Are social marketing campaigns effective in preventing child abuse and neglect?

NCPC Issues No. 32 – October 2010

Characteristics of child maltreatment social marketing campaigns

One of the primary aims of this project was to determine the characteristics (including strengths and limitations) of social marketing campaigns targeting child maltreatment. The characteristics of the 21 social marketing campaigns identified are described and examined in terms of:

  • campaign type according to the public health model (primary, secondary, tertiary);
  • aim of the campaign (i.e. what does it aim to influence) (awareness, attitudes, knowledge, behaviour);
  • primary target audience;
  • stand-alone campaigns (narrow) or part of a broader community-level intervention (broad);
  • the media mix (television, print);
  • content - either positive messages (incentive appeals) and/or hard-hitting (threat appeals);
  • types of evaluation identified (formative, pilot, process, impact and outcome, see Box 1 for definitions);
  • duration of the campaign;
  • funding (government, not-for-profit organisation etc); and
  • paid and/or community (i.e., unpaid) advertising.

For a brief description of each individual campaign see Table 3 (Australian campaigns) and Table 4 (International campaigns).

Table 3. Australian social marketing campaigns related to child maltreatment
Campaign

(year of campaign)

Topic Type Aims to influence Key message Primary audience Strategy Media mix Content style Evaluation type Duration Funding Advertising
NEWPIN parenting campaign (n. d.) Parent support Secondary Attitude Behaviour It is ok for parents to get help. Parents Broad TV, print media Positive message None Not stated NGOs - originally established by UnitingCare Burnside Community advertising
Families (Part of Triple-P trial) (n. d.) Positive parenting Primary Awareness Behaviour Teach parents positive parenting strategies. Parents Broad TV Positive message Pilot testing 12-episode television series over 6 weeks1 Not stated Not stated
It's Not OK to Shake Babies (1994)2 Child abuse prevention Primary, secondary & tertiary Knowledge Behaviour Shaking babies is dangerous and can cause brain damage or death. Parents Broad TV, radio, cinema, Hard-hitting Pilot testing Impact evaluation 3 months Government Paid advertising
It's Got to Stop (1995) Impact of domestic violence on children Secondary & primary Awareness Attitudes Domestic violence is not love. Two TV commercials portrayed the impact on children. All adults Broad TV, radio, cinema, print media, phone helpline Hard-hitting & positive message mix Impact evaluation 12 months3 Government Not stated
NAPCAN child abuse prevention media campaigns independent evaluation (1994-2000)4 Child abuse prevention Secondary & primary Awareness Behaviour Overall message to promote effective care and protection of children, including a positive behaviour for adults or parents to seek help for a specific problem. Parents Narrow TV, radio, print media Hard-hitting & positive message mix Impact evaluation Various5 NGO Community advertising
Accentuate the Positive (1996) Positive parenting Primary Attitudes Behaviour Promoted positive parenting and normalised help-seeking. Models of positive parenting behaviours, e.g., "praise works wonders". Parents Broad TV, radio, print media, Internet, phone line, resources, community outreach Positive message Formative assessment Impact evaluation Outcome evaluation 2 years Government Paid advertising
Be Cool ... Not Cruel (1998-99) Effect of domestic violence on children & young people Tertiary & secondary Awareness Attitudes Domestic violence is not acceptable & help is available for children and young people who experience it at home. Children & young people (10-15 years) Broad TV, print media, information resources, posters, child-friendly consumables (e.g., stickers), phone helpline for children and parents Positive message Formative assessment Impact evaluation Not stated Government Paid advertising
Every Child Is Important (2000-04, national 2003-05) Child abuse prevention Primary Knowledge Attitude Behaviour Children are valuable and need safe, respectful, non-abusive relationships. Parents Broad TV, radio, print media, Internet, resources Positive message None Not stated Government, corporate and philanthropic sectors Community advertising
16 Days of Activism: Survivors of Child Sexual Assault (2002) Child sexual abuse Tertiary & primary Awareness Behaviour Child sexual abuse occurs in the community. People need to believe and support victims who disclose they have been abused. All adults Narrow Posters, postcards, bus adverts, some radio & newspaper attention Hard-hitting & positive message mix Formative assessment Process evaluation 16 days (bus advertising was visible for 30 days) NGO Community advertising
Child Abuse Hurts Us All (2004-05) Child abuse prevention Primary Knowledge Behaviour All adults have a responsibility to "play your part, protect our children". All adults Narrow TV, print media Hard-hitting None Not stated State government Paid advertising
Children See, Children Do (2006-07) Child-friendly communities Primary Attitudes Behaviour Adults are always modeling behaviour for children, so adults should have a positive influence Parents and other adults Narrow TV, cinema, Internet Hard-hitting None Not stated NGO Not stated
Stop Child Abuse Now (2008-09) Child abuse prevention & intervention Tertiary & primary Awareness Behaviour Messages of "child abusers are counting on you doing nothing", "stop doing nothing" and a list of 10 actions for adults to intervene and prevent abuse. All adults Narrow TV, radio, print media, posters, Internet, resources Hard-hitting None Not stated NGO Paid advertising

Notes:

1 Parents were provided with 12 videotapes of 20-30 minutes in duration, with a 5-7 minute Triple-P component. They were instructed to watch two of those videotapes in their own home each week.

2 The National Association for the Prevention of Child Abuse and Neglect (NAPCAN) "It's Not OK to Shake Babies" campaign was also included in the Key Young (2000) independent evaluation of NAPCAN media campaigns. However, the It's Not OK To Shake Babies campaign was separately evaluated in 1995. Therefore, the two publications represent two individual evaluations. Both the NAPCAN (1995) evaluation and Keys Young (2000) evaluation were each located in the Informit (Family and Society Plus) database. The Family and Society database is a bibliographic database that indexes and abstracts articles from published and unpublished material on research, policy and practice issues about, or of relevance to, Australian families from 1980 onwards.

3 This is the period of time during which three surveys were conducted in order to evaluate the campaign. The first survey was conducted before the launch of the campaign (October 1995) and the last surveys were conducted upon the cessation of the screening of the television advertisements. The date at which the media ceased to show the campaign advertisements is not recorded in the available publications.

4 There was a range of campaigns included in this evaluation. Six examples of these campaigns are included in the associated publication. It is not clear how many campaigns in total are included in the evaluation.

5 Two media campaigns in the examples provided include information about duration: the Use Words That Help, Not Hurt national community education campaign and the It's Not OK To Shake Babies campaign. The Use Words That Help, Not Hurt campaign was 3 months in duration. The It's Not OK To Shake Babies campaign was also 3 months in duration although on some television and radio stations the advertisements ran for 12 months.

Table 4. International social marketing campaigns related to child maltreatment
Campaign (year of campaign) Topic Type Aims to influence Key message Primary audience Strategy Media mix Content style Evaluation type Duration Funding Advertising
Some Secrets You Have to Talk About (1991) (Netherlands) Children's disclosure of abuse Tertiary Behaviour Message to children that abuse was not their fault, they were not alone and to tell someone. Victims (children & adolescents) Narrow TV, radio, print media, billboards, phone line, child & adult resources Positive message Formative assessment Impact evaluation Outcome evaluation 9 months Community fundraising Paid TV advertising, TV documentaries and radio. Free newspaper advertising.
Alcohol Abuse, Drug Abuse, Child Abuse, One Thing Leads To Another (1993-94) (US) Child maltreatment & parental substance abuse Tertiary & secondary Knowledge Behaviour Family members and friends of parents with substance abuse problems can engage in helpful behaviours to stop child abuse and neglect. Adults who know a parent with a substance problem Narrow TV, print media, billboards, posters, phone line Positive message Formative assessment Process evaluation Impact evaluation TV campaign went for a week, other forms of advertising lasted up to 10 months. Federal Government grant & NGO Paid TV advertising, newspaper/magazine advertising. Community billboards paid for by sponsors.
Stop It Now (1995-97) (US) Child sexual abuse Primary, secondary & tertiary Knowledge Attitude Behaviour Perpetrators and parents of young people with sexually abusive behaviours should seek help. Parents & perpetrators Broad TV, radio, print media, bus adverts, Internet, phone line, community outreach Hard-hitting Formative assessment Impact evaluation 2 years NGO Paid TV, radio and bus advertising
Breaking the Cycle (1995-2000) (NZ) Child abuse & early intervention Tertiary & secondary Awareness Knowledge Behaviour Appealing to parents that a "change in your behaviour can change the behaviour of your child and make your lives more enjoyable". Parents Broad TV, radio, print media, phone line, resources Hard-hitting Formative assessment Pilot testing Impact evaluation Not stated Government Paid TV advertising
It's OK to Talk About Incest (1998) (NZ) Child sexual abuse & incest Tertiary & primary Awareness Behaviour Incest is a social problem in New Zealand and encouraged victims to get support. Victims Narrow Posters, print media, unpaid media exposure, phone line Hard-hitting None One week Government Not stated
Darkness to Light (2001-08) (US) Child sexual abuse Secondary & primary Knowledge Behaviour Messages on talking to children about sexual abuse, prevalence, consequences of child sexual abuse and how to get more information. Parents & adults in contact with children Narrow TV, resources, Internet Hard-hitting Pilot testing Not stated NGO Not stated
Triple-P Parenting Population Trial - included a mass media component (2003-09) (US)1 Positive parenting Secondary & primary Knowledge Behaviour Positive parenting is an effective parenting strategy and it is normal for parents to seek support. Parents Broad Radio, print media, household mail, community events, Internet Positive message Impact evaluation Outcome evaluation 2 years Not stated Community advertising
It's Not OK (2007-08) (NZ) Family violence Secondary & primary Awareness Attitudes Behaviour "It's not OK... but it is ok to ask for help" about family violence. Perpetrators of family violence (fathers) Broad TV, media advocacy, print resources, website, information helpline, community projects Positive message Formative assessment Impact evaluation Not stated2 Government Not stated
Domestic Abuse - There's No Excuse, wave 11: Domestic Abuse Effects Children Too (2007-08) (Scotland) Domestic violence & effects on children Primary Awareness Attitudes Behaviour Domestic violence effects children too. General public & mothers Broad TV, radio, billboard posters, public relations activity Positive message Impact evaluation Outcome evaluation 1 month Government Not stated

Notes:

1 The Triple-P program was developed in Australian and then adapted for an overseas audience.

2 Funding for the It's Not OK campaign was originally projected to 2011, however at the end of 2009 funding for the final round of the campaign ceased. It is not clear from the available documents when the campaign ceased (it began in September 2007).

Campaign classification according to the public health approach

The majority (16/21) of the social marketing campaigns identified were classified as taking a primary intervention approach, either specifically or in combination with a secondary and/or tertiary approach. For example, the Children See, Children Do campaign (2006-2007) in Australia carried the message that all adults are modelling behaviour to children all the time, and encouraged all adults to consider their behaviour and make their influence on children positive.

Campaigns that had a secondary intervention component (10/21) usually included additional tertiary and/or primary approaches. The secondary approach was most frequently used to appeal to parents to seek support when they were experiencing difficulties that had not yet reached a threshold for statutory child protection intervention. For example, the Triple-P parenting population trial (2003-2009) in the United States involved a mass-media campaign to promote positive parenting, de-stigmatise help-seeking and to recruit parents to participate in a Triple-P program to improve parenting capacity (Prinz & Sanders, 2007; Prinz, Sanders, Shapiro, Whitaker, & Lutzker, 2009). The various levels of the program engaged parents according to the severity of their problems. Campaigns, like the Triple-P mass-media campaign, constitute a secondary intervention because they offer a way to encourage parents to recognise when they need support and to seek support services before problems escalate to a level of severity requiring statutory intervention.

Nine of the 21 campaigns included a component that could be classified as a tertiary level intervention. Tertiary interventions intended to reach families in which child maltreatment was occurring. For instance the Stop It Now campaign (1995-1997) in Vermont (USA) aimed to appeal to perpetrators of child sexual abuse to seek help. The campaign promoted a confidential helpline and referral to treatment services.

Aim of the campaign

Almost half (10/21) of the child maltreatment social marketing campaigns stipulated that generating awareness among the general community about child abuse or parenting issues was a specific aim. A smaller sub-set of campaigns aimed to change attitudes (9/21) and to increase knowledge (8/21).

As the fundamental goal of social marketing is behaviour change (Andreasen, 2003) it is perhaps not surprising that the most prevalent aim of the campaigns was behaviour change: 19/21 campaigns intended to generate a specific behaviour related to the theme of child maltreatment prevention. Of those campaigns that sought to bring about a change in behaviour some clearly aimed to stop end-behaviour, that is, stop or prevent maltreatment itself (e.g., don't shake babies), others aimed to bring about a change in intermediate behaviour, that is, behaviours that can indirectly influence the incidence of child maltreatment (e.g., teaching positive parenting strategies) and some aimed to influence both intermediate and end behaviours.

Overall help-seeking behaviour was the most common desired action across the campaigns, such as motivating fathers who perpetrate family violence to make contact with a phone helpline service or website (e.g., It's Not OK, New Zealand). Evidence for the effect of campaigns that aim to promote behaviour change is examined further in relation to impact evaluations in section 3 of this NCPC Issues paper.

Primary target audience

The most common primary target audience of child maltreatment social marketing campaigns was "parents" in general (13/21), however one of these campaigns specifically targeted fathers and another specifically targeted mothers. Secondary audiences (not specified in the tabular descriptions above) were targeted at the whole of a community (all adults). Mass media is useful in this sense because it has a wide reach and thereby can communicate with a broad range of people, not just a specific target group (Saunders & Goddard, 2002). It is appropriate that campaigns would seek to appeal to parents given that they have primary responsibility for ensuring the care and protection of their children, however there is limited evidence for campaign messages specifically designed to make protecting children everyone's responsibility.

Only two campaigns were designed to primarily address children and young people. One Australian campaign, the Be Cool...Not Cruel campaign (1998-1999, Northern Territory), aimed to increase awareness amongst children and young people that domestic violence is a problem and that there is help available if they are experiencing domestic violence at home. This campaign included children and young people in the design process thereby potentially strengthening the message of the campaign. This occurred despite some opposition from adults who expressed concern children would "dob in a parent", undermining "their right to have arguments and discipline children" (Rudd & Jacob, 2000, p. 8).

Campaign strategy

Almost half of the campaigns identified (9/21) were implemented along with broader community-level strategies, such as activities that build community capacity or the provision of practical support. Some theorists have argued the social marketing campaigns will be more likely to bring about population-wide changes when coupled with broader community-level strategies (Donovan & Henley, 2003; Siegel & Doner, 1998). It is important to take into account however that a campaign that is implemented along with a broader community-level strategy is likely to require more intensive resources (e.g., time and funding), than a campaign that does not. Not all social marketing campaigns will have the resources available to implement a community-level strategy.

Of the nine campaigns that were implemented along with a broader community-level strategy, the two most common community-level approaches linked the campaign to either government social policy or activities that build community capacity. Three campaigns demonstrated these approaches:

  • The Domestic Abuse - There's No Excuse campaign in Scotland has been implemented over 12 waves to date as part of their anti-domestic violence policy. This demonstrates the power of government to make a long-term commitment to social marketing as a way to challenge entrenched social norms.
  • The It's Not OK family violence campaign in New Zealand used a community development fund to sponsor 93 local projects across the country. The projects were intended to engage whole communities and build community capacity to respond to family violence. The strength of this approach was demonstrated by the strong campaign awareness achieved amongst Maori and Pacific communities.
  • The Accentuate the Positive parenting campaign in Western Australia established parent information resource centres in community shopping areas. This strategy sought to normalise parents' help-seeking behaviour and deliver support for parents in their community.

The media mix

All the campaigns identified in this systematic review used, or had planned to use, some form of media as part of the dissemination strategy. The majority of campaigns used television advertising as the main channel to deliver messages (18/21). Although television was relied upon as the main communication channel, 17 of the 18 campaigns that used television also utilised at least one additional form of mass media, such as print media (newspapers, magazines) and posters or billboard advertising. Using more than one form of media increases the exposure of the campaign and recognises that people often use a range of sources to obtain information (Palmgreen & Donohew, 2006).

Nine out of the 21 campaigns used paid advertising as part of the campaign, five used community advertising, and for seven campaigns the advertising arrangement was not stated in the papers identified. Whether or not advertising was paid is especially significant for those campaigns that utilised television advertising (18/21). Television is a popular source of information for social marketing campaigns with messages about child maltreatment, however the success of television as a medium depends upon the amount of funding available to buy advertising. Relying on television corporations to broadcast advertising for free (community advertising or public service announcements) can be problematic because these advertisements tend to be aired outside normal viewing times (Fuhrel-Forbis, Nadorff, & Snyder, 2009). Australian social marketing campaigns appear to be more reliant on community advertising than international campaigns; only 1/9 of the international campaigns relied upon community advertising compared to 4/12 of the Australian campaigns.

Phone lines and Internet websites were the most common communication channels for people to access further information, directly receive help or be referred to services. Eleven of the 21 campaigns used a phone line and/or the Internet. Half of the 12 Australian campaigns were reported as providing a phone line and/or website for help or information compared to almost all international campaigns (8/9). This may have limited the audience reach of the Australian campaigns.

Campaigns that do not have an associated phone line and/or website may be less likely to bring about individual behaviour change because they do not have an accessible source through which people can begin to seek information or help. Poor utilisation of Internet technology in the campaigns reviewed may partly be explained by the availability and cost of that technology at the time the campaign was undertaken.

Style of the content of the campaign

There was a relatively even spread of hard-hitting (i.e., graphic, emotive and/or shocking content) and positive messages (i.e., positive, affirmative and/or "feel good" content) styles of content across the 21 campaigns; 8 were exclusively hard-hitting, 10 used only soft content and 3 campaigns utilised both hard-hitting and positive message content.

Hard-hitting content was used in the Breaking the Cycle campaign (1995-2000) in New Zealand, which, it is reported, "shocked New Zealanders into debating the issue of child abuse" (Stannard, Hall & Young, 1998: p. 64). The campaign portrayed emotional and physical abuse as a vicious cycle and conveyed the message to parents that they can change their abusive behaviour (Stannard, Hall, & Young, 1998; Young, Rout, Hall, & Stannard, 1999).

An example of positive message content comes from the Accentuate the Positive campaign (1996) in Western Australia. The campaign message conveyed the benefits of positive parenting, including "praise works wonders" and "be firm but fair". The message also portrayed corresponding affirmative emotions (joy, humour, love). Accentuate the Positive has been recognised in social marketing literature as having a positive incentive approach to motivate parenting behaviour change (Henley, Donovan, & Moorhead, 1998).

The evidence from this systematic review does not suggest that hard-hitting content is more effective than positive message content or vice versa. Atkin (2001) claimed that social marketing campaigns that employ positive appeals can bring about more desired behaviours. However, Henley and Donovan (1999) claimed that it is widely agreed that social marketing campaigns that utilise "fear arousal" are effective provided the desired behaviour can be consciously controlled by the audience, and is perceived by the audience as effective - the stronger the threat, the more effective the appeal. In some contexts and with some specific audiences however, positive messages may be more effective (Henley & Donovan, 1999).

The issue of whether hard-hitting social marketing campaigns are effective in reducing child maltreatment requires further investigation. It is a particularly pertinent issue to address in light of the risks of hard-hitting child maltreatment social marketing campaigns to children and to child abuse survivors. These risks, including exposing children to traumatic themes and re-traumatising child abuse survivors, have been highlighted in relation to campaigns that target child sexual abuse (ACSSA, 2010), however it is likely that a hard-hitting campaign targeting other types of child maltreatment would also pose similar risks.