Sunday, January 5, 2014

Why the Infect Me Not Campaign is Ineffective and how it can be Improved---ZM

            The Infect Me Not campaign was an initiative of the San Francisco Department of Public Health’s division of Communicable Disease Control and Prevention. This campaign aimed to improve the health and wellbeing of San Francisco residents by introducing healthy habits that could help reduce the spread of infectious diseases. The campaign was implemented in the fall of 2008 as a response to public concern that citizens felt threatened by germs and wished other people would better keep their germs to themselves. The operation had a twofold aim to educate residents about infectious diseases and germs and to encourage healthy habits to protect people from these diseases. They highlighted eight healthy habits: wash hands often, clean and disinfect, cough and sneeze into your sleeve, handle and prepare food safely, get vaccinated, don’t share personal items, stay home when sick and avoid touching wild animals. The organization used print, audio and visual materials to deliver their message including brochures, posters, reference materials, songs and videos. Interestingly, the three videos made were humorous and the song was the winner from a contest where local songwriters competed to create the best catchy song to teach others about good health habits. To reach the public, various methods were employed: public service advertisements launched on the public train and bus systems (BART, MUNI), radio, newspaper, television stations and written materials were shared at street fairs, community meetings, health care clinics, trainings, and other venues throughout the city. (1)
            Three critiques of the program are the predominant use of reason explained by some traditional health models, fear and the use of framing theory and humor with the unsuccessful use of advertising theory.
Critique Argument 1
            This program’s aim is to educate and inform San Franciscans about germs and healthy habits. The proponents of this program believe that humans are rational and reasonable creatures. That by informing them of the hazards and dangers of their behaviors, man will see sense. Furthermore, that if a person knows the health risks involved with their behavior, they will immediately correct their behavior to forestall those health risks. For example, the campaign website lists these concerns:
· Some viruses and bacteria can live 20 minutes, 2 hours, or longer on surfaces like cafeteria tables, doorknobs, and desks.
· Hand washing greatly reduces the transmission of many common infectious diseases that affect the respiratory system (flu, or cold) and gastrointestinal system.
· 20% of people do not wash their hands.
· Over 22 million school days are lost every year due to the common cold.
· Employees who go to work sick, risk infecting their co-workers and may be less productive.
· 47% of people feel angry or annoyed when a co-worker comes to work sick with the flu. (1)
These bullets show how many germs and thus diseases can spread by not washing hands and how people feel about that. The logical progression of these facts demonstrates that a person would rationally realize the health risk of germs and viruses and logically want to change his habits.
            This belief stems from some of the traditional health behavior models. Firstly, the Health Belief Model attempts to explain and predict health-related behaviors by suggesting that that people's beliefs about health problems, perceived benefits of action and barriers to action explain the engagement or lack of it in positive health behavior(2). The campaign touted the influenza and potential pandemic flu to increase the perceived seriousness among people. Furthermore, the program also increased the people’s perceived susceptibility by enumerating that contact with germs is out of one’s control and is largely dependent on the behaviors of others. Hence, people think that they are more at risk because environmental circumstances are out of their control. The campaign targets the combined perceived threat and also the perceived benefit by augmenting the fact that washing hands will decrease disease dramatically. However, they fail to take into account the perceived barrier, that a person will see hand washing as an added inconvenience that he must factor into his decision of changing his behavior towards a positive health outcome. (3) In view of that, according to the Theory of Reasoned Action, if people evaluate suggested behavior as positive and if they think their significant others want them to perform the behavior (subjective norm), this results in a higher intention (motivations) and they are more likely to do that behavior (4). Believing that people act rationally for some behaviors especially deeply ingrained ones is a flawed (9).
            Relying on these health models is unsound because it does not take into account habitual health behaviors such as a person who never washes their hands. Furthermore, the model excludes potential environmental factors that are outside an individual's control that may prevent engagement in the desired behavior (2).  For instance, one might not be able to access vaccinations or afford to take a sick day.  Thus, one critique of the Infect Me Not campaign is the use of the Health Belief Model and Theory of Reasoned Action which say that people are rational creatures and if they know the perceived threats and benefits they will modulate their behavior appropriately to affect positive change in their health outcome. These models do not take into account various factors such as human irrationality, emotion and environmental factors. Therefore, inundating the public with information about how harmful infectious diseases are and giving them behaviors to combat those maladies will not work.
Critique 2
            The approach of this campaign is weak. The use of pamphlets, brochures, print ads on buses and trains coupled with them mainly outlining only steps to healthy habits is not effective. The way of disseminating information is not geared towards having a lasting impression. Cues such as a public service announcement on television or on a billboard may be fleeting and individuals may not be aware of their significance in prompting them to engage in a health-related behavior (5). The more serious the concern the more lasting the impression must be to an individual, and with the proliferations of ads everywhere, a salient message is hard to convey via a poster on a transitory medium.  
Furthermore, the ads that depict the steps to healthier habits frame the issue ineffectively. A” Stay at Home when Sick” poster depicts a coworker sneezing in an elevator as other workers cringe away in disgust. In big block letters the posters declares, “Considerate coworker or office outcast?” (1) This advertisement portrays feelings of fear and alienation that if one comes to work sick they will be pushed out as an outcast. Additionally, the “Get Vaccinated” poster shows a couple sitting on a sofa with gas masks on and the blurb states, “There are easier ways to protect yourself”. (1) There is a strong element of fear radiating from these posters and one can see that the aim of the campaign was to scare the citizens into getting vaccinated so as to avoid the potential sickness the couple is trying to avoid by going so far as to wear gas masks. Moreover, the campaign name itself, “Infect Me Not” has an undercurrent of fear running through its message, a command of sorts to not dare infect someone. The campaign has framed its message primarily with the element of fear.
            A key component of Framing Theory is that, “Framing involves more than a message; knowing what change will advance public health interests comes first, followed by a clear analysis of what it will take to make the change happen” (6). Therefore, framing theory suggests to target the audience and discern what message will effectively and lastingly impact them the most. This campaign targets children and adults in all walks of life, perhaps those that are less educated, that do not already know about healthy habits.  Additionally, Researchers have found that framing decision problems in a positive light generally results in less-risky choices; with negative framing of problems, riskier choices tend to result (7). Hence, using the negative frame of fear towards the general public which includes children, adolescents and adults is in a way, urging riskier choices. Thus, the second critique of this program is that framing the entire campaign name and subsequent crucial messages with the theme of fear is ineffective and not a targeted approach to the key audience.
Critique 3
            The third critique is the campaigns use of humorous videos, songs and posters to market their message by ineffectively using Advertising Theory. For instance a poster depicting just hands holding on to handholds on the bus states, “Public transportation is so, well, public- wash your hands often” (1). The diction used has trace amounts of humor; a kind of obviousness is imbibed in the sentence. In addition, three videos part of the campaign are titled, “Cover Your Cough & Sneeze”, “Wash Your Hands”, and “Stay Home Sick” (1). They are publicized as being thirty second humor breaks and funny videos to see bad habits in action. Furthermore, the campaign had a songwriting contest where local songwriters had to create a song about coughing and sneezing into your sleeve. The lyrics of the first place winner are as follows:
Cough and Sneeze, only in your sleeve (4x)
Don't cough in your hand or
Put it in the Air
Cough in your Sleeve
and we know that you care.
You got germs,
Just like any other
So don't your cough upon
Your sister or brother
Now when you sneeze
you know I really wish you'd
Use your sleeve or
Get a tissue
Don't be cranky,
use a hanky
Yes I'm talking to you mister,
Don't sneeze upon your sister!
The tune is catchy and childish. Overall, the jingle is too flippant to be taken seriously. That is the problem with these marketing techniques, the use of humorous and light-hearted songs, videos, witticisms and contests, although clever do not allow for the message to be digested seriously.
            This is evidenced with Advertising Theory in that it enumerates the strategy that the organization that is selling the product must convince the target audience that the desired belief supports the key message or brand the company is trying to sell (8). The message must be profound and hard hitting to really ring true with the consumer. Therefore, humor and flippancy is not emotionally gripping enough to reign in the public towards the key message. Furthermore, the campaign used mainly facts, fear-inducing pictures and frivolous media as support for their main campaign message. This support is ineffective because it does not affect the public’s core values and therefore the message does not sit with them.
            The Infect Me Not campaign uses the Health Belief Model and Theory of Reasoned Action Model ineffectively because people are not rational and they will not avoid risk because they now know the cause of illness or because it is the rational thing to do. Furthermore, the campaign using Framing Theory frames its campaign name among other messages by using fear as the overarching element- this is also ineffective because a negative emotion can inspire the undertaking of negative risks. Lastly, the program uses Advertising Theory failingly because the humor and frivolity felt in the message does not account for a legitimate profound idea that the audience can believe and rally behind.  The three critiques of the program are the overarching use of reason explained by some traditional health models, fear and the use of Framing Theory and humor with the unsuccessful use of Advertising Theory.
The proposed intervention would refocus and repurpose the materials used in the campaign. Money and resources put into the print media including the posters and brochures would be funneled into videos and television ads because they leave a more lasting emotional impact on the audience and one can tell a story with videos. The posters on trains and buses are surrounded by so many other advertisements on the street that they all blur into background noise when one is focused on getting from point A to point B. Thus, the bus and train ad resources would be better utilized in a video ad that would play on TV or on online mediums such as ad spots on Hulu or YouTube.
As an answer to the rational response to health risk critique, the use of Psychological Reactance Theory would turn around that feeling of fear and lack of control with regards to germs and make it seem like there is no loss of freedom when one gets infected. This would occur by conveying a message through a video ad on how to control germs and not let them control you when you get sick.
The proposed intervention for the fear frame would be to flip the frame and using the same Framing Theory, target resounding core values such as hope, family and stability. This can be accomplished by changing the entire narrative of the campaign, starting with the website and existing print materials. All negative ideas, imagery and emotions would be removed and replaced with positive messages related to the core values.
The humorous and frivolous advertisements that left no real impact would be revolutionized to emotional and gripping stories that everyone could relate to and that would strike a chord with the masses. These stories would be told via video advertisements that would air where and when the biggest target population could view them, as much as the budget can allow. The stories themselves would be the support for the key message that would be then seriously felt, heard and understood.
The intervention overall would appeal to the citizens emotions rather than mind. Their heart would get involved and therefore the message to have healthier habits and therefore reduce the transmission of infectious disease would resonate and stick with them more because positive emotion is associated with positive habits.
Defense of Intervention 1
            This campaign was started mainly as a response to the public’s fear and concern of how germs were unmanageable and out of their control.  The theory of Psychological Reactance can be used as a way to bring back some control to the public. The campaign used the Health Belief Model coupled with the Theory of Reasoned of Action to show that believing that a person will see the uncontrollable threat of germs to his health and act rationally and reasonably to correct the behavior that may cause that threat is incorrect. The entire premise of Dan Ariely’s book, Predictably Irrational: The Hidden Forces That Shape Our Decisions is that humans act irrationally in a manner that is predictable (9). Therefore this irrationality merged with the predictable pattern outlined by the concept of psychological reactance is the basis for the proposed intervention with regards to this critique.
            Psychological reactance occurs in response to threats to perceived behavioral freedoms. The fear of loss of freedoms can spark this arousal and motivate people to re-establish the threatened freedom. (10) This can be applied to the loss of control one feels when someone sneezes or coughs on you or the timing of when sickness befalls you. This theory also works as a defense in another facet. The campaign outlines steps you should take and its name also is a command, Infect Me Not! When a person is told to do something, he feels a loss of control and a loss of freedom and therefore wants to do the exact opposite to make sure that the freedom remains (10).
            Hence, a video that sends the message to not let germs control you but to control those germs instead would give people the sense of control they believe is slipping away. Therefore, with these healthy habits modeled in a way that depicts a battle between them and humans, with humans winning and successfully controlling these microbes, would be effective. The threat of a freedom being taken away would be absent because the message would be about giving control, regarding the germ problem, back to the public. Also, because the public wants this control and the ensuing freedom, there would be no psychological reactance towards this because no perceived freedom was being taken away, and therefore the public would follow the guidelines. Psychological Reactance Theory and the predictable irrationality of people illustrate that to get people to act rationally, one must flip the story and make it about winning a battle for control rather than bettering health. This will be effective in ensuring the lasting impact of the campaign’s message.
Defense of Intervention 2
            The campaign uses fear as the primary frame. An intervention recommendation is to still use Framing Theory, but to flip the frame and make the conversation about core values that resound with the human heart. Nelson states that, "frames influence opinions by stressing specific values, facts, and other considerations, endowing them with greater apparent relevance to the issue than they might appear to have under an alternative frame” (11). Therefore, the campaign should stress the strong specific values of hope, stability and family. The campaign should also remove all negative images and sayings from the campaign materials and website. A cohesive message should be apparent.
            The mind does not like to work more than it has to and the reason framing is effective is because if a frame is tied to a core value that is cherished, then whatever the organization is trying to promote will be cherished through association. (12) Thus, the values of hope, stability and family can be illustrated by changing the entire theme of the campaign from Infect Me Not to “Infection Prevention and the Hope for a Better Tomorrow”. In addition, the entire website can be changed to include statements and illustrations of how controlling infection by controlling one’s habits can build a better future for the next generation due to fewer infections and thus fewer microbe and antibiotic resistance issues. This message weaves in hope and the simultaneous stability of the family in the future. This approach directly addresses the critique in that a fear frame is switched to a frame with values that have a greater long lasting impact on an individual.
Defense of Intervention 3
            The humorous videos, songs and posters used in this campaign lacked real impact and would not be taken seriously. Advertising Theory can remediate this by telling a story. The real power in delivering a message is in the story told. In advertising, the advertisement should contain among other things the brand character which is the image created for the product, the focus of the sale which includes the promise and the tone which is the finished feel of the ad (13). Therefore, the proposed intervention would be a video that has elements of emotion conveyed through heartfelt stories.
            The video should not be more than two minutes because in today’s rampant media consumption culture, no one is going to want to watch anything longer. Furthermore, it should use rich visuals and high definition because grainy cheap shots are not appreciated. (14) The stories themselves can be varied however they must have the core components of stating a promise and supporting this promise with anecdotal evidence. The story preferably need not have to do anything with health.  As long as it backs up a powerful promise that is unrelated to the product/idea, it will succeed because people will associate that promise with the product. (13)
            For instance, a proposed video could be about a long estranged family member finally coming home and embracing his beloved family members. This image of reconciliation, hope, love, with a bit of longing and moreover the feelings themselves will tug on the heartstrings of the masses and they will remember and associate those feelings with the brand of the company. This addresses the critique of having frivolous humorous ads that do not affect any change directly in that this video ad that relates a story with deep emotion makes a promise related to the brand. That if one partakes in the company’s message one will have that promise come true. In the example above one can say that if one performs healthy habits and is conscious of infectious disease transmission then he will have a whole and stable family just like the family in the video. This video because of its strong emotion will be taken seriously and that can affect real change.
            The Infect Me Not campaign aimed to improve the health and wellbeing of San Francisco residents by introducing healthy habits that can help reduce the spread of infectious diseases. Three critiques of the program are the overarching use of reason explained by some traditional health models, fear and the use of Framing Theory and humor with the unsuccessful use of Advertising Theory.  The interventions would revitalize the narrative by using: Psychological Reactance to allow people to have perceived control over microbes and disease, Framing Theory to turn the fear frames into hope, stability and family frames and Advertising Theory to tell a powerful story infused with emotion.
            The intervention would appeal to the citizen’s emotions rather than mind. Their heart would get involved and so the message to have healthier habits and therefore reduce the transmission of infectious disease would resonate and stick with them; in turn increasing the health and well-being of the populace.
1.San Francisco Department of Public Health. Infect Me Not Campaign. San Francisco, CA, 2008.
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