Multicultural Campaigns

Multicultural Campaigns

significantly better than no treatment. Interventions with booster sessions (a follow-up phone call or a meeting at a later date) have stronger effects. For tobacco use, MI was more effective than no intervention; however, findings were mixed between two meta-analyses as to whether MI may be more effective. For nonaddictive behaviors such as reducing risky behaviors (e.g., condom use) and increasing healthy behaviors (e.g., exercise), MI is a promising new approach; however, more research is needed to establish its efficacy. MI has been used with limited success among adolescents and specific racial and ethnic populations. MI generally takes less treatment time than other interventions; therefore, it is a cost-effective alternative to traditional health intervention formats. However, training costs may be higher, as it requires that counselors receive extensive training. Given that MI does not impart knowledge and skills, those counselors trained as health educators may have difficulty adhering to MI principles and techniques. For example, if a participant states, “Everyone has six or seven drinks when they go out. It’s pretty normal, and as long as you can stand up, you’re not really drunk,” an appropriate, MI-adherent counselor response would be, “All of your friends drink six or seven drinks whenever you go out.” Using MI-adherent statements are often difficult for health educators to use, as they may, at the surface, seem like they condone the problematic behavior. However, an MI-adherent, supportive statement moves the conversation forward to explore a participant’s ambivalence around positive behavior change. As it can be adapted to treat a variety of health behaviors, MI is growing in popularity. Health communication scholars may be especially interested in how MI uses specific principles and methods that are expressed through counselor language to support discussion between counselors and participants to help participants move beyond ambivalence toward positive behavior change. Generally, MI is considered equivalent to other health interventions, however more research is needed to fully understand the mechanisms that underlie motivational success. Laura Min Mercer Kollar Jennifer L. Monahan University of Georgia

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See Also: Adolescent Substance Abuse Prevention; Change Approaches, Transtheoretical and Stages of; Drug and Alcohol Abuse Minimization; Interviewing in the Health Care Context. Further Readings Amrhein, Paul C. “How Does Motivational Interviewing Work? What Client Talk Reveals.” Journal of Cognitive Psychotherapy, v.18/4 (2004). Lundahl, Brad W., Chelsea Kunz, Cynthia Brownell, Derrik Tollefson, and Brian L. Burke. “A MetaAnalysis of Motivational Interviewing: TwentyFive Years of Empirical Studies.” Research on Social Work Practice, v.20/2 (2010). Miller, William R. “Motivational Interviewing With Problem Drinkers.” Behavioural Psychotherapy, v.11/2 (1983). Miller, William R. and Stephen Rollnick. Motivational Interviewing: Helping People Change. 3rd ed. New York: Guilford Press, 2013. Moyers, Theresa B. and Tim Martin. “Therapist Influence on Client Language During Motivational Interviewing Sessions.” Journal of Substance Abuse Treatment, v.30/3 (2006).

Multicultural Campaigns Communication campaigns are not new to the health field. Some of the first mass media health campaigns took place in the 1700s with the smallpox epidemic and later in the 1800s with the promotion of healthy eating. Grand-scale research on mass populations, public health, and social marketing campaigns have all garnered important space in the health communication literature. While the health campaign literature is rich with large-scale mass media, community-based, and social marketing campaigns, there are also formative bodies of research and theory to advance multicultural campaigns. Cultural awareness, competency, and information dissemination are important factors in a multicultural campaign. Overview Campaigns generate specific outcomes and effects by targeting a large number of individuals at specific times while using an ordered set

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of communication strategies. Multicultural campaigns have the same objective; however, their primary goal is to reach a culturally diverse audience with specific attention to various ethnic groups. Moreover, multicultural campaigns seek to create culturally sensitive messages that highlight specific health disparities among historically marginalized and high-risk groups. Careful attention to smaller population groups and communities with message construction and dissemination nuanced for racial and ethnic group’s subgroups is crucial. These groups include recent immigrants, members of marginalized cultures such as American Indians, non-English-speaking minorities such as Asians and Latinos, high-risk subcultures such as the homeless or low-income youths, and different subgroups such as African American or Native Indian women or elderly Latino males. As communities become increasingly more ethnically, nationally, and racially diverse, campaigns that reflect their unique cultures and values generate behavior modification and changes. Successful multicultural campaigns are typically community based and factor in the target audience’s attitudes and perceptions of the health and health disparities. In addition, campaigns that have the most success incorporate formative research and health behavior theories. By using the best principles of marketing and communication, multicultural campaigns seek to deliver important messages about building healthy behavior at different life stages. Formative Research and Theoretical Objectives Successful campaigns incorporate formative and/ or exploratory research to best articulate campaign attributes and important characteristics of ethnic and racial groups. Formative evaluation, whereby researchers conduct focus groups, qualitative interviews, or survey data collection, can provide a clear understanding of the health issues and “problem areas” in multicultural populations. This is paramount particularly in settings in which little prior research or direct knowledge exists. Additionally, formative research elevates barriers and communication issues that might not have normally emerged. Most importantly, formative evaluation allows researchers to build rapport in the community and establish key stakeholders. Trust is a critical and important aspect

when conducting formative research. Researchers who invest in the well-being of the community and conduct ethically grounded research garner respect within that community. This can result in rich findings and leave individuals and community members empowered and educated. It can also result in long-term benefits and future partnerships. Multicultural campaigns that use exchange theories and behavioral theories advance health promotion and behavior changes on an individual, community, and societal levels. The application of a theoretical framework should be executed with the assumption that messages reflecting the specified cultures’ values can have greater potential for implementation and behavior modification and change. Cultural Awareness, Competency, and Information Dissemination Cultural awareness and competency is a key factor in the implementation of a successful multicultural campaign. Researchers must acknowledge the cultural beliefs and values of individuals from distinct cultures. Numerous scholars have stressed that researchers who conduct multicultural campaigns must take into account past experiences, cultural beliefs, and norms while concurrently honoring cultural uniqueness. From a research perspective, this knowledge can drastically alter the way individuals process information and make decisions about health behaviors. Social science research can account for discrepancies and poor treatment in minority and lowincome communities. This has resulted in ongoing misperception about research goals and objectives among people of color. For example, encouraging communities of color to participate in clinical trials has been a difficult endeavor. Unfortunately, years of mistrust toward scientific and academic institutions have left communities of color on the outside of important research. Reframing relationships that typically translate as unwelcome nuisances can transpire through awareness and cross-cultural development. Powerful dissemination of information can transpire in communities when researchers use community segmentation to reach target audiences. Multicultural campaigns have been used to address obesity, smoking, breast cancer, organ



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donation, sexually transmitted infection, and drug and alcohol use. Within these campaigns, segments can fall into categories of race, gender, age group, and behavioral characteristic. For example, understanding the increases in pregnancy rates among Hispanic adolescent girls or using print media to target older populations and Internet-based campaigns to target young adults can be useful in message design and information dissemination. Notable Multicultural Campaigns Well-executed campaigns can promote behavior change and influence health knowledge. The following is a selection of distinct theory-driven campaigns that have used formative research and engaged multicultural communities. The national multicultural campaign VERB, launched by the U.S. Centers for Disease Control and Prevention (CDC), promoted healthy lifestyles among tweens. It segmented target population by age and parents/influencers prior to conducting research. Next, it identified important differences among specific segments within the tween audience on the basis of activity level, receptivity to physical activity, ethnicity, and gender. The process of segmenting the target market helped increase the program’s effectiveness and efficiency. It also served to address distinct needs, fostering appropriate resource allocation decisions. A primary objective of the campaign was to use interactive media, promote positive physical activities, and reach a multicultural youth population. The Yuonihan Project, a five-year CDC-funded multicultural campaign, addressed fetal alcohol spectrum disorder (FASD) among American Indian communities in the Northern Plains. The overall objective was to help the community understand FASD, address prevention, and disseminate information. A series of community-led focus groups with female tribal members of different ages were conducted prior to any campaign development. The campaigns, which included posters, radio ads, brochures, and other materials, used traditional language and images. Surveys were used to evaluate the campaign. Female participants rated the outcome as cultural appropriate in that it increased knowledge and decreased actual drinking.

The “Take Charge. Take the Test” social marketing campaign uses print and broadcast media, billboards, the Internet, and other channels to encourage African American women to get tested for HIV. Well-executed multicultural campaigns can promote behavior change and influence health knowledge.

The Hombres Sanos (Healthy Men) campaign used formative research guided by the behavioral ecological model to respond to the increasing need for culturally and socially acceptable HIV prevention among heterosexually identified Latino men who have sex with men and women (MSMW) in North San Diego County, California. Materials that appealed to Latino cultural norms were developed to change social norms related to condom use and promote HIV/STI testing. Posters and photographs with evocative Spanish-language captions about risk behaviors were placed in community venues and local clubs. The results of the intervention had a positive outcome for


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Multilevel Interventions

both heterosexually identified Latino MSMW and men who have sex with women (MSW). Additionally, the campaign resulted in a significant reduction in sexual risk practices of MSMW with female partners. Quit Today! is a targeted communication campaign to increase use of the Cancer Information Service (CIS) by African American smokers. Traditionally, African Americans have made little use of the CIS, an information and education program of the National Cancer Institute for smoking cessation assistance. This study evaluated whether a targeted communication campaign utilizing strategically placed radio and television advertisements in combination with community outreach could lead more adult African American smokers to call the CIS for smoking cessation information and materials. The CDC developed the African American Women and Mass Media (AAMM) pilot campaign. This multicultural campaign used black radio, radio stations, and print media to increase early breast cancer awareness and screening among more African American women. Historically, black radio has had a large African American listenership. This unique medium offers a relevant platform for targeting culturally competent health promotion and outreach to low-income, African American women. Guided by the Witte’s persuasive health messages (PHM) framework, which combines three prominent persuasion theories, focus group findings were used to create campaign material for radio and print in two Georgia communities. Evaluation of the AAMM campaign found that the campaign successfully reached its target audience of low-income, African American women and increased women’s awareness of breast cancer screening services through the Breast and Cervical Cancer Program in Savannah and Macon, Georgia. Conclusion Multicultural campaigns are valuable for unraveling culturally specific health issues. Although multicultural research is in a formative stage, the creative application of health behavior theories, relevant methodology, and segmentation to explore and describe phenomena among ethnic/ racial populations is critical. Culture is complex and multilayered. Given the changing demographic

profile in our society, scholars must become savvy as they work to address different health disparities using culturally relevant campaigns. Angela Cooke-Jackson Emerson College See Also: Campaign Effects Versus Effectiveness; Developing Countries, Campaigns in; Cultural Differences; Cultural Sensitivity; Culture-Centered Approaches; Social Marketing. Further Readings Backer, T. E., E. M. Rogers, and P. Sopory. Designing Health Communication Campaigns: What Works. Thousand Oaks, CA: Sage, 1992. Kar, S. B. and R. Alcalay. Health Communication: A Multicultural Perspective. London: Sage, 2001. Kreps, G. and E. N. Kunimoto. Effective Communication in Multicultural Health Settings. London: Sage, 1994. Noar, S. M. An Audience-Channel-MessageEvaluation (ACME) Framework For Health Communication Campaigns. Health Promotion Practice, v.13/4 (2012). Rice, R. E. and C. K. Atkin. Public Communication Campaigns. London: Sage, 2001. Skloot, R. The Immortal Life of Henrietta Lacks. New York: Crown Publishing Group, 2010. Smith, S. Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890– 1950. Philadelphia: University of Pennsylvania Press, 1995.

Multilevel Interventions Interventions are intended to change behavior and sustain positive outcomes within a target audience. A multilevel intervention (MLI) is designed to target a specific audience on, within, and between two or more levels (e.g., individual, group, societal) to encourage and sustain behaviors. Because MLIs account for internal and external factors that influence human behavior, these interventions have the potential to more accurately depict real-life scenarios and provide a better understanding of individuals’ barriers to
