Advertisers as Agents for Change in Health and Risk Messaging
Summary and Keywords
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.
The advertising industry is often seen as being at odds with various public health efforts. Commentaries have been written critiquing advertisers’ approach to marketing to children; helping sell unhealthy products such as sugar-sweetened beverages, or alcohol and tobacco; and contributing to poorer relations between healthcare providers and their patients (Belstock, Connolly, Carpenter, & Tucker, 2008; Pomeranz, 2012). While not discounting the validity of many of these criticisms, some of these concerns are driven by misunderstandings of how advertisers go about their work (Mackert, Guadagno, & Champlin, 2015).
The perspective of advertisers, and the way in which they solve communication problems, which can enrich health communication research, policy, and practice, is presented. Creativity in advertising is outlined, along with advertising agency structure, and a particular advertising agency role and perspective (account planning) that could provide valuable lessons to those working in health communication is described. Specific examples of how the advertising approach to solving health communication problems can generate novel solutions are presented, as well as thoughts on how to improve the dialogue between advertisers and those working in health communication.
The Pursuit of Creativity
Creativity pervades the advertising industry. At each step in the process—from developing the strategy of a campaign to the particular media channels to best deliver it—the role of creativity in advertising is pursued and celebrated as essential to success (Reid & Rotfeld, 1976; Zinkhan, 1993). Industry awards celebrate creativity and are touted by advertising agencies in the pursuit of new clients (Tippins & Kunkel, 2006).Given the value placed on creativity in advertising, it could be surprising that little academic advertising research has focused on creativity (Griffin, 2008). There are many reasons for this, not the least of which is that creativity could be seen as a particularly challenging concept to define, measure, and study (Precourt, 2013).
However, a recent review found that most definitions of creativity—looking across academic publications, advertising trade press, and advertising textbooks—show some consensus: that creativity exists along two dimensions of novelty and appropriateness (Wyeth, 2015). This matches others who have also pointed to general consensus around novelty (also referred to as unique or divergent) and appropriateness (also referred to as meaningful or useful) (Baack, Wilson, & Till, 2008; Burroughs, Dahl, Moreau, Chattopadhyay, & Gorn, 2011).
One thread of academic research into creativity has focused on the actual process of being creative, such as the step-based model of Wallas (1926): preparation, incubation, illumination, and verification. Others have considered the people engaged in creative tasks and considered necessary components of creativity, such as Amabile (1983), who proposed a model consisting of task motivation, domain-relevant skills, and creativity-related skills. Guilford (1967) investigated what is necessary to generate new ideas, and proposed a structure of intellect model: contents (what a person knows), operations (how people use that information), and products (what results from the combination of the first two dimensions).
When considering the academic study of creativity, though, it must be noted that there is a large—and often lamented—gap between how academics study the field of advertising and how advertising agencies actually operate to meet the needs of their clients (Gabriel, Kottasz, & Bennett, 2006; Nyilasy & Reid, 2007; O’Donohoe & Tynan, 1998). Thus, it may be more beneficial for those working in health communication to understand how advertising agencies and professionals operate to generate that creativity and harness it to serve clients’ advertising needs.
Advertising Agency Structure
In many ways, advertising agencies are structured to produce creativity that is both novel and useful to meet the needs of their clients. Agencies must consistently produce advertising that is creative along both of those parameters, or they will eventually lose their clients’ business. Agencies are therefore designed to generate such creativity consistently over time.
The number of potential structures for advertising agencies is virtually limitless, especially as agencies are launched to provide expertise in a niche area. As examples, there are firms focused on multicultural advertising, digital advertising, healthcare advertising, brand identity, and direct marketing.
For our purposes, the structure of a general mass market advertising agency will be described, as many of these functions also exist within more boutique agencies. The description will focus specifically on those roles that are most directly involved in the development of advertising, though advertising agencies also include professionals to be found in virtually any large organization (e.g., a CEO, human resources).
In laying out a straightforward description of roles in an advertising agency, Kocek (2013) begins with account services, which he describes as the “central nervous system” of the agency. Account service team members are ultimately responsible for the accounts they manage for the agency, and thus represent the perspective of both the client and the agency at the same time. When working within the agency, the account services representative must have a deep understanding of the perspective of a client and be able to represent what the client might find acceptable or not when considering various advertising approaches.
The creative department—“the creatives”—are the art directors, copywriters, and creative directors who will take a given advertising strategy and determine the best way to bring it to life in various media channels. Upon being given a strategy for a particular campaign, it is up to the creative team to explore various concepts for executing that strategy, refining those concepts to make them as clear and effective as possible, and also to meet the needs and standards of the client.
Many large advertising agencies also have an in-house media department, though this function can also be an area of specialization for a standalone media agency. The media department is assigned the role of finding the most appropriate media to deliver a campaign to the desired target audience.
In larger agencies, a production department can serve to coordinate the creative and media departments. This department schedules the campaign, manages budgets, and can work with external vendors (such as a video production firm) when necessary to actually execute an advertising campaign. In smaller agencies many of these tasks can be handled by the account services team.
There are other roles that might exist in agencies, such as an internal research department, information architects, and user experience designers. These roles vary by agency and depend on what tasks they manage within the agency or might outsource to a more specialized firm.
Many of these tasks, perhaps with different job titles, may seem familiar to those who have worked on health communication campaigns. Advertising agencies have also created a particular role (the account planner) to address a very specific responsibility that can help ensure more creative and effective advertising—bringing the perspective of the consumer into every stage of the development process. This angle, focusing on the perspective of the consumer who will eventually experience an advertising campaign, is essential to understanding how advertisers work as agents of change and can provide important lessons to those working in health communication research and practice.
One of the primary challenges facing advertising agencies can be the conflicting interests and roles of those working within the advertising agency itself and their clients. Clients—and the account services staff within the agency—are often understandably very interested in their brand and product or service and can struggle to think about it like a normal consumer. Similarly, creatives within an advertising agency can become extremely attached to their own work and lose perspective on how it can help achieve the client’s goals. The account planning role was created to solve that problem, by incorporating the consumer perspective into every phase of the advertising development process (Steel, 1998).
There are conflicting reports of where exactly account planning originated, but most accounts point to two agencies in the United Kingdom in the 1960s (King, 2008a; Pollitt, 2008). The account planning role appeared in U.S. advertising agencies starting in the 1980s (Steel, 1998). Not all agencies have account planners, nor is the integration of this role into an advertising agency always a smooth process (Hackley, 2003). Proponents argue that account planners can make advertising campaigns more effective with their focus on the consumer perspective and bringing that angle to the rest of the advertising agency team.
Perhaps the simplest definition of account planning is that it brings the “voice of the consumer” to the advertising development process (Steel, 1998). But some account planners state that this definition does not capture the full scope of the role and that it misses some of what account planners bring to the development of advertising, such as identifying trends in what consumers will want in the future (Baskin, 2008; Goldman, 1995).
Account planners go about their work through interviews, focus groups, and observations of consumers in their natural environment to uncover useful consumer insights that can guide the development of more effective advertising (Fortini-Campbell, 2001; Steel, 1998). Account planners can also rely on quantitative research methods in their work, but the use of qualitative research and consumer personas is often a staple of the approach to present information to creative teams and inspire the best possible work from the creative department (Fortini-Campbell, 2001).
Account planners present their work to creative teams through a creative brief, which is a written document about what the campaign is meant to achieve—but also requires ongoing conversation with creative teams and is an iterative process (Steel, 1998). Account planners must be able to operate at multiple levels of overall strategy (what the right broad message for a campaign might be) and provide direction to a creative team on how consumers might respond to a particular advertising concept (helping to fine-tune a print advertisement) (King, 2008b).
The account planning role was developed to solve a particular problem facing advertising agencies, specifically that no one within the agency was thinking first and foremost about the perspective of the consumer a campaign was developed to reach and persuade. Advertisers work as agents of change through the development of creative and engaging messages that can change consumers’ behavior, and understanding the account planning approach and philosophy of advertising development is essential to understanding how advertising agencies go about their work. Specific examples of how the account planning approach was used to solve communication challenges are presented.
Appropriating the Advertising Approach
While those working in public health and health communication might express concern over the impact of advertising on public health, there are cases where advertisers have successfully solved what could be considered health communication and health promotion challenges in extremely effective ways. Examples of how advertising agencies have solved such problems for commercial clients (promoting milk and bike helmets), as well as how that approach has been adopted in the service of health communication to support public health efforts (folic acid promotion and hand hygiene), can serve as models of how to appropriate this advertising approach to solving health communication problems.
Folic Acid Promotion
While some of the functions of an account planner might exist only within the context of an advertising agency, the approach to solving problems inherent in the account planning role can certainly be applied to solving health communication issues. A first example of this is provided by health communication research to address gaps in the promotion of folic acid to Hispanic women to reduce the disparity of neural tube defects (NTDs) in pregnancy impacting Hispanics (Mackert, 2012).
The health communication challenge in this context is twofold. First, to get the full benefits of folic acid to support brain and spinal cord development, and reduce the likelihood of NTDs, a woman must be taking a prenatal vitamin or supplementing folic acid intake through diet change for months before becoming pregnant. Second, approximately half of all pregnancies are unplanned, so messages focusing exclusively on prenatal health promotion could be deemed as irrelevant to many women who would benefit from increased folic acid to help ensure the health of an unplanned pregnancy.
To solve this problem, formative research conducted with Hispanic mothers was done to learn more about what they think of existing folic acid promotion campaigns and to discover insights that might guide the development of new health communication efforts (Mackert, Kahlor, Silva, & Padilla, 2010). Participants in these focus groups provided a wealth of useful information about the formatting of existing health promotion materials (e.g., they featured too much text) and thoughts from the women themselves on how to solve the problem (e.g., use a fear appeal).
But perhaps the most substantial finding was that almost all participants knew about the benefits of folic acid for prenatal health, contrary to public health research that would suggest Hispanic women are less likely to know those benefits. Crucially, they all learned this information as a result of their first pregnancy, suggesting that at least for their first pregnancies they were all also at greater risk for NTDs.
This key idea—that these mothers already knew about the value of folic acid for prenatal health—was the inspiration for the eventual campaign. The proposed solution also borrowed heavily from the approach of the Gardasil One Less campaign: delivering one message to mothers of Hispanic adolescent females and a different but complementary message to the Hispanic adolescent females themselves. This shift in strategy could be an easier approach, as it would rely on mothers’ knowledge of folic acid to lead to an interest in starting their adolescent daughters on a daily multivitamin for general health reasons (regardless of their likelihood or intentions of becoming pregnant) rather than trying to convince young women who are not planning on becoming pregnant that they should take a prenatal vitamin.
For mothers, a message of “You got lucky” was used to employ the fear appeal suggested by participants in a manner that would engage them in the message of the campaign but not overwhelm them; this message did mention the benefits of prenatal health from folic acid but focused more on the broad health benefits of a daily multivitamin habit. A campaign featuring the line “What’s her secret?” was developed and focused on the Hispanic adolescents themselves, completely omitting the information about prenatal health but rather focusing on short-term benefits of a daily multivitamin; the prenatal health information was omitted strategically to avoid adolescents seeing the information about prenatal health and then ignoring the rest of the message. The resulting materials were reviewed favorably, particularly by the mothers of Hispanic adolescents (Mackert, Donovan, & Guadagno, 2013).
While this campaign was not developed in an advertising agency, it employs many of the principles inherent in account planning: a focus on formative research to drive message design, a knowledge of the culture and media environment to appropriate useful messages, and a willingness to re-frame a communication problem to achieve positive outcomes.
Involving Dads in Maternal Health in Indonesia: Suami SIAGA
Another example of an advertising approach to a complex health communication issue is the successful Suami SIAGA campaign launched in Indonesia in 1999–2000 (Shefner-Rogers & Sood, 2004). During the 1990s, the maternal mortality rate in Indonesia was exceedingly high, and the federal government pledged to reduce the rate by 50% by the end of the decade.
The Ministry for the Role of Women had already conducted secondary research on ways to reduce maternal mortality. Research identified that in developing countries, particularly those with patriarchal systems, males were often the gatekeepers of maternal healthcare. Although men had a key role in when their partners should seek healthcare during pregnancy, research found that they often lacked the knowledge to identify obstetrics emergencies that could lead to maternal death. Thus, a major goal of the Suami SIAGA project was to educate males (usually husbands) on how to recognize emergencies during pregnancy and where to seek immediate help.
The government wanted to reach males of reproductive age with important information on how to determine danger in pregnancy. Traditionally this information would have been put in maternal clinics, but husbands were not consistently present during these visits—other females in the family typically attended with the pregnant woman. A major Indonesian advertising agency was brought in to do extensive research on planning and executing a campaign that would be seen by men and that would resonate with them.
The advertising agency came up with the creative concept of Suami SIAGA—which translates to “I am an alert husband”—it is also a play on words that indicates immediate action is necessary when confronted with danger. The campaign was wide-reaching in the three provinces selected for implementation. The multimedia campaign consisted of TV commercials, radio broadcasts featuring Indonesian popstars, print materials, stickers, T-shirts, and even a three-episode TV miniseries with messages about safe motherhood. The campaign ran for 18 months before entering an evaluation stage.
The evaluation included levels of exposure to the ads in the three provinces, interpersonal communication about the message, new knowledge about pregnancy, and intentions to become an “alert husband.” Results indicate the campaign was a success—it reached more than half of all men in the selected provinces and spurred interpersonal communication with spouses, friends, and community leaders on how the men could take steps toward becoming an alert husband.
The inclusion of the advertising agency allowed the government to collaborate on a creative campaign that resonated with the intended primary audience. The insights of the advertising planning allowed the message to be crafted so that men would understand the importance and be empowered to take action.
Milk Promotion: Got Milk?
A particularly well-known advertising campaign, which also serves as an exemplar of the account planning process, is the got milk? campaign. Steel (1998) lays out the fundamental problem facing the milk industry in California, where the campaign was born: milk consumption was declining in the state due to a variety of factors (it was not necessarily exciting, people were concerned about fat content, and it was perceived as a child’s drink), and the California Fluid Milk Processors’ Advisory Board (CFMPAB) wanted to reverse that trend.
If account planning is about asking the right questions, creativity in research, and consumer insights to guide effective advertising campaigns, the account planners working on the got milk? campaign certainly achieved that. Two basic ideas guided their work. The first was that it would be easier to get people who were already consuming milk to consume more, rather than convert non-milk users into milk users. This ties in to the notion of segmentation and targeting—strategies used in both consumer marketing and social marketing. The second was that it might be more effective to promote things that are better with milk (cereal, coffee, cookies, etc.) than encourage people to drink glasses of milk in isolation. The agency conducted research to determine that most milk consumption took place in the home, and most milk was consumed in conjunction with other food.
To pursue this line of thinking, the account planners conducted focus groups about milk consumption. Participants were offered an extra incentive if they agreed to avoid milk for the week leading up to the focus group. The focus groups turned into what amounted to support groups, with participants reporting that it was only after agreeing to participate in the focus groups did they realize what avoiding milk for a week actually meant—no milk in cereal, in coffee, or to pair with treats like cookies or brownies.
The end result of this research and thinking about how people actually consume milk was the got milk? campaign. It was not designed so much to change people’s attitudes about milk but more to change their feeling about what it is like to run out of milk. Creative spots (like the famous Aaron Burr TV commercial) executed that milk deprivation message and reminded consumers of how terrible it was to run out of milk.
The end result of the got milk? campaign was that milk sales in California increased while consumption in the rest of the country fell, which led to the eventual adoption of the campaign across the entire United States. And while those working in public health and health communication might not necessarily want to exactly adopt the approach of using cookies to sell more milk, the method—a focus on how people actually consumed milk and this account planning perspective—could be widely applied to other health communication issues.
Bike Helmet Promotion: Bell Bike Helmets
While Steel (1998) does not go into nearly the same level of depth as he does with the got milk? campaign, he uses another health communication context for illustrating the importance of focused consumer-driven research in advertising message development: bike helmets.
One of the challenges of promoting bike helmets was that the end users of children’s bike helmets (children) are not the actual purchasers (their parents). And the very different perceptions of bike helmets among children and parents creates a challenging communication problem to be solved. While the case of Bell bike helmets is presented as an advertising challenge, the lessons could apply to any bike helmet safety campaign.
Research for the Bell bike helmet campaign focused on the perceptions both children and parents had of bike helmets and how Bell could use those feelings to better promote its premium product. The account planner working on Bell talked to parents and their children about bike helmets. On the parent side, the account planner heard about concerns over child safety and other expected issues. When interviewing children, though, it became clear that children definitely did not feel the same way about bike helmets. One child talked about wearing his bike helmet until out of sight of his house, hiding the helmet under a bush so as not to be mocked by his friends for wearing it, and putting it back on only on the way home after spending the day happily helmet-free.
The not-surprising disconnect between parents’ and children’s perceptions of bike helmets indicated a two-pronged solution. The solution for parents was the more straightforward, expected approach: focus on Bell’s reputation of producing high-quality helmets, ensuring the safety of children, and so on. Ads focusing on the high safety of Bell helmets were placed in media that were parent-oriented and unlikely to be seen by children.
The promotion of Bell bike helmets to children was less intuitive, however. Bell bike helmets were popular among professionals in a variety of extreme sports (e.g., auto racing), so the advertising approach was designed to highlight Bell bike helmets as for cool kids, risk takers, and those who might be too extreme for “normal” bike helmets—again, making children a different segment of the market and selecting the appropriate media to reach children with these specific messages.
Thorough research focused on two different groups—the people who buy children’s bike helmets and those who actually wear them—led to a different and more effective approach to promoting bike helmets than might have been achieved otherwise. This example also highlights the importance of thinking about advertising and campaign design from the perspective of the end consumer, where decisions—whether they be to buy a product or around health—can rely on the interaction of different people with different perspectives on a decision.
Understanding the Advertiser Perspective
While sometimes it is possible to look at an advertising campaign and accurately assess what it was meant to achieve, those working in communication have long understood that the message being sent is not necessarily the same as that being received (Shannon, 1948). Thus, it is essential for those working in health communication to better understand the perspective of advertisers. This better understanding could enrich health communication research, practice, and policy by incorporating core methods of consumer research, targeting, tailoring, and creativity. (Mackert, Guadagno, & Champlin, 2015).
Direct-to-consumer (DTC) prescription drug advertising may be the most illustrative example of how those with an interest in health communication might benefit from understanding the perspective of advertisers. There is no shortage of research on DTC prescription drug advertising, illuminating both potential benefits and concerns on a range of issues ranging from the role of DTC prescription drug advertising in the medicalization of aging to impact on provider-patient relationships (Auton, 2004). Much of this research was conducted through content analyses, as well as interviews and surveys of both providers and patients.
The study of issues related to literacy in DTC prescription drug advertising highlights the issues in omitting the advertiser perspective. Research in this area showed a range of legitimate concerns, with most results showing that the content of DTC prescription drug advertisements could be problematic for people who are low health literate and might struggle with health information: benefits of drugs are presented more simply than potential adverse effects, the content is written at a high grade level, and the pace of audio reporting potential side effects is faster (Kaphingst, DeJong, Rudd, & Daltroy, 2004; Kaphingst, Rudd, DeJong, & Daltroy, 2004, 2005). This could easily be attributed to pharmaceutical companies and their advertising agencies keeping the benefits of drugs as simple and clear as possible, while purposely complicating the potential side effects and concerns about an advertised drug. However, interviews with advertising professionals who work on DTC prescription drug campaigns suggested that many of these professionals has been trained in issues related to health literacy and clear communication; complicated language included in prescription drug ads present when simpler language could be substituted (e.g., using “kidney” instead of “renal”) was not possible because of federal regulations and concerns about being sued (Mackert, 2011). This disconnect between how advertisements appear in the media, and the process that leads to them, simply could not have been discovered without actively seeking the input of advertising professionals.
Similarly, DTC prescription drug advertisements have been critiqued for their use of emotional appeals. It is only through interviewing the professionals directly that one can understand their use of emotion in these advertisements (Ball & Mackert, 2013). And studies have been conducted outside the context of DTC prescription drug advertising to better understand the work and perspectives of advertising professionals, such as how advertising creatives use theory in their work (Kover, James, & Sonner, 1997) or the ethical understanding and decisions of advertising professionals (Drumwright & Murphy, 2004).
The relationship between those working in health communication and the field of advertising has often been strained, and not without reason. But the concerns of those working in health communication and public health are to some degree an acknowledgment of the power advertisers can have to influence consumer behavior. More constructive conversations between those working in both fields, and a willingness of health communication scholars and practitioners to adopt effective strategies for developing persuasive messages, could help advance the field of health communication. Through focused research on advertising professionals themselves, those interested in health communication can better understand how these individuals go about their work, which can improve understanding of the resulting campaigns. The knowledge and perspective of advertising professionals could help those working in health communication to better understand the power of advertisers as agents of persuasion and change, which would lead to improved health communication practice and policymaking.
Discussion of the Literature
Communication researchers have spent decades trying to advance knowledge of how the advertising industry influences consumers. Advertising research itself often borrows from longer-established fields, such as psychology and marketing, to build theories and models of influence (Bineham, 1988; Petty & Cacioppo, 1986). Though the application of these borrowed theories may provide a solid foundation for research, several unique characteristics of advertising arguably provide reason to pause and to determine if they are appropriate in both the context of the discipline and in the fast-evolving way media are consumed. Some variables unique to advertising include the source, consumer skepticism, media, and “noise,” such as clutter (Nan & Faber, 2004).
Nan and Faber (2004) argue that source variables, or “who” the message is coming from, is an important factor in advertising because ads ultimately intend to persuade. The level of perceived credibility (e.g., trustworthiness) and attractiveness (e.g., likability) of the source is particularly central to the effectiveness of the message. Despite attempts to tick all the boxes of credibility and attractiveness-of-source, advertisers often find that consumers are skeptical of ads and question the objectivity of the messages. A pertinent example is the aforementioned direct-to-consumer (DTC) prescription drug ads, which consumers across various socioeconomic sectors have been found to have a level of distrust of (Spake, Joseph, & Megehee, 2014). Research shows that a person’s social environment, such as peers, parents, interactions, and more, contributes to a level of persuasion knowledge that the consumer then draws on when interpreting and responding to advertisements (Nan & Faber, 2004).
While there has been in-depth research into consumer perceptions of source, implications for advertising research also call for the importance of taking source perspectives (e.g., advertising agency professionals who design DTC prescription ads) into account. This incorporation helps develop a better-rounded portrait of the advertising industry, bridges gaps between theory and practice, and can affect policy surrounding complex issues, such as DTC drug advertising and advertising to children.
Media, Repetition, and Clutter
The rapidly changing landscape of how people consume media makes this variable crucial for advertising practice, research, and education alike. Nan and Faber (2004) suggest the level of control that advertisers have over the media and coordination of their message makes “media” a distinguishable factor of advertising versus other forms of communication. The introduction of new media has forced advertising scholars to even further rely on “mother disciplines,” such as psychology, to begin to build theoretical frameworks that can guide advertising development and effectiveness in a digital environment (Laczniak, 2015). Research has suggested that most consumers are rarely out of arm’s reach of their mobile device throughout the day—with many people even sleeping near the smartphone—allowing advertisers to reach consumers directly and constantly at any given time (Grewal, Bart, Spann, & Zubcsek, 2016). The fact that digital media are highly individualized (e.g., location-based) offers tremendous opportunities for advertisers to target and tailor messages—both of which have been shown to be an effective part of persuasion in messaging, particularly for health behavior change (Rimer & Kreuter, 2006).
Repetition is another factor that makes advertising unique (Nan & Faber, 2004), and the ever-evolving media environment, where information is readily available and accessible, will continue to shape how consumers respond to advertising messages. The intense level of exposure may lead to quicker wear-out, where the ad no longer has an effect or it has a negative effect on the consumer, and will force advertisers to become more strategic and creative in their work. It will also demand expanded research parameters for academics who seek to understand this crucial variable to advertising effectiveness.
Finally, clutter has been at the top of advertisers’ consciousness since early on in the discipline. Clutter generally refers to competing messages in a particular space. It has been shown to reduce consumers’ recall and cognitive response to advertisements (Nan & Faber, 2004). Simply put, it is information overload. Competing clutter was already deemed “unavoidable” at the time that Nan and Faber published their call for a re-conceptualized approach to advertising theory and practice in 2004. In the current environment and in the foreseeable future, clutter in terms of competing advertisements, brands, and media will force both practitioners and researchers to reassess effectiveness. They will need to leverage consumers’ perspectives with even more understanding than ever before in order to become agents of behavior change—whether that is increasing milk consumption or adopting healthier lifestyles.
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