A Case Study of Sesame Workshop’s Cleaner, Happier, Healthier Intervention in Bangladesh, India, and Nigeria: Reporting on Exposure and Impact
Dina L. G. Borzekowski
The Cleaner, Happier, Healthier hygiene intervention was developed and tested in 2013, featuring the Sesame Workshop characters. Through broadcast television, four public service announcements (PSAs) addressed washing hands with soap, using a latrine, wearing sandals, and drinking clean water. The main audiences were young preschool children and their parents or guardians.
Research occurred in Bangladesh, India, and Nigeria, exploring the reach and impact of these PSAs. Although low percentages, from well-drawn samples of extremely vulnerable populations in these countries, reported awareness and recall of these messages, such percentages can reflect large numbers of viewers. Considering data from the participating children, measures of knowledge and attitudes were associated with engaging in several of the behavioral outcomes. As well, awareness and recall of the PSA messages predicted “all the time” for several of the hygiene behaviors. In contrast, parents’ reports of PSA awareness and recall were not associated with reports of children’s hygiene behaviors.
Conducting reach studies is extremely difficult, especially in developing countries and communities. Despite the challenges, this study is encouraging. Participants reported seeing the messages, and in several models, this “reach” predicted reports of hygiene and health behaviors. Lessons learned from this case study and research can offer valuable insight into the production of future health PSAs, especially with harder-to-reach populations.
Michael Mackert and Marie Guadagno
Advertising as a field and industry often has a contentious relationship with both health communication and public health due to legitimate concerns about how advertising for certain products, such as alcohol and tobacco, could contribute to less-healthy decisions and behaviors. While acknowledging such concerns, advertisers and their approach to solving communication problems could also provide valuable lessons to those working in health communication. Indeed, advertising agencies are designed to develop creative and effective messages that change consumer behavior—and health communication practitioners and scholars aim to change population-level behavior as well. The perspective and approach of the account planner in the advertising agency—a role whose chief responsibility is to bring the consumer perspective into every step of the advertising development process and inspire effective and creative campaigns—would be particularly valuable to those working in health communication. It was account planning work that shifted traditional milk advertising from promoting it as a healthy drink to the iconic “got milk?” campaign, which positioned milk as a complement that makes other food better—an approach that drove positive sales after years of declining milk consumption. Yet many who work in health communication and public health often know little of how advertising agencies work or their internal processes that might be productively adopted. This lack of understanding can also lead to misperceptions of advertisers’ work and intentions. As an example, one might assume dense medical language in prescription drug advertising is intended to add unnecessary complexity to the advertisements and obscure side effects; instead, advertising professionals who work on prescription drug advertising have often been trained on clear communication—but cannot fully utilize that training because of regulations that require medically accurate terminology that might not be comprehensible to most viewers. Improved understanding of how advertisers can act as agents of change, and increased dialogue between the fields of advertising and health communication, could contribute to improved health communication research, practice, and policy.
Jen Ptacek, Kirstin N. Dolick, and Marifran Mattson
Advocacy can be defined as the systematic process set in motion by an individual or group of individuals to encourage, support, and empower others surrounding a topic in need of change. Individuals may become an advocacy group in support of an issue, such as health care, civil rights, environment, or labor. Advocacy groups often serve as mediators between vulnerable/underprivileged populations and policymakers or decision-makers. The Health Communication Advocacy Model (HCAM) is a tested advocacy model comprising five phases including assembling the team, formative research, message development, message implementation, and evaluation. HCAM also includes a correction loop allowing for revisions of campaign messages. The HCAM is an adaptable model that offers a perspective in which advocacy groups may be considered a dynamic framework for building successful campaigns. Once the advocacy group is established, members can agree upon goals and responsibilities and craft a position statement. The group can then develop messages to reach the intended target audience(s). Target audiences may include legislators, the population affected by the issue, and media organizations. When crafting messages, care should be taken to ensure messages are stimulating, motivational, culturally consistent, resource contingent, and without barriers. Advocacy groups may use a number of channels to send messages through, such as social media, rallies, press releases, and other media outlets. Overall, advocacy groups must address a variety of needs to effectively reach the target audiences and impact change.
Karyn Ogata Jones
Since McCombs and Shaw first introduced the theory in 1972, agenda setting has emerged as one of the most influential perspectives in the study of the effects of mass media. Broadly defined, “agenda setting” refers to the ability of mass media sources to identify the most salient topics, thereby “setting the agendas” for audiences. In telling us what to think about, then, mass media sources are perceived to play an influential role in determining priorities related to policies, values, and knowledge on a given topic or issue.
Scholars have studied this phenomenon according to both object (issue) salience and attribute salience and along aggregate and individual audience responses. The audience characteristics of need for orientation, uncertainty, relevance, and involvement are advanced as moderating and predicting agenda-setting effects. When agenda-setting theory is applied to the study of messaging related to health and risk communication, scholars have reviewed and identified common themes and topics that generally include media’s role in educating and informing the public about specific health conditions as well as public health priorities and administrative policies.
Agenda setting is often examined in terms of measuring mass media effects on audiences. Looking at interpersonal communication, such as that coming from medical providers, opinion leaders, or peer networks, in studies will allow research to examine the combined effects of interpersonal and mass communication. Testing possible interactions among differing sources of information along with assessment of issue and attribute salience among audiences according to an agenda-setting framework serves to document audience trends and lived experiences with regard to mass media, health, and risk communication.
E. Ann Kaplan and Sally Chivers
Age discrimination, long habitual internationally, is now developing into age panic as longevity becomes the norm. People are increasingly living through their 80s and 90s, threatening social systems—not just health care, but also education, transportation, and economics. A by-product of longevity is Alzheimer’s disease (AD) or dementia more broadly, and this the focus of our essay. Five million people in the United States (the greater part women) currently have Alzheimer’s or dementia, and the figure is projected to grow exponentially as the baby boom generation ages. Fear, and other powerful affects, are generated in the aging Eurocentric public through overwhelmingly negative images of dementia. Prominent circulating AD images portray white, middle-class women and men; they are typically cared for by heroic family members, with the occasional, backgrounded appearances of racialized care workers. Such discourses betray a noticeable ageism, together with gendering, racialization, and medicalization of the illness. The reification of neuroscience studies of AD perpetuates understanding of AD subjects as having lost their subjectivity and as a burden to health-care systems. As the politics of care becomes ever more fraught with the increase in numbers of diagnosed elderly people, media discourses take on particular significance. Largely negative, images have obvious implications for long-term care in discourse and in practice. Since improving care depends on how the AD subject is visualized and conceptualized, critical analyses of works dealing with age panic, and especially how it arises in relation to cultural understandings of dementia, are essential. Critiques by humanists and psychologists may contribute to improving care of AD subjects, both in long-term facilities and “in place.” Improved care can contribute to transforming the popular understanding of a dementia crisis, thus addressing the central impetus of age panic. Meanwhile, new films, fiction, memoirs, and graphic arts projects are powerful complements to psychological studies aimed at developing new ways of seeing AD subjects.
Evan K. Perrault
Due to their sheer scope in trying to reach large sections of a population, and the costs necessary to implement them, evaluation is vital at every stage of the health communication campaign process. No stage is more important than the formative evaluation stage. At the formative stage, campaign designers must determine if a campaign is even necessary, and if so, determine what the campaign’s focus needs to be. Clear, measurable, and realistically attainable objectives need to be a primary output of formative evaluation, as these objectives help to guide the creation of all future campaign efforts. The formative stage also includes pilot testing any messages and strategies with the target audience prior to full-scale implementation. Once the campaign is implemented, process evaluation should be performed to determine if the campaign is being implemented as planned (i.e., fidelity), and also to document the dose of campaign exposure. Identifying problem areas during process evaluation can ensure they get fixed prior to the completion of the campaign. Detailed process evaluation also allows for greater ease in replicating a successful campaign attempt in the future, but additionally can provide potential reasons for why a campaign was not successful. The last stage is outcome evaluation—determining if the objectives of the campaign were achieved. While it is the last stage of campaign evaluation, campaign designers need to ensure they have planned for it in the formative stages. If even just one of these stages of evaluation is minimized in campaign design, or relegated to an after-thought, developers need to realize that the ultimate effectiveness of their campaigns is likely to be minimized as well.
Jessica Gall Myrick
Celebrities are famous individuals, well known by many members of the public, who appear frequently in media content. When celebrities appear in the media alongside another cause, be it selling soap or promoting public health, the message becomes a celebrity appeal. Celebrity appeals are messages where a celebrity advocates for or is implicitly associated with a target behavior. In the context of health and risk-related messages, celebrity appeals can take the form of public service announcements, advertisements for health and risk-related products, or even news coverage of a celebrity’s personal struggles with a health issue or risky behavior.
Research on celebrity appeals overlaps with the marketing literature investigating the effects of celebrity endorsements on product preferences and purchasing behavior. This work on the persuasiveness of celebrity endorsements demonstrates that celebrities can draw attention to a product or idea, but also that many other factors, like involvement, familiarity, source credibility, and endorser gender can moderate how persuasive a celebrity-based appeal is. Additionally, research on celebrity disclosures of illnesses reveal that these de facto awareness campaigns can elicit emotions in audiences and motivate behavior change. However, media coverage of celebrities has also been associated with harmful effects on lay individuals’ wellbeing, suggesting important caveats for message designers who rely on celebrities to garner attention for a cause or to motivate lay individuals to change their own health and risk-related behaviors. The existing empirical evidence on celebrity appeals and additional theoretical perspectives for understanding their potential persuasiveness provides many insights for message designers.
Amy E. Chadwick
Climate change, which includes global warming, is a serious and pervasive challenge for local and global communities. Communication theorists, researchers, and practitioners are well positioned to describe, predict, and affect how we communicate about climate change. Our theories, research methods, and practices have many potential roles in reducing climate change and its effects. Climate change communication is a growing field that examines a range of factors that affect and are affected by how we communicate about climate change. Climate change communication covers a broad range of philosophical and research traditions, including humanistic-rhetorical analyses, interpretive qualitative studies, and social-scientific quantitative surveys and experiments. Climate change communication examines a range of factors that affect and are affected by how we communicate about climate change. Much of the research in climate change communication focuses on public understanding of climate change, factors that affect public understanding, media coverage and framing, media effects, and risk perceptions. Less prevalent, growing areas of research include civic engagement and public participation, organizational communication, and persuasive strategies to affect attitudes, beliefs, and behaviors related to the climate. In all of these areas, most of the research on climate change communication has been conducted in the United States, United Kingdom, Australia, Canada, and Western European countries. There is a need to expand the climate change communication research into other regions, particularly developing countries. In addition, climate change communication has natural links to environmental and health communication; therefore, communication scholars should also examine research from these areas to develop insights into climate change communication.
Sophie Christman Lavin and E. Ann Kaplan
Ecocinema involves the human gaze looking at cinema through the lens of the environment, in a manner analogous to the way feminists provided the cinematic lens of gender in the 1970s. However, as with feminism, enormous differences pertain in regard to how the ecocinema lens is mobilized.
In analyzing films from the late 1800s to the early 21st century, ecocinema studies has evolved to include critical lines of inquiry from perspectives of psychology, feminism, socioeconomics, science, and activism. Research frames used in these inquiries include: setting and landscape in films, ecological analyses of mainstream and independent fictional films, posthuman cinematic representations, transnational and regional, and more recently, trauma in speculative dystopian films. Ecocinema critics analyze films of various types, including Hollywood, independent, transnational, documentary, animated, art cinema, and especially climate fiction (“cli-fi”) films.
Ramachandra Guha’s transnational typology of environmental ideologies will provide a useful starting place for the mapping of different perspectives in ecocinema. Guha distinguished utopian wilderness environmentalism, pervasive in the United States, from the agrarian focus typical in India. Meanwhile, most developed nations utilize scientific industrial methods to exploit the environment. Oftentimes, these latter approaches are grounded in growth economies and are thus in conflict with the unrealistic ideals of so-called neo-primitivism (NP). Neo-primitivism involves returning to simple, sustainable lifestyles within or close to the natural world—lifestyles that do no environmental damage. NP is beloved by many, but the consensus is that it is idealistic to consider going back to this way of life. A film such as Avatar (produced and directed by James Cameron in 2009) addresses the complexity of diverse constructions of nature by providing examples of utopian wilderness ideology that compete with, and are opposed to, the destructive scientific industrialism that disregards and dominates nature without compunction. Other films, such as Amazon Sisters (Sweeny, 1992), Elemental (Koch, Roshan, & Vaughan-Lee, 2012), Into the Wild (Blocker, Hildebrand, Kelly, & Penn, 2007), or Grizzly Man (Beggs & Herzog, 2005), act as simultaneous celebrations and critiques of wilderness ideologies and deal with gender and racial identities, and thus they have been a central focus of ecocinema scholarship.
Although films from all genres have historically engaged environmental issues, it was rarely in a way that made a self-conscious or critical statement about the human impact on the natural world from the perspective of ecological concerns—this is the focus of ecocinema. See for example, Birt Acres’s Rough Sea at Dover (1895), the Lumiere Brothers’ Oil Wells of Baku (1896), Thomas Edison’s Sorting Refuse at Incinerating Plant, NYC (1903), and the British South Africa Company’s Rhodesia To-Day (1912). In the early 21st century, the genre that most often engages with the contemporary politics of climate change is the documentary. Documentaries, such as An Inconvenient Truth (Guggenheim, 2006), Manufactured Landscapes (Baichwal, 2006), Into Eternity (Eskilsson & Madsen, 2010), Chasing Ice (Ahrens & Orlowski, 2012), E-Waste Tragedy (Esteve, Popp, Úbeda, & Dannoritzer, 2014), This Changes Everything (Cuarón & Lewis, 2015), among others, critique human damage to the planet and thus position viewers as ethical witnesses. Such works hope to influence the outcome of our shared anthropocentric future.
The analyses of ecocinema are addressed using two distinct methods—the macro and the micro. The macro method studies how films represent the large-scale processes of earth-based climate systems, and its lens evaluates how films represent climate and environmental dilemmas facing humans as a species. The micro-lens provides enhanced analyses that explore how gender, race, and class figure into the cultural work climate fantasies perform. This lens indexes the ways in which various cultures are often disproportionately impacted by climate systems.1 Oftentimes the macro and micro levels are both incorporated in a single film and reveal the intersection between climate and culture, as seen in Taklub (Trap, Castillo & Mendoza, 2015), a film that portrays Super-typhoon Haiyan and its impact on residents in Tacloban, Philippines. As background to mapping the texts, evolving science discourses will be emphasized as evidence for global warming but with the understanding that this evidence relies on modeling. Although our main concern with this cultural work in ecocinema is how climate change impacts across gender, race, and class, the inequalities revealed also speak to the politics of climate change evident in cinematic treatments of the issue.
Srinivas Melkote and H. Leslie Steeves
The decades that immediately followed World War II witnessed the political independence of most of the so-called Third World from colonization and the birth of the United Nations, marking the formal beginning of development and directed social change to facilitate it. The role of communication in development (devcom) has evolved according to the overarching goals of the development programs and theories during each historical period since then. The process of modernization, in which devcom was initially nurtured, was influenced by quantitative and empirical social sciences theory, philosophy, and methodology; in particular, it had a strong economics orientation. It has been one of the most powerful paradigms in development study and practice to originate after World War II, with enormous economic, social, and cultural consequences. Concepts and theories that articulated the development of Western Europe and North America were used by sociologists, economists, political scientists, anthropologists, and others to generate development models for countries in Asia, Africa, Latin America, and the Caribbean. Mass media were accorded a central position in the modernization paradigm. The use of media for transmission of information and for persuasion, derived from World War II–related psychological warfare research in the United States, were transferred to areas such as extension education, instruction, agricultural, and health extension in development. By the 1970s, the concept of development and change expanded to include many more types of social change guided by different theories, disciplinary influences, geographical considerations, and methodologies. Change now included a widely participatory process of social change in a society and included social and cultural aspects besides the economic. While the participatory mode of communication for development programs and activities was a welcome addition to the devcom toolbox, the definitions of participation reflected a wide variety of approaches. In many contexts, the level of participation required by the people was low and perfunctory.
Toward the end of the 1980s, the concept and practice of empowerment expanded upon the earlier objective of participation in development communication models and practice. Broadly, empowerment is a process by which individuals, organizations, and communities gain control and mastery over their social and economic conditions. The concept and practice of empowerment posed a challenge to the identity and practice of development communication. It changed the way communication was conceptualized earlier and used in development and change work. At present, social justice within the processes of development and social change has gained traction and urgency. In the last 40 years, there has been a steep increase in income inequality and individual opportunity globally. Millions of people are still exposed to life-threatening diseases, malnutrition, hunger, and other debilitating conditions, and have very limited access to basic resources, such as education and healthcare. What are the progressive alternatives to the neoliberal model of directed change? What should be the place and role of devcom in alternative approaches? These concerns are addressed by anchoring ideas within a critical theory of social change for social justice.