuse sex if the sex partner refused to use a condom were the most significant predictors for women. One implication of the findings is that for men, effective interventions should emphasize correct condom use know-how and address the issue of negative peer pressure and group norms around condom use. For women, interventions should focus on sexual empowerment."


"To evaluate the readability of such materials in a more robust and transparent manner, the Humane Research Council (HRC) partnered with VegFund and FARM to test a selection of outreach materials that are commonly used by vegan advocates. The average readability scores placed these materials in the range of the 11th grade reading level or higher, which is three to four grade levels higher than the average U.S. adult."


"Narrative engagement evoked by exemplars in news articles can alter behavioral intention, one of the most effective predictors of behavior (Fishbein & Ajzen, 2010). Green (2006) suggested that transportation and identification in response to narratives delivering cancer information can change behavioral beliefs and intentions. Empirical evidence is also robust. Individuals who are more engrossed in a narrative tend to form stronger narrative-consistent beliefs, attitudes, and intentions (e.g., Green & Brock, 2000)."


"The study found that television spots were more effective at generating high emotional engagement and aided next-day recall than online video, online display, radio and newspaper. Results showed that television ads delivered:

  • Three times higher emotional engagement and three times higher aided next-day recall than radio ads.
  • 1.8 times higher emotional engagement and 1.4 times higher aided next-day recall than online video ads.
  • Five times higher aided next-day recall than online display ads.
  • 5.5 times more total emotional engagement and comparable aided next-day recall than newspaper ads."

"Some companies, including the Lender, regularly use promotional giveaways as part of their marketing. What is the effect of these giveaways on demand? In principle, under the economic model, these should have a small positive or no effect on demand, depending on the magnitude of the prize. In contrast, there is some behavioral evidence that these giveaways could backfire and in fact end up reducing demand. Studies have shown that endowing an option with a feature that is intended to be positive but in fact has no value for the decision maker, can reduce the tendency to choose that option, even when it is understood that the added feature comes at no extra cost (Simonson, Carmon, and O’Curry, 1994)."


"For example, imagining a political candidate winning the election can increase the perceived likelihood of the candidate’s victory (Carroll, 1978), and imagining winning the lottery can increase the perceived chance of winning (Gregory et al., 1982). Imagery has also been demonstrated to increase the intentions to perform a behavior (Anderson, 1983; Cialdini, 2001; Gregory et al., 1982). Imagining taking a trip, starting a new job, or donating blood increased an individual’s intentions to engage in these activities (Anderson, 1983)."


"Because transportation is a valued and pleasurable
experience, individuals react negatively to messages
which interrupt a transporting narrative [54]. Therefore, anti-smoking messages should be delivered at a time or in a way that does not affect the entertainment value of a movie (e.g. before the film begins[58])."


"One key moderator of effect sizes was whether or not the campaigns were accompanied by enforcement of laws or regulations, such as police roadside checks for seat belt usage or checks for sale of alcohol to minors, and used messages to that effect. Campaigns that included enforcement had a stronger effect (r = .17, 95% CI [.13, .21]), representing a 17% net change in behavior than campaigns that did not (r = .06, 95% CI [.052, .064]).

A recent meta-analysis covered road safety campaigns promoting seat belts, driving while intoxicated, and speeding. ...The findings are worth including: a reduction in accidents of 12%. The effects were greater for campaigns conducted earlier, of shorter duration, supplemented with personal communication, and including enforcement. Interestingly, the differences between the enforcement campaigns and others were slight. It is possible that the first generation of enforcement campaigns in the 1990s had a much greater impact because of the novelty and that, by later campaigns, the enforcement message was stale and less effective."


"A meta-analysis of online social marketing interventions on topics, such as weight loss, mammogram screening, or smoking cessation, found larger effects for the health interventions employing the following messages strategies: tailoring or feedback on performance, source similarity to the targets, information on the consequences of behaviour, goal setting, action planning, normative information about others' behaviour, arranging for social support, behavioural contracts, self-monitoring of behavioural outcomes, time management, self-talk prompts, rewards for successful behaviour, and those focusing on knowledge, norms, and consequences."


"A meta-analysis of HIV interventions found that messages about attitudes, expectancies, and behavioural skills were more successful than messages about the threat, norms, disease transmission, or disease prevention information: information about the mechanisms of HIV transmission was negatively related to condom use. Among Hispanics, messages emphasizing how to address barriers to condom use, changing peer norms, practicing condom use skills, problem-solving sills such as personal goal setting, and using the culturally appropriate concept of machismo were associated with greater behavioural impact."


"Fear appeals may work, but care should be taken in how resulting anxiety will be dealt with. Laboratory studies suggest that fear appeals have more of an impact on behaviour if they are accompanied by specific messages about how to control the danger and even counseling and testing to relieve anxiety."


"Other analyses suggest that targeting ethnic minorities or people with lower socioeconomic statuses results in effect sizes at least as large as those for the general population."


"PSI with characters within an entertainment-education program may offer another way to reduce reactance. Using peers to deliver persuasive risk messages can be an effective persuasive strategy because peers are seen as less authoritative and controlling, thus arousing less reactance. This argument may apply to parasocial relationships as well in that these characters act as as 'superpeer' to whom viewers look for guidance. Therefore, characters with whom viewers have parasocial relationships should similarly lead to reductions in reactance when presented in the context of entertainment-education messages."

"Perceived similarity with a character who is portrayed as vulnerable to the harmful consequences of a risky behaviour may increase viewers' perceived vulnerability. If this perceived similarity is combined with identification, the effect on perceived vulnerability may be especially strong given the nature of the identification process. While identifying with a character, viewers imagine themselves doing, thinking, or feeling something they ordinarily would not because they are experiencing it vicariously as the character."


"Although the media have been criticized for portraying unrealistic depictions of health-risk behaviours as being normative and the potential influence this may have on young viewers' perceived norms, a program depicting a character who does not engage in risky behaviour, may have the reverse effect. The critical factor is to select a character with whom a viewer experiences PSI. When a viewer parasocially interacts with a character, the character is seen as a part of his or her social network. In this way, entertainment-education programs may be able to change perceived norms by showing characters that resonate as normative referents among viewers in ways that contradict the existing perceived norms about the prevalence of a health-risk behaviour."

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