Are social marketing campaigns effective in preventing child abuse and neglect?
This systematic literature review has shown that there is relatively little evidence regarding the effectiveness of social marketing campaigns in preventing or reducing child maltreatment. Only 12 campaigns relating to child maltreatment were identified as having published evidence of impact and/or outcomes evaluation. As observed by WHO (2006), more evidence that social marketing campaigns can change community awareness, attitudes, knowledge and behaviour associated with child maltreatment is required, especially as campaigns can "highlight the extent and nature of child maltreatment and encourage the provision of services to children and families" (p. 37).
The 12 social marketing campaigns related to child maltreatment that provided impact and/or outcome evaluation evidence have collectively demonstrated some capacity to positively affect people's awareness, knowledge, attitudes and behaviour. One of the campaigns, that formed part of a broader strategy with a range of activities, demonstrated a capacity to bring about improvements in child maltreatment at a population level.
Based on the strengths and limitations of these campaigns, six key areas have emerged for optimising any future social marketing campaigns that aim to address child maltreatment in Australia. These are:
- comprehensive evaluation;
- pairing mass media with a community-level strategy;
- issues relating to reliance on television advertising;
- aligning campaigns with support services;
- assessing the needs of the target audience; and
- using a suitable theoretical framework.
The issue that emerges most strongly in this review is the importance of comprehensive evaluation of social marketing campaigns relating to child maltreatment. As previously discussed, interventions that intend to have an impact on child maltreatment or parenting problems need to be evaluated to determine if they have been of any benefit to children and their families (Holzer, Higgins, Bromfield, Richardson, & Higgins, 2006). Indeed it could be argued that there is a very good reason for evaluating social marketing campaigns that relate to child maltreatment, especially those with hard-hitting content, because they have the potential to be harmful to vulnerable members of the community, including children and maltreatment survivors. Any benefits of social marketing campaigns related to this sensitive issue need to be weighed against the potential risks. This type of assessment requires that evaluations of these campaigns are conducted and the findings of those evaluations are made publicly available.
Ideally evaluation should include measures of behaviour change, especially as this is the fundamental purpose of social marketing campaigns. Using the number of calls to a helpline as a measure of behavioural change is a relatively easy way of gathering data about a campaign, however the usefulness of these data are limited in terms of measuring whether children's lives are improved. Using data on self-reported behaviour change as a measure of the success of a campaign that targets a highly sensitive issue such as child abuse may also be problematic. As discussed previously, social marketing campaigns about child maltreatment may raise the awareness of the stigma surrounding a topic and thereby influence people's responses to a question regarding their behaviour. A self-reported change in behaviour in this case may not represent a change in actual behaviour.
As noted in this paper, the empirical evaluation of social marketing campaigns is challenging. Issues such as a lack of access to expertise, technology and resources can impinge upon evaluation efforts and rigorous experimental or quasi-experimental designs across the population can be inappropriate. Identifying any unintended negative consequences of a social marketing strategy is also critical to prevent people being harmed as a result of campaign messages. Given that most social marketing campaigns receive some form of government funding, evaluation ensures that public money is directed towards interventions that are effective and represent value for money.
Another important issue to emerge is the importance of pairing social marketing campaigns with a community-level component. The integration of both mass media and community-level strategies appreciates that attitudes and behaviours are complex and that a campaign is unlikely to produce long-term change without broader social reinforcement. Community-level strategies recognise that individual behaviour does not occur in isolation. Social relationships create the environment to either support or challenge child maltreatment, through neighbourhoods, schools, workplaces, health services and other institutions (WHO, 2006). Experts in the field of public health are optimistic about the potential of mass media-based social marketing to be a powerful strategy when paired with broader community interventions that actually address the social context of individual wellbeing (Abroms & Maibach, 2008; Hornik, 2002a). For child maltreatment, pairing mass media with a community-level component would help reinforce the message that child protection is everyone's responsibility.
A common feature of the campaigns that were explored as part of this systematic review was the utilisation of multiple delivery methods however television advertising continues to be a key medium for social marketing campaigns. The reliance upon television advertising is especially relevant to future social marketing campaigns considering mediums such as television and newspapers are becoming less popular as a means for accessing information, especially amongst younger age groups (Ahlers, 2006; Dimmick, Chen, & Li, 2004; Havick, 2000). However, any employment of new technologies such as the Internet need to be deployed strategically so as not to increase inequalities between social groups (i.e., unequal access to the Internet in rural and remote areas of Australia and low levels of digital literacy amongst some groups) (Wise, 2000). Furthermore, in Australia especially the reliance upon community advertising for televised social marketing advertisements needs to be considered in light of the evidence that suggests that the effectiveness of community advertising is limited by the fact it is often televised during non-peak viewing times.
Aligning social marketing campaigns with support services reflects the aspirations of a public health model for the protection of Australia's children (Council of Australian Governments, 2009). There are two important issues to consider in relation to this theme. First, social marketing campaigns related to child maltreatment must offer ways to access further information and support that are tailored to the needs of the target audience. Second, if mass media has the intended effect of generating individual and community change, then increases in demand for assistance, information and support services are to be anticipated. This requires investing in the economic and human capital of support services so that they are prepared for the public's response (Andrews et al., 1995).
Assessing the attitudes and beliefs of the target audience has emerged as a key process to undertake when deciding which social problem should be the subject of a campaign. This means tuning into the "consumers" of a social marketing campaign about child maltreatment by using formative assessment and research to find out what needs to be understood from the perspective of the target population (Stead et al., 2007). Extensive formative assessment and research provides insight into the existing awareness, knowledge, attitudes or behaviours of the target audience to increase the likelihood a campaign will have an impact (Stead et al., 2007). Incorporating a sample of the target audience as participants in the design and evaluation process also represents an ethical redistribution of power between those implementing a campaign and those whom the campaign is intended to impact (Grier & Bryant, 2005).
A theoretical framework for individual and community-level change is important to social marketing campaigns about child maltreatment. Underpinning the campaign with a theory of change guides the development, implementation and evaluation of the intervention. A theoretical framework builds an understanding of the determinants of individual behaviour associated with child maltreatment; identifies the social influences that can lead to desirable behaviour change; and informs the appropriate message required to influence the desired behaviour (Randolf & Viswanth, 2004; Stead et al., 2007). As Wray (2006) has argued in relation to public communication about interpersonal violence, "if we do not think through and test our theories of behaviour as an integral part of the intervention planning process, then we are broadcasting aimlessly" (p. 44). A theoretical framework provides a strategy to conscientiously tackle complex individual behaviour and community-level change and assess its efficacy.
Overall, the analysis has shown that future Australian social marketing campaigns that aim to address child maltreatment need to be empirically informed, designed with a theoretical foundation, be rigorously evaluated and embedded in a wider community strategy for the benefits of child abuse prevention and effectual interventions to be achieved.