Theory and Research for Obesity Prevention: Media, Materials and Real Moms

Background: The evolution of campaigns over time can provide unique insights to challenging issues today. It is clear that the use evidence-based and theory informed methods are important for vexing issues such as obesity, healthy eating and physical activity. Runyon Saltzman Inc. (RSE) and researchers at NORC fostered a long-standing collaboration to use theory and research to create customized communication materials for the California Department of Public Health Nutrition Education and Obesity Prevention Branch aimed at preventing obesity among low-income families and communities. The work spanned over 14 years, starting in 2005, and included not only communication materials, but mass media, social media, training for local change ambassadors, and tools for health departments, community-based organizations and partners. The campaigns included real mothers from low-income neighborhoods and elements of the final campaign are still present today.

Program background: Communication approaches evolved to fit the needs and experiences of a vulnerable target audience. The aim of the work was to increase self-efficacy and social normative beliefs and improve the lives of families struggling with a legacy of obesity, type-2 diabetes and neighborhoods with lack of access to healthy foods and physical activity environments. Message strategies were based on the Fishbein/Cappella Integrative Model of Behavior Change. These behavioral constructs became important foundations for all communication elements to develop a voice that resonated with families.

Evaluation Methods and Results: Formative research was conducted at every opportunity using quantitative and qualitative methods including focus groups, in-depth interviews and advanced analysis of survey data with the target audience to understand what resonated or not. In-depth interviews helped select the best framing and appeal for messaging. Social normative, self-efficacy and parental protection appeals were tested as well as a social versus individual framing. Evaluation surveys with approximately 1200 low-income mothers of school aged children were conducted using CATI methods. Results from the 2016 evaluation showed unaided recall of 21% and aided recall of 78%, and a significant increase from baseline to follow-up in respondents reporting they made it easy for their children to be physically active every day (+10.2%, p = .04). Advanced pathway analysis was conducted in 2013 to examine drivers of key behaviors including eating fruits and vegetables, consumption of water instead of sugary beverages and physical activity. Both individual and family behaviors were examined, finding that self-efficacy is a consistent driver of nutrition and physical activity, but normative beliefs influence self-efficacy beliefs.

Conclusions: Findings from the research were integrated into strategy and applied communications. We learned that theory and qualitative/quantitative research are critical for developing meaningful and effective communication pieces to reduce and prevent obesity. Evidence-based approaches designed for use at population-level application are scalable for use at local levels and integrated communication strategies support a common voice for social change.

Implications for research and/or practice: Our collaboration merged research and practice to develop communication strategies and materials for more than a decade. We learned what worked and what didn’t. The partnership between research, advertising, and public relations created relevant, compelling and effective approaches to address obesity in low-income families.