Economics of mass media health campaigns with health-related product distribution: a community guide systematic review

Systematic review and meta-analysis comparing educational and reminder digital interventions for promoting HPV vaccination uptake

Global Human papillomavirus (HPV) vaccination rates remain low despite available WHO-approved vaccines. Digital interventions for promoting vaccination uptake offer a scalable and accessible solution to this issue. Here we report a systematic review and meta-analysis examining the efficacy of digital interventions, comparing educational and reminder approaches, for promoting HPV vaccination uptake (HVU). This study also identifies factors influencing the effectiveness of these interventions. We searched PubMed, PsycInfo, Web of Science, and the Cochrane Library from each database's inception to January 2023. Three raters independently evaluate the studies using a systematic and blinded method for resolving disagreements. From 1929 references, 34 unique studies (281,280 unique participants) have sufficient data. Client reminder (OR, 1.41; 95% CI, 1.23-1.63; P < 0.001), provider reminder (OR, 1.39; 95% CI, 1.11-1.75; P = 0.005), provider education (OR, 1.18; 95% CI, 1.05-1.34; P = 0.007), and client education plus reminder interventions (OR, 1.29; 95% CI, 1.04-1.59; P = 0.007) increase HVU, whereas client education interventions do not (OR, 1.08; 95% CI, 0.92-1.28; P = 0.35). Digital intervention effectiveness varies based on participants' gender and the digital platform used. Interventions targeting male or mixed-gender participants demonstrate greater benefit, and reminder platforms (SMS, preference reminders, or electronic health record alerts) are more effective in increasing HVU. Digital interventions, particularly client and provider reminders, along with provider education, prove significantly more effective than client education alone. Incorporating digital interventions into healthcare systems can effectively promote HPV vaccination uptake. Reminder interventions should be prioritized for promoting HVU.

Systematic Review on Information Technology Approaches to Evaluate the Impact of Public Health Campaigns: Real Cases and Possible Directions

Evaluating the success of a public health campaign is critical. It helps policy makers to improve prevention strategies and close existing gaps. For instance, Brazil's “Syphilis No!” campaign reached many people, but how do we analyze its real impact on population awareness? Are epidemiologic variables sufficient? This study examined literature on using of information technology approaches to analyze the impact of public health campaigns. We began the systematic review with 276 papers and narrowed it down to 17, which analyzed campaigns. In addition to epidemiological variables, other types of variables of interest included: level of (i) access to the campaign website, (ii) subject knowledge and awareness, based on questionnaires, (iii) target population's interest, measured from both online search engine and engagement with Social Network Service, and (iv) campaign exposure through advertising, using data from television commercials. Furthermore, we evaluated the impact by considering several dimensions such as: communication, epidemiology, and policy enforcement. Our findings provide researchers with an overview of various dimensions, and variables-of-interest, for measuring public campaign impact, and examples of how and which campaigns have used them.

A Scoping Review of Foci, Trends, and Gaps in Reviews of Tobacco Control Research

INTRODUCTION

The burden of disease associated with tobacco use has prompted a substantial increase in tobacco-related research, but the breadth of this literature has not been comprehensively examined. This review examines the nature of the research addressing the action areas in World Health Organization's Framework Convention on Tobacco Control (FCTC), the populations targeted and how equity-related concepts are integrated.

METHOD

A scoping review of published reviews addressing tobacco control within the primary prevention domain. We searched PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Educational Resources Information Centre, and PsycInfo from 2004 to 2018.

RESULTS

The scoping review of reviews offered a "birds-eye-view" of the tobacco control literature. Within the 681 reviews meeting inclusion criteria, there was a strong focus on smoking cessation targeting individuals; less attention has been given to product regulation, packaging, and labeling or sales to minors. Equity-related concepts were addressed in 167/681 (24.5%); few were focused on addressing inequity through structural and systemic root causes.

CONCLUSION

This analysis of foci, trends, and gaps in the research pursuant to the FCTC illustrated the particular action areas and populations most frequently addressed in tobacco control research. Further research is needed to address: (1) underlying social influences, (2) particular action areas and with specific populations, and (3) sustained tobacco use through the influence of novel marketing and product innovations by tobacco industry.

IMPLICATIONS

This scoping review of the breadth of tobacco control research reviews enables a better understanding of which action areas and target populations have been addressed in the research. Our findings alongside recommendations from other reviews suggest prioritizing further research to support policymaking and considering the role of the tobacco industry in circumventing tobacco control efforts. The large amount of research targeting individual cessation would suggest there is a need to move beyond a focus on individual choice and decontextualized behaviors. Also, given the majority of reviews that simply recognize or describe disparity, further research that integrates equity and targets various forms of social exclusion and discrimination is needed and may benefit from working in collaboration with communities where programs can be tailored to need and context.

Economic evaluations of public health interventions for physical activity and healthy diet: A systematic review

Physical inactivity and unhealthy dietary habits are associated with an increased disease and economic burden. The aim of this systematic review was to identify economic evaluations of public health interventions targeting physical activity and healthy diet, and assess the quality and transferability of the findings to the Swedish context. A search of published economic evaluations was conducted through electronic databases including PubMed, Web of Science, PsycINFO, National Health Service Economic Evaluation Databases (NHS EED) and the Health Technology Assessment Database (HTA). An additional search was done using references of relevant systematic reviews and websites of relevant organizations were checked to find grey literature. Quality and transferability of the economic evaluations were appraised using a quality assessment tool developed by the Swedish Agency for Health Technology Assessment. Thirty-two economic evaluations, rated as moderate or high quality, of 178 interventions were included; thirteen studies targeting physical activity, thirteen targeting healthy diet and six targeting both. The interventions varied in terms of their content, setting, mode of delivery and target populations. A majority of the economic evaluations reported that the interventions were likely to be cost-effective; however, considerable variations in the methodological and reporting qualities were observed. Only half of the economic evaluations were rated to have a high probability of transferring to the Swedish context. Public health interventions targeting physical activity and dietary habits have a high potential to be cost-effective. However, decision makers should consider the variation in quality and transferability of the available evidence.

Awareness of Pregnancy-Associated Health Risks Among Pregnant Women and Male Partners Surveyed in a Prenatal Clinic

Background: Underestimation of pregnancy-associated health risks could compromise informed decision-making and reduce demand for preconception care. We assessed the knowledge of pregnant women and male partners about several health risks posed by pregnancy to identify potential gaps in reproductive health literacy. Materials and Methods: Pregnant women and male partners were surveyed about their knowledge of seven common health risks associated with pregnancy (venous thromboembolism [VTE], diabetes, gallstones, hemorrhoids, hypertension [HTN], kidney infection, and anemia) in either English or Spanish in a prenatal clinic at Harbor-UCLA Medical Center in Torrance, California. Results: The response rate for women was estimated to be 66% and was 85% for men. Of the 285 respondents, 5.0% of women and 5.6% of men were able to correctly report that all seven health risks increased during pregnancy. Overall, 30.6% of women and 24% of men recognized that pregnancy increased the risks of the three most serious conditions (VTE, diabetes, and HTN). While higher education was associated with a higher awareness of these three serious risks, the majority of individuals with the highest education nonetheless incorrectly reported that these risks were reduced or unchanged in pregnancy. Age, parity, language, gender, and gestational age did not impact study findings. Overall, 77.9% of respondents rated oral birth control pills more hazardous to a woman's health than pregnancy. Conclusions: Surveyed pregnant women and male partners have significant knowledge deficiencies concerning common and serious health hazards associated with pregnancy that may hamper women's ability to make informed choices about their reproductive health options.

An assessment of child passenger safety levels of service in Michigan

Objective: The purpose of this article was to assess the match between child passenger safety resources (child passenger safety technicians [CPSTs], car seat checks, and child restraint system [CRS] distribution programs) and the child population in Michigan by utilizing geographic information systems approaches and to analyze the impact of Michigan's CPSTs on child passenger safety behaviors on departure from a seat check. Methods: Data were collected from administrative sources and a survey of CPSTs to determine the number and location of child passenger safety resources and children in Michigan. The main analyses used data from 2014. The child population ≤4 years old per county and per traffic safety region was determined from census data. CPST and car seat check locations were determined from a list from the Michigan Office of Highway Safety Planning (Mi-OHSP) and a survey of CPSTs who coordinate seat checks. Summary sheets from Mi-OHSP served as the data source for CRSs distributed through their occupant protection program. Data from child passenger safety checklists completed with seat checks were obtained from Safe Kids Michigan. Addresses were geocoded using Google Maps Geocoding API and then mapped at the county level using ArcGIS Desktop 10.3.1. Descriptive statistics were calculated and levels of service were determined at the county and regional levels. Results: In 2014, there were 570,929 children ≤4 years old in Michigan and 979 CPSTs who worked at 209 known seat check locations. An average of 6,854 seats was checked per year through Safe Kids Michigan Coalitions. All but 3 regions met an intermediate service level for seat check locations by offering one or more per 5,000 children ≤4 years old. There was at least one CPST in 80 of 83 counties (median 5; interquartile range, 2, 10.5). Assuming that an average Michigan CPST provides 10 h of service each year, all but 2 regions reached an intermediate service level of at least one technician hour per 90 children ≤4 years old. Fewer regions reached a basic level of service for the number of seat checks. Almost half (49.5%) of Safe Kids Michigan seat checks resulted in a change in child passenger safety behaviors. Conclusions: Child passenger safety resources in Michigan are not evenly distributed yet most regions and counties meet intermediate levels of service. Reallocating resources to areas that are providing basic levels of service could help reduce disparities in child passenger safety behaviors.

Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence

Background

Mass media campaigns can be used to communicate public health messages at the population level. Although previous research has shown that they can influence health behaviours in some contexts, there have been few attempts to synthesise evidence across multiple health behaviours.

Objectives

To (1) review evidence on the effective use of mass media in six health topic areas (alcohol, diet, illicit drugs, physical activity, sexual and reproductive health and tobacco), (2) examine whether or not effectiveness varies with different target populations, (3) identify characteristics of mass media campaigns associated with effectiveness and (4) identify key research gaps.

Design

The study comprised (1) a systematic review of reviews, (2) a review of primary studies examining alcohol mass media campaigns, (3) a review of cost-effectiveness evidence and (4) a review of recent primary studies of mass media campaigns conducted in the UK. A logic model was developed to inform the reviews. Public engagement activities were conducted with policy, practitioner and academic stakeholders and with young people.

Results

The amount and strength of evidence varies across the six topics, and there was little evidence regarding diet campaigns. There was moderate evidence that mass media campaigns can reduce sedentary behaviour and influence sexual health-related behaviours and treatment-seeking behaviours (e.g. use of smoking quitlines and sexual health services). The impact on tobacco use and physical activity was mixed, there was limited evidence of impact on alcohol use and there was no impact on illicit drug behaviours. Mass media campaigns were found to increase knowledge and awareness across several topics, and to influence intentions regarding physical activity and smoking. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. The evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.

Limitations

Statistical synthesis was not possible owing to considerable heterogeneity across reviews and studies. The focus on review-level evidence limited our ability to examine intervention characteristics in detail.

Conclusions

Overall, the evidence is mixed but suggests that (1) campaigns can reduce sedentary behaviour, improve sexual health and contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective.

Future work

Future work could fill evidence gaps regarding diet mass media campaigns and new-media campaigns, examine cost-effectiveness in areas other than tobacco and explore the specific contribution of mass media campaigns to multicomponent interventions and how local, regional and national campaigns can work together.

Study registration

This study is registered as PROSPERO CRD42015029205 and PROSPERO CRD42017054999.

Funding

The National Institute for Health Research Public Health Research programme.

A data-driven allocation tool for in-kind resources distributed by a state health department

OBJECTIVE

The objective of this study was to leverage a state health department's operational data to allocate in-kind resources (children's car seats) to counties, with the proposition that need-based allocation could ultimately improve public health outcomes.

METHODS

This study used a retrospective analysis of administrative data on car seats distributed to counties statewide by the Georgia Department of Public Health and development of a need-based allocation tool (presented as interactive supplemental digital content, adaptable to other types of in-kind public health resources) that relies on current county-level injury and sociodemographic data.

RESULTS

Car seat allocation using public health data and a need-based formula resulted in substantially different recommended allocations to individual counties compared to historic distribution.

CONCLUSIONS

Results indicate that making an in-kind public health resource like car seats universally available results in a less equitable distribution of that resource compared to deliberate allocation according to public health need. Public health agencies can use local data to allocate in-kind resources consistent with health objectives; that is, in a manner offering the greatest potential health impact. Future analysis can determine whether the change to a more equitable allocation of resources is also more efficient, resulting in measurably improved public health outcomes.

Mass media health communication campaigns combined with health-related product distribution: a community guide systematic review

CONTEXT

Health communication campaigns including mass media and health-related product distribution have been used to reduce mortality and morbidity through behavior change. The intervention is defined as having two core components reflecting two social marketing principles: (1) promoting behavior change through multiple communication channels, one being mass media, and (2) distributing a free or reduced-price product that facilitates adoption and maintenance of healthy behavior change, sustains cessation of harmful behaviors, or protects against behavior-related disease or injury.

EVIDENCE ACQUISITION

Using methods previously developed for the Community Guide, a systematic review (search period, January 1980-December 2009) was conducted to evaluate the effectiveness of health communication campaigns that use multiple channels, including mass media, and distribute health-related products. The primary outcome of interest was use of distributed health-related products.

EVIDENCE SYNTHESIS

Twenty-two studies that met Community Guide quality criteria were analyzed in 2010. Most studies showed favorable behavior change effects on health-related product use (a median increase of 8.4 percentage points). By product category, median increases in desired behaviors ranged from 4.0 percentage points for condom promotion and distribution campaigns to 10.0 percentage points for smoking-cessation campaigns.

CONCLUSIONS

Health communication campaigns that combine mass media and other communication channels with distribution of free or reduced-price health-related products are effective in improving healthy behaviors. This intervention is expected to be applicable across U.S. demographic groups, with appropriate population targeting. The ability to draw more specific conclusions about other important social marketing practices is constrained by limited reporting of intervention components and characteristics.