Media advertising campaigns are used to promote sales of products, but they can also be used to give the public information about health and to encourage them to be more healthy (eg. adverts encouraging people to stop smoking, or to drink sensibly, or to use condoms). In recent years, we have seen a growth in new types of advertising and media, particularly on the internet and mobile phones. The evidence base on these newer types of media campaign is still emerging.
This systematic review-based study will attempt to pull together all the evidence on media advertising campaigns about health, to provide clear answers to the questions:
By effective, we mean in the first instance ‘do they encourage the changes in behaviour which they are trying to change?’. However, sometimes campaigns do not try to change behaviour, but to move people towards being able to change behaviour in the future, for example by encouraging them to think differently about a health issue, or to feel more confident in their ability to change. We are interested in all of these types of effects.
We will focus on mass media campaigns for alcohol use, illicit drug use, diet, physical activity, sexual and reproductive health, and smoking cessation and prevention. By media, we mean campaigns which use television and radio advertising, cinema advertising, advertising in newspapers and magazines, advertising on billboards and other types of outdoor advertising (eg. bus shelters, taxi cabs), advertising on the internet and on mobile phones, and other types of advertising (eg. advertising in video games).
The study will involve wide consultation with public health practitioners and commissioners at national and local level, and with representatives of public involvement groups.
ISM Staff: Linda Bauld, Martine Stead, Kathryn Angus and Fiona Dobbie
External collaborators: Sarah Lewis and Tessa Langley, University of Nottingham; James Thomas and Kate Hinds, University of London, EPPI; Shona Hilton and Srinivasa Katikireddi, University of Glasgow
This study will explore the barriers and facilitators to smoking cessation in pregnancy through reviewing relevant literature, conducting qualitative research and developing proposals for future interventions. A qualitative study design will combine 3 systematic reviews and 3 exploratory studies conducted over a two year period. A set of literature reviews of barriers and facilitators to cessation in pregnancy and following childbirth will be taken.
ISM Staff: Linda Bauld, Lesley Sinclair, Jennifer McKell, Kathryn Angus and Allison Ford
Flemming K, Graham H, McCaughan D, Angus K, Sinclair L and Bauld L (2016). Health professionals’ perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and during the post-partum period: a systematic review of qualitative research. BMC Public Health, 16: 290. doi:10.1186/s12889-016-2961-9
Flemming K, Graham H, McCaughan D, Angus K and Bauld L (2015). The barriers and facilitators to smoking cessation experienced by women’s partners during pregnancy and the post-partum period: a systematic review of qualitative research. BMC Public Health, 15: 849. doi:10.1186/s12889-015-2163-x
Flemming K, McCaughan D, Angus K and Graham H (2015). Qualitative systematic review: Barriers and facilitators to smoking cessation experienced by women in pregnancy and following childbirth. Journal of Advanced Nursing, 71(6): 1210-1226. doi: 10.1111/jan.12580. Epub 2014 Nov 28.
The aim of the study was to conduct two systematic reviews on:
The purpose was to support the development by NICE of their Public Health Guidance (November 2013) covering smoking cessation in secondary care in acute, maternity and mental health services. The reviews provided the best available evidence on smokefree strategies and interventions in these settings. The reviews were led by the Institute for Social Marketing in partnership with the University of Nottingham and collaborators from the EPPI-Centre at the Institute of Education and the NCSCT Community Interest Company.
ISM Staff: Kathryn Angus, Douglas Eadie and Laura Macdonald
Angus K, Murray R, Macdonald L, Eadie D, O’Mara-Eves A, Stansfield C and Leonardi-Bee J (2013). Review 6: A review of the effectiveness of smokefree strategies and interventions in secondary care settings. London: National Institute for Health and Care Excellence. Review
Eadie D, Macdonald L, Angus K, Murray R, O’Mara-Eves A, Stansfield C and Leonardi-Bee J (2012). Review 7: A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. London: National Institute for Health and Care Excellence. Review
Plain Tobacco Packaging: A Systematic Review (2011-2012)
(Commissioned by the Department of Health)
This project was commissioned by the Department of Health via ISM's involvement in the Public Health Research Consortium. Colleagues from the University of Nottingham and the EPPI Centre at the University of London were also involved. The project consisted of a systematic review of all the available published evidence on standardised (or 'plain') packaging of tobacco products. The review set out to answer the following questions:
What effect, if any, does plain packaging have on:
It also set out to identify any other potential benefits, whether the effects differ between groups and what the facilitators and barriers to impact are.
The review included studies from 1980 and from over 4,000 initial citations, 37 studies met the inclusion criteria.
ISM Staff: Martine Stead, Linda Bauld, Crawford Moodie, Kathryn Angus, Gerard Hastings, Richard Purves and Stuart Bryce (left 2011)
Stead M, Moodie C, Angus K, Bauld L, McNeill A, Thomas J, Hastings G, Hinds K, O’Mara-Eves A, Kwan I, Purves RI and Bryce SL (2013). Is consumer response to plain/standardised tobacco packaging consistent with Framework Convention on Tobacco Control guidelines? A systematic review of quantitative studies. PLoS One, 8(10): e75919. doi:10.1371/journal.pone.0075919
Moodie C, Bauld L and Stead M (2013). UK government’s delay on plain tobacco packaging: how much evidence is enough? BMJ, 347: f4786. doi:10.1136/bmj.f4786
Final report: Moodie C, Stead M, Bauld L, McNeill A, Angus K, Hinds K, Kwan I, Thomas J, Hastings G and O’Mara-Eves A (2012). Plain Tobacco Packaging: A Systematic Review. Available: http://phrc.lshtm.ac.uk/papers/PHRC_006_Final_Report.pdf
Protocol: Moodie C, Hastings G, Thomas J, Stead M, Angus K and Bauld L (2011). Protocol for plain tobacco packaging: a systematic review. Available: http://phrc.lshtm.ac.uk/papers/PHRC_006_Protocol.pdf
A Systematic Literature Review of the Evidence for Effective National Immunisation Schedule Promotional Communications (2010-2011)
(Commissioned by the European Centre for Disease Prevention and Control (ECDC))
This review was part of an ECDC funded project ‘Translating Health Communications: Establishing a programme for dissemination of evidence based health communication activities and innovations on communicable diseases for country support in the EU and EEA/EFTA 2009-2012’.
Sub-optimal uptake of routine immunisations, resulting in resurgence of infectious diseases and outbreaks, eg. measles, is a current public health concern in Europe. There are a number of complex social factors contributing to ‘immunisation hesitancy’ such as: declining levels of trust in expert opinion; rapid dissemination of information and misinformation; and lack of awareness of the consequences of immunisation avoidance or delay because this is seldom seen at first-hand. The traditional public health response of relying exclusively or largely on the scientific evidence for the safety, efficacy and population-wide benefits rationale for immunisation, is an inadequate response to the problem.
The review explored and assessed the evidence for the effectiveness of immunisation promotional communications, with a focus on the European evidence. The findings intended to support the development of effective communications policies and strategies.
ISM Staff: Georgina Cairns, Laura Macdonald and Kathryn Angus
Macdonald L, Cairns G, Angus K and de Andrade M (2013). Promotional communications for influenza vaccination: A systematic review. Journal of Health Communication, 18(12): 1523-1549. doi:10.1080/10810730.2013.840697 eprint
Cairns G, Macdonald L, Angus K, Walker L, Cairns-Haylor T and Bowdler T (2012). Systematic Literature Review of the Evidence for Effective National Immunisation Schedule Promotional Communications. Stockholm: European Centre for Disease Prevention and Control (ECDC). Report online
A Systematic Literature Review to Examine the Evidence for the Effectiveness of Interventions that Use Theories and Models of Behaviour Change: Towards the Prevention and Control of Communicable Diseases (2010-2011)
(Commissioned by the European Centre for Disease Prevention and Control (ECDC))
The review was part of the ECDC funded project ‘Translating Health Communications: Establishing a programme for dissemination of evidence based health communication activities and innovations on communicable diseases for country support in the EU and EEA/EFTA 2009-2012’.
Behavioural and social theories and models are considered an important tool in effective behaviour change interventions and programmes. They have the potential to help identify what changes can take place, explain and support change dynamics, identify key influencers on outcomes and select participants who are the most likely to benefit. The use of behavioural and social theories in health intervention planning and management also improves the prospects for replication, modification and scaling up of effective interventions, and improves the learning that can be derived from practice, whether successful or unsuccessful.
This review assessed the effectiveness of interventions that were based on theories and models of behaviour change to prevent or control communicable diseases relevant to Europe.
ISM Staff: Kathryn Angus, Georgina Cairns, Laura Macdonald, Richard Purves and Stuart Bryce (left 2011)
Angus K, Cairns G, Purves R, Bryce S, Macdonald L and Gordon R (2013). Systematic literature review to examine the evidence for the effectiveness of interventions that use theories and models of behaviour change: towards the prevention and control of communicable diseases. Stockholm: ECDC. Report online
A Review of the Evidence for Effective Alcohol Education for the UK (2009-2010)
(Commissioned by the Alcohol Education and Research Council (AERC))
The Alcohol and Education Research Council, on behalf of Drinkaware, commissioned ISM to conduct a review of reviews of the international evidence base, with special reference to its applicability and relevance to the UK. ISM was asked to recommend and develop proposals for next steps to strengthen the research agenda and evidence base. ISM developed the design and research objectives for a systematic review of most promising approaches for alcohol education based interventions, and a longitudinal study of a community and/or family + school-based intervention.
AERC Second Stage: A Systematic Investigation of Critical Elements for Optimum Effectiveness of Promising Approaches and Delivery Methods in School and Family Linked Alcohol Education
Building on the findings of the first stage scooping study, this project systematically reviewed the evidence base on interventions intended to reduce or prevent alcohol misuse amongst young people. The review identified and interrogated the evidence base over a ten year period. Thematic analysis, case study and process and impact evidence collation methods were used. Internal and external elements of intervention programmes most frequently associated with positive behavioural outcomes were reported and strategic implications for future development were identified.
ISM Staff: Georgina Cairns, Martine Stead, Kathryn Angus, Richard Purves, Jennifer McKell and Stuart Bryce (left 2011)
Cairns G, Purves R, Bryce S, McKell J, Gordon R and Angus K (2011). Investigating the Effectiveness of Education in Relation to Alcohol: A Systematic Investigation of Critical Elements for Optimum Effectiveness of Promising Approaches and Delivery Methods in School and Family Linked Alcohol Education. Stirling: Institute for Social Marketing. Report online
Community, School and Workplace Initiatives to Encourage Individuals to Use the Outdoor Environment for Physical Activity (2009-2010)
(Commissioned on behalf of the National Physical Activity Research and Evaluation group (NPARE) by NHS Health Scotland)
The aim of this review was to identify and review evidence of the effectiveness of initiatives and interventions delivered in the community, school, or workplace setting which have been designed to encourage individuals to use their local outdoor environment to increase their physical activity, and to identify and describe similar initiatives currently being delivered in Scotland. To do this we conducted a rapid review using systematic methods. The study involved two elements, an Evidence Review and the compilation of a Database of Current Activity in Scotland. For the Evidence Review, we searched for systematic reviews, primary studies and grey literature reports. Studies were assessed for relevance and rated for quality. For the Database of Current Activity, we used a mixed methods approach combining online searches, email and telephone contact. The results suggest that some approaches for promoting physical activity in the outdoor environment are effective (for example, walking groups, modifications to the physical environment, some organisational changes). There is insufficient evidence to date for some other approaches, such as conservation and forest schools.
ISM Staff: Martine Stead and Kathryn Angus
Collaborators: Ruth Jepson, Department of Nursing & Midwifery and Adrienne Hughes, Department of Sports Studies, University of Stirling; and Cecilia Oram, Sustrans
Stead M, Angus K, Jepson R, Hughes A and Oram C (2010). Community, school and workplace initiatives to encourage individuals to use the outdoor environment for physical activity. Edinburgh: NHS Health Scotland. Report online
ISM revised and updated its 2006 systematic review for the World Health Organization. The review found commercial food marketing aimed at children and young people continued to be intensive and predominantly for low quality nutrition foods. The review did not identify any evidence of significant change in the nature or extent of commercial food marketing practice. An emerging evidence base on food marketing using new channels such as digital media and viral networks was noted, although TV advertising remains the most heavily researched medium. The evidence that food marketing influences food preferences, purchase, and consumption and diet-related health outcomes was once again confirmed. The review evidence was commissioned to support, and was used in the development of a Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children. The recommendations were subsequently endorsed at the 63rd World Health Assembly, May 2010.
ISM Staff: Georgina Cairns, Kathryn Angus and Gerard Hastings
Cairns G, Angus K and Hastings G (2009). The Extent, Nature and Effects of Food Promotion to Children: A Review of the Evidence to December 2008. Prepared for the World Health Organization. Available here
Review of Social Marketing as a Strategy for Workplace Health and Wellbeing (2007)
(In collaboration with GfK and the National Social Marketing Centre for the Health and Safety Executive)
The Health and Safety Executive (HSE) is increasingly aware of the impact that work has on the health and wellbeing of employees. Over and above individual differences between workers, what happens in the workplace – working relationships, job design and content, the physical environment and so on – has a strong effect on employee health and wellbeing. In turn, health and wellbeing is a major determinant of workplace productivity and levels of ill health and sickness absence.
This project explored how social marketing was applied in the area of workplace health, and examined the potential use and benefits of taking a user-driven social marketing approach. The implications for the HSE, businesses and other stakeholders of adopting a social marketing user-driven approach to health safety and wellbeing at work were explored, and the project worked with HSE to shape recommendations for action resulting from the research.
This project had five main deliverables:
ISM Staff: Martine Stead and Kathryn Angus
The Extent, Nature and Effects of Food Promotion to Children: A Review of the Evidence (2006)
(Commissioned by the World Health Organization)
A review of the extent and nature of food promotion to children and its effects on their food knowledge, preferences and behaviour was undertaken on behalf of the World Health Organization in preparation for the WHO meeting of stakeholders on "Marketing food and non-alcoholic beverages to children" held in Oslo (2-4 May 2006). The review updated and extended upon two earlier reviews of food promotion to children undertaken for the UK Food Standards Agency and the World Health Organization in 2003 and 2004 respectively.
The study used systematic review methods to identify and assess evidence of food promotion's effects. It found that in both developed and developing countries: (i) there is a great deal of food promotion to children, particularly in the form of television advertising; (ii) this is typically for highly processed, energy dense, unhealthy products with evocative branding; and (iii) that children recall, enjoy and engage with this advertising. Evidence from more complex studies (capable of establishing causality) shows that this promotional activity is having an effect on children. It can have an effect on specific types of nutritional knowledge and influence their food preferences, encouraging them to ask their parents to purchase foods they have seen advertised. Food promotion has also been shown to influence children's consumption and other diet-related behaviours and outcomes. These effects are significant, independent of other influences and operate at both brand and category level. These more complex studies have all been undertaken in the developed world. However survey research shows that children respond to advertising in much the same way regardless of their country's place on the development ladder.
The study confirms that global action is needed on the marketing of food to children.
ISM Staff: Laura McDermott (left 2008), Martine Stead, Kathryn Angus and Gerard Hastings
Hastings G, McDermott L, Angus K, Stead M and Thomson S (2006). The Extent, Nature and Effects of Food Promotion to Children: A Review of the Evidence. Technical Paper Prepared for The World Health Organization. Available here
McDermott L, O’Sullivan T, Stead M and Hastings G (2006). Food advertising, pester power and its effects. International Journal of Advertising, 25(4): 513-539.
The aim was to conduct three systematic reviews to support the development of public health guidance by NICE on the most appropriate means of generic and specific interventions to support attitude and behaviour change at population and community levels.
Reviews 1 and 2 examined the characteristics of interventions, evidence for effectiveness of interventions and factors which influenced effectiveness. Review 3 examined the nature of marketing and social marketing as behaviour change techniques; reviewed the nature and effects of marketing to low-income consumers; and summarised the effect of commercial food marketing on children and the effectiveness of social marketing in changing health behaviours.
ISM Staff: Martine Stead, Laura McDermott (left 2008), Kathryn Angus and Gerard Hastings
Collaborators: Paul Broughton
Stead M, McDermott L, Broughton P, Angus K and Hastings G (2006). Review of the Effectiveness of Road Safety and Pro-Environmental Interventions. Prepared for the National Institute for Health and Clinical Excellence (NICE). Stirling: Institute for Social Marketing, University of Stirling.
Stead M, McDermott L, Angus K and Hastings G (2006). Marketing Review. Prepared for the National Institute for Health and Clinical Excellence (NICE). Stirling: Institute for Social Marketing, University of Stirling. Available here
The UK National Social Marketing Centre commissioned a programme of research to examine the potential of social marketing approaches to contribute to both national and local efforts, and to review current understanding and skills in the area among key professional and practitioner groups to inform their first National Social Marketing Strategy for Health. The ISM was commissioned to conduct three effectiveness review reports for the Strategy:
ISM Staff: Martine Stead, Ross Gordon (left 2010), Laura McDermott (left 2008), Kathryn Angus and Gerard Hastings
Stead M and Gordon R (2010). Providing evidence for social marketing’s effectiveness. Chapter 6 in French J, Blair-Stevens C, McVey D and Merritt R (eds), Social Marketing and Public Health: Theory and Practice. Oxford; New York: Oxford University Press; p81-96. ISBN: 978-0199550692.
Stead M, Gordon R, Angus K and McDermott L (2007). A systematic review of social marketing effectiveness. Health Education, 107(2): 126-191. doi:10.1108/09654280710731548
Gordon R, McDermott L, Stead M and Angus K (2006). The effectiveness of social marketing interventions for health improvement: What's the evidence? Public Health, 120(12): 1133-1139. doi:10.1016/j.puhe.2006.10.008
Systematic Review of the Effectiveness of Social Marketing Nutrition and Food Safety Interventions (2004-2005)
(Commissioned by Safefood Ireland)
The public health community has met with growing demands to intervene on matters relating to nutrition and food safety. Rapidly increasing obesity rates and the increased risk of chronic disease have sparked efforts to improve dietary health. Similarly, there is a need to reduce the risk of food poisoning, food borne illness and other problems associated with matters of food safety.
This systematic review evaluates the effectiveness of social marketing interventions designed to influence people's knowledge, perceptions, and behaviour in relation to nutrition (food, diet and diet-related health) and food safety (food handling, preparation, poisoning and labelling). It employs rigorous, transparent, and replicable procedures to critically appraise evidence and seeks to determine which approaches have had the best effect. The research will guide the development of future social marketing efforts in these areas.
ISM Staff: Laura McDermott (left 2008), Gerard Hastings, Kathryn Angus and Martine Stead
McDermott L, Hastings GB and Angus K (2004). A Systematic Review of Social Marketing Nutrition and Food Safety Interventions. Social Marketing Advances in Research and Theory Conference (SMART), Alberta, Canada.
McDermott L, Stead M, Hastings G, Angus K, Banerjee S, Rayner M and Kent R (2005). A Systematic Review of the Effectiveness of Social Marketing Nutrition and Food Safety Interventions - Final Report - Prepared for Safefood. Stirling: Institute for Social Marketing. Report
Systematic Review of the Effects of Food Marketing on Children in Developing Countries (2003-2004)
(Commissioned by the World Health Organization)
This systematic review extended the scope of the FSA Review of Food Promotion to Children by examining the effects of food marketing on children in the developing world. Consistent with the first review's findings, this research found that children from developing countries are heavily exposed to food advertising which promotes high salt, sugar and fat products, that they recall and like this advertising, and use it to prompt their own and parents' purchase decisions.
None of the studies was methodologically sound enough to determine whether or not a causal relationship existed between food promotion and children's food behaviour and diet. However, the findings of the FSA review, which examined promotion in developed countries, suggest that it is logical to assume that food advertising in developing countries is likely to have an influence, albeit hitherto unmeasured, on children.
ISM Staff: Laura McDermott (left 2008), Gerard Hastings, Kathryn Angus and Martine Stead
Co-Investigators:Dr Michael Rayner, University of Oxford
Systematic Review of Research on the Effects of Food Promotion to Children (2002-2003)
(Commissioned by the Food Standards Agency)
This major study was the first ever systematic review to examine evidence of the effects of food promotion on children. It sought to answer the highly topical question of whether children's food behaviour and diets are influenced by food advertising and other forms of promotion. Specifically, it reviewed evidence of the extent and nature of food promotion to children; how children respond to food promotion; whether it influences their food preferences; and if it does, the extent of that influence compared to other factors and whether the influence applies to types of food as well as brands.
The review reached a number of significant conclusions about the link between promotional activities and children's eating behaviour. In particular, it concluded that food advertising to children does have an effect, particularly on children's preferences, purchase behaviour and consumption, and these effects are apparent not just for different brands but also for different types of food. Since its publication in 2003, the report has acted as a catalyst to UK and European policy debate on this highly important public health issue.
ISM Staff: Gerard Hastings, Martine Stead, Laura McDermott (left 2008), Anne Marie MacKintosh, Kathryn Angus, Dr Alasdair Forsyth (left 2003)
Co-Investigators: Dr Michael Rayner, University of Oxford; Dr Christine Godfrey, University of York; and, Dr Martin Caraher, City University
Stead M, McDermott L and Hastings G (2007). Towards evidence-based marketing: The case of childhood obesity. Marketing Theory, 7(4): 379-406.
Hastings G, McDermott L and Stead M (2004). Food advertising and children: There is an effect - get over it. Innova: Food and Beverage Innovation, January/February: 27-28.
McDermott L, Hastings G and Stead M (2004). Food promotion to children: A time for action. ChildRIGHT, 205: 14-16.
Stead M, McDermott L and Hastings GB (2004). From the billboard to the school canteen: How food promotion influences children. Education Review, 17(2): 17-23 .
McDermott L, Hastings G, Stead M, Mackintosh AM, Rayner M, Godfrey C, Caraher M and Angus K (2004). Evidence-based marketing: The transferability of the systematic review to marketing research. European Marketing Academy Conference, Murcia, Spain.