Identifying effective healthy weight and lifestyle advertisements: Focus groups with Australian adults
Introduction
Globally, rates of overweight and obesity have increased substantially since 1980 (Ng et al., 2014), placing more people at risk of developing chronic diseases such as type 2 diabetes, cardiovascular disease and some cancers (World Health Organization, 2003). In Australia, 63.4% of adults were overweight or obese in 2014–15, compared to 56.3% in 1995 (Australian Bureau of Statistics, 2015). Demographic variations in overweight and obesity prevalence are apparent, with rates higher among men, older age groups (i.e. 45–74 years), and persons living in inner regional, outer regional and remote areas of Australia (Australian Bureau of Statistics, 2015). Dietary risks and high body mass (BMI) are the top two risk factors accounting for the most disease burden in Australia (Institute for Health Metrics Evaluation, 2014).
Given the magnitude of the obesity problem, there is a pressing need for population-based interventions to reduce its impact. The mass media's unique ability to reach vast numbers and to play an important role in influencing community attitudes places it at the forefront of prevention strategy discussions (National Preventative Health Taskforce, 2009). There is good evidence that mass media campaigns can motivate behaviour change in several areas of public health; however, the results of specific obesity-related campaigns have been variable (Wakefield, Loken, & Hornik, 2010). This variability has led to some scepticism and debate as to the utility of mass media for this area. Experience from other public health areas, particularly tobacco control, suggests that some approaches (content and style) can be more effective than others (Durkin, Brennan, & Wakefield, 2012); that careful design of advertisements (ads) using comprehensive development and testing can influence success (Cotter et al., 2010); and that ads need to be seen more than once over a period of time to have impact (intensity and duration) (Dunlop et al., 2013, Durkin and Wakefield, 2014, Langley et al., 2014, Sims et al., 2014). Audience ratings of perceived effectiveness are an important indicator of campaign success, with studies linking anti-smoking ad ratings of perceived effectiveness with subsequent changes in attitudes and quitting intentions, as well as reduced smoking behaviour (Brennan et al., 2014, Davis et al., 2013).
To date, research on public perceptions of obesity prevention campaigns has largely focused on assessing the extent to which stigmatising versus non-stigmatising content is effective in motivating improved lifestyle behaviours (Puhl et al., 2013a, Puhl et al., 2013b). Recently our research team quantitatively tested adult's reactions to existing public health television ads promoting healthy weight and its primary behavioural routes (physical activity and healthy eating) that varied in terms of message content and execution style. Findings revealed that ads emphasising the negative health consequences of excess weight were more likely than other obesity prevention ads to promote message acceptance, be perceived as personally effective and also prompt negative emotional reactions – especially among adults with overweight or obesity (Dixon, Scully, Durkin, et al., 2015). The present study aimed to expand on this quantitative evidence by exploring adult responses to various public health ads promoting healthy weight and lifestyle, using an in-depth qualitative approach, in order to gain further insights into the key persuasive message elements of such ads. As encouraging adults to achieve and/or maintain a healthy weight is a population-wide issue in Australia, this study also aimed to explore whether responses to particular types of obesity prevention messages differed among certain priority population subgroups.
Section snippets
Participants
Twenty-four groups comprising an average of seven participants per group (N = 179) were conducted across metropolitan and regional areas of three Australian states (Victoria, New South Wales (NSW) and Queensland). Eight groups were conducted for each topic (weight, activity, or nutrition) addressed by the stimulus ads. To canvass responses to the ads by key demographic subgroups within the broad target group of Australian adults, groups were segmented by sex, education (no tertiary vs. at least
Types of messages
Four main themes were identified in participants' discussions about the ads' main messages – (i) Why is it a problem? (ii) Who is it a problem for? (iii) What should I do about it? (iv) How do I make the changes? Appendix A (column 3) summarises which of these central message elements participants tended to comment on in relation to the respective ads.
Ads that provided ‘why’ messages were interpreted as emphasising the seriousness of overweight and obesity and giving people a reason to take
Conclusions
The results of this qualitative study suggest that messages focusing on the problem (‘why’) as well as messages focusing on solutions (‘what’ and ‘how’) are both necessary components of broadly targeted public health advertising campaigns aimed at promoting healthy weight or lifestyle. Different types of messages appear to be motivating for different people depending on their existing knowledge and current weight or lifestyle status. Messages about solutions appear to have considerably greater
Conflict of interest disclosure statement
Two of the authors (HD & MS) are employees of Cancer Council Victoria who were involved in the development, implementation and/or evaluation of five of the advertisements (Man eating sugar, Sugary drinks, Stairs or escalator, Toxic fat and Piece of string) included in this analysis. Michael Murphy and Trish Cotter were involved in the development of the LiveLighter campaign. Michael Murphy was also involved in testing of the appropriateness of the Man eating sugar advertisement for the
Acknowledgements
This work was supported by the Australian National Preventive Health Agency [grant number 86DIX2011].
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