What persuasive techniques are used in the Change4Life campaign from the Department of Health and how effective are they for a social marketing campaign?

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What persuasive techniques are used in the Change4Life campaign from the Department of Health and how effective are they for a social marketing campaign?

Bettinghaus (1968, p.13) writes that in order to be persuasive, communication requires:

a conscious attempt by one individual to change the behaviour of another individual or group of individuals through the transmission of some message.

Therefore when evaluating a campaign, the outcomes are more indicative of effectiveness than the outputs (Lindemann 2006 p.14). Bettinghaus distinguishes between persuasion and compliance in the recipient; the receiver has to be convinced by the message and want to take action.

Proctor (2007 p.186) argues that social marketing should engage the audience causing them to realise that change is needed, rather than simply increasing awareness. He reports findings from the Department of Health (DoH) (2004 cited in Proctor 2007 p.186):

in order to begin to build meaningful and sustained relationships with clients people need to make healthy choices, rather than having decisions imposed upon them.

This represents an approach based on relationships, echoing Grunig’s Model of Excellence; a two-way symmetrical approach (See Appendix 1). Andreasen advised: persuade, don’t preach (2006 p.10) but states that the challenge for social marketing is that the behaviours are often entrenched (Proctor 2007 p.181). This essay will explore whether the persuasive techniques used by the DoH in the Change4Life campaign are effective and represent best practice for social marketing.

Who: Department of Health

Change4Life was introduced by the DoH in 2009 to tackle the obesity epidemic and has utilised a range of communication channels including TV advertising, press releases, a survey, action packs, posters, websites and marketing materials. It follows on from previous health campaigns such as Five a Day in 2003.

Behaviours causing obesity are deep-rooted and the scale of the problem poses a challenge; “what ministers regard as a national crisis” (Boseley 2009). The initial analysis by the DoH of Change4Life was quantitative; they looked at the number of people who saw the campaign or responded to the survey (DoH, 2009). Also, the website for the DoH states that the campaign aims “to raise awareness and increase understanding of the issue of obesity” yet this objective doesn’t include behaviour change. To establish the effectiveness of the campaign they would need to monitor behaviour to see if people have acted as a result.

The DoH did however report a halt in the rise of childhood obesity in April (Press Release 6/4), albeit just four months from the launch of the campaign. Andreasen raises an important point (2006 p.99):

One does not go overnight – or even in a few months – from being overweight or obese to be a conscientious dieter and regular exerciser for a lifetime.

Proctor (2007 p.182) outlines that the target audience experiences five stages of change taking years. Those who signed up for the pack would be at the third, Preparation phase, in which they intend to take action. Kotler (2006 p.195) suggests that a campaign should “target those in the Contemplation and Preparation/Action stages” in a similar way to Quirke’s theory that unguided missiles are the best target group (2000 cited in Tench & Yeomans 2006 p.340), but this leaves a further Maintenance phase. To move from targeting children to adults this year seems premature, as the success of response cannot yet be established. However, this change could be indicative of successful evaluation, as Andreasen (2006 p.98) advises on regular assessment of the audience and research showed the obesity rate in men is rising whilst progress is being made with children (DoH 2009).

Says what: Messages

Leventhal (1965 cited in Rosnow 1967 p.169) reiterates the point made by Bettinghaus that to be persuasive, the communicator must changed the inner attitudes of the receiver. He adds that:

Some form of arousal, activation or drive is necessary for change in attitude and action (p.170).

He says they could be positive or negative drives and examines the impact of fear message appeals, stating that these are necessary where fatal illnesses are concerned (p.170). Change4Life places fear at the heart of the campaign, with the first advert stating that children could have their “lives cut short” (YouTube 2009) by overeating and the second using a shocked tone of a child’s voice saying he may get “heart disease, cancer and type 2 diabetes”. Leventhal (Rosnow 1967 p.175) continues, for the audience to want to take action from a fear-arousing campaign, it needs to be readily available. Change4Life had a direct call to action in the adverts so it would seem to have taken the most effective approach.

However Tench and Yeomans outlined that the shocking early AIDS campaigns were found to be counterproductive (Miller 1998 cited in Tench and Yeomans 2006 p.274). The response also varies from person to person and Leventhal found that feelings of invulnerability can inoculate a person against fear (Rosnow 1967 p.178). Research by the DoH into families’ attitudes and behaviours surrounding diet and exercise did show that parents find it hard to connect inactivity and long-term health problems (DoH 2008). Therefore fear may not have been appropriate, as the audience may feel immune to the problem.

Further analysis of the language reveals there are more emotions addressed. Humour is used through the characters to create warmth giving family appeal. The target audience were families with children aged 0-11 and this mixture of emotions reaches the children as well as their parents, particularly with Aardman animation. Bang (2000 p.480) warned against trying “to speak to too many target audiences at once” so it may have been too wide in its scope. However, Andreasen (2006 p.105) suggested the best strategy uses the appropriate approach towards each target group.

However, despite the DoH claiming on its website that Change4Life:

pins the blame on modern life, which affects all of us, rather than pointing the finger at parents

there is guilt levelled at the parents: “we love the little blighters”; “mum feeds me enough for a horse” (YouTube 2009). This appeals to the basic physiological and safety needs, as identified by Maslow (Drummond 2005 p.73); it is shocking to feel your children may die young due to your parenting. O’Shaughnessy states that guilt is commonly used in social marketing but is not effective (1996 p.64).

Message types were tested prior to the launch and ‘killing with kindness’ produced the most effective response across the three target groups, demonstrating that parents’ “desire to love and nurture is actually harming their children”(DoH 2008). Combining shock with empathy proved effective in spurring parents to want to change their behaviour:

That makes me really think about all those times I give in and it makes me want to go home and throw all our sweets and crisps in the cupboard away (DoH 2008).

It demonstrates effective planning that these messages were tested with the audiences and Proctor said this was crucial (2007 p.184). The emotions targeted are the same in the real campaign, albeit toned down.

Aristotle argued that:

emotion was central to persuasion: pathos, distinguished from ethos and logos (cited in O’Shaughnessy 1996 p.63)

and the language in the press releases was emotive, naming Change4Life a “lifestyle revolution” with Dawn Primarolo calling for a “yes you can approach” (Press release 11/2). The Elaboration Likelihood model (Appendix 2) developed by Petty and Cacioppo is relevant here. They discovered the peripheral route, involving emotional reaction, creates short-term results, whilst the central route, which draws on reason, is more effective in the longer term. Change4Life is clearly using emotional messages, but as the DoH is aiming for long-term behaviour change we would expect to see the central route being used.

Toumlin (1958 cited in Tench and Yeomans p.275) said effective persuasion based on reason, the central route, requires evidence to make a claim backed by a warrant. In the adverts the evidence is given by the visual portrayal of fat build-up, the claim is reflected in the ‘game over’ sign, implying that this could cause lives to be cut short, and the warrant is evident in the second advert (YouTube 2009): ‘maybe we should do the how are the kids questionnaire.’ A combination of both routes is apparent in the press releases, which use shock tactics whilst focusing on evidence as Dawn Primarolo states (Press release 7/10):

Obesity is the biggest health challenge we face - every year 9,000 people die prematurely.

Sir Liam Donaldson adds to this, referring to the ‘health time bomb’:

In England almost two-thirds of adults and a third of children are either overweight or obese; without effective action this could rise to nine in ten adults and two-thirds of children by 2050.

So whilst emotional techniques were used to create an initial response, the central route was also used to produce longer-term results. However, O’Shaughnessy argues that the Elaboration Likelihood model devalues the power of emotion:

for the deepest influences on behaviour – personal attitudes, religion, morality etc – are integrally linked to emotion” (1996 p.64).

Perhaps both routes have been used in order to reach the widest audience, both in the short and longer term, though the DoH may have tried to do too much.

The language used in the Change4Life campaign is effective in its simplicity: Eat well, move more, live longer and Kotler (2006 p.196) advocated clear, action-orientated messages. It could be argued that it is too simplistic for what is a complex problem requiring a number of behavioural changes, as Victoria Macdonald points out in the Guardian:

Smoking kills is an easy message to get across. Overeating kills is more complex (2008 p.6).

Yet in creating the 4Life brand there is consistency which Proctor (2007 p.182) argued is “required to move target audiences through the various ‘stages of change’”.

However some of the complexity could have been avoided if just one behaviour change was focused on, such as exercise and Kotler (2006 p.196) advocates presenting them one at a time. Tench and Yeomans also point out (2006 p.275) that

there is some evidence that making people feel good is more effective than making them feel bad

so a more positive campaign could have looked at the benefits of exercise such as enjoyment and good health instead. Proctor argued (2007 p.184) that

alternative behaviours should be promoted as substitutes for undesirable present behaviours

to act as a guide and the Change4Life adverts do show the characters doing exercise, though they also demonstrate the negative behaviours. However, Hovland (cited in Bettinghaus 1968 p.156-7) found that a two-sided message approach was more effective for an audience that is likely to disagree with the message. We know from the research that the parents didn’t feel their actions were harming the children (DoH 2008) so perhaps the two-sided approach was necessary to gain attention.

Andreasen (2006 p.97) said social marketing campaigns should contain motivating benefits appealing to the target audience. Kotler pointed out that real benefits should be made clear to the audience (2006 p.199). He argued that health isn’t necessarily as high on the audience’s agenda, rather “they are more concerned with looking good”. These more commonly found desires could have been tapped, though with children this would be ethically challenging. It was found in the research that people saw the benefit of having family time (DoH 2008) so this was suggested through the campaign instead.

To whom: Audience

However Andreasen raises further points about the need to relate to the audience. He says the ‘costs’ which could prevent change need to be minimised (2006 p.103-4), explaining that junk food is heavily marketed and this points to a need for better legislation and food labelling to accompany this ‘movement’, as was done in Finland (Kotler 2006 p.189). Unfortunately the sponsorship has been met with criticism, as Nestlé and PepsiCo are among them; a move named as “controversial” (Boseley 2009).

Andreasen said the campaign should:

feature communications that ‘talk’ effectively to audiences about the offer, and provide a mechanism that will make it feasible and easy for the audience to act. (Andreasen 2006 p.97).

The campaign in Finland (Kotler 2006 pp.188-191) provides a good example, as they engaged in conversation with the audience, to learn which activities they prefer. They were supported in doing these, 2000 men were lent bikes for example, and barriers were removed by a shift from competitive to health-enhancing sports.

This is an example of Grunig’s model of Excellence involving listening and two-way symmetrical communications. For the Change4Life to be most effective there should be evidence of this model being used. However, the approach was asymmetrical, with the emphasis through sending packs more on the DoH advising families, rather than creating dialogue. It is based on a push strategy as defined by Cutlip et. al (1985 cited in Tench & Yeomans 2006 p.508), though there was also an element of pull strategy in the form of the DoH website and the dedicated campaign website.

The packs sent out address the issue outlined by Proctor:

the key problem seems to be the lack of immediate reinforcement to effecting a change of attitude (2007 p.181)

The DoH provided a phone line and sent action packs to those who filled in the survey which also address the issue of self-efficacy as they were intended to make the changes seem possible and manageable. As Andreasen says of smokers and obese people (2006 p.103-4):

They do not act because (sometimes based on their past experience) they simply think they cannot succeed.

Yet as we saw earlier, the DoH had learnt that decisions should not be imposed upon the public. If the survey had asked parents which changes they would like to see, the response could have been tailored leading to a greater level of engagement, which in turn would have been more effective.

Social media could also have been used more effectively to reach the audience. The Facebook group and Twitter profiles have only been recently set up, six months into the campaign, whilst previously there was just a staff Facebook group. As the DoH has been reactive, the opposing groups ‘Gamers fight back’ and ‘I am outraged at the Change4Life campaign’ both have almost three times as many members. A more effective approach would have seen planners utilising these platforms to gauge opinion about diet and exercise and this could have led to a more successful strategy based on engagement.

The target group was young families and many of this group will use these networks. The negative gaming group was reacting to the poster campaign led by the DoH. This showed a young boy playing on a games console with the words: ‘Risk an early death, just do nothing’ whilst Proctor advised that the young should not be talked down to (2007 p.184). The leader of the group claims that the Government has found inconclusive evidence (Facebook group ‘Gamers fight back’) about the impact on technology on obesity and those planning Change4Life should therefore have identified this threat to the success of their campaign. As one journalist writes:

As usual, they are out of touch, respond too late and their so-called facts or intelligence is normally flawed (www.mcvuk.com 2009).

The u-turn made subsequently with the announcement that the Government will launch an anti-obesity TV ad promoting videogames requiring physical activity (Sweney 2009) demonstrates their reactive stance to the issue.

A further threat arose from another “active public” (Grunig 1984 cited in Theaker 2001 p.238). Diabetes UK who formed the other negative Facebook group arguing that the campaign leads to ignorance; not everyone with Diabetes is overweight and this campaign has sparked embarrassment for young sufferers. The charity gained 634 signatures for their petition and they were successful in getting the wording changed, as outlined in the article by Rebecca Smith (2008). This further demonstrates the danger of simplifying the message and the need for accurate stakeholder analysis.

With what effect: Conclusion

Behaviour change is the ultimate goal of a social marketing campaign, whilst Change4Life sought initially just to change attitudes and appears to be moving on to a new target audience too soon. The challenge is that behaviours leading to obesity are entrenched in our society and legislation is needed to support the campaign. As the problem is deep-seated in our culture there was a need for clear, strong messages without preaching. The messages used were memorable but found to be too simplistic for what is a complex problem. This led to a backlash from Diabetes UK as well as the gaming industry due to the use of stereotypes. Due to this lack of engagement with the audience, this could lead to a criticism of it coming from the ‘nanny state’.

Change4Life took a predominately negative approach, using a mixture of fear and guilt and we have seen some evidence that it is better to make people feel good as guilt is not effective, though fear is sometimes necessary. Also, there was some humour and warmth in the use of animation so it would seem that both children and adults were targeted, which would indicate that the DoH were trying to do too much. This is also evident in the message: Eat less, move more, live longer; focusing on exercise and using a positive emphasis, tapping into the real benefits would have been more effective.

The DoH had found previously that it was best to encourage the audience to engage and this would necessitate a two-way approach as exemplified by Grunig. We saw some evidence of this in the use of a survey, action packs and the website but social media was not embraced in a proactive way which would have been a good means of listening to and relating to the target audience. Greater segmentation was needed and more research to fully understand the audience would have led to a campaign that could reach out to the relevant people and achieve maximum impact.

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Appendix One: Grunig’s Model of Excellence (Tench and Yeomans 2006, p.148).

Appendix Two: Elaboration Likelihood Model (Tench and Yeomans 2006, p.274)