Thinking First Before Using “ThinkFirst for Teens” – Malindi Thompson

INTRODUCTION

Head and spinal cord injury bears a substantial burden on society, especially among certain higher-risk populations (1). Most head and spinal cord injury-related morbidities are the result of motor vehicle and traffic-related accidents, in which injury may have been avoided had safer driving behaviors and proper precautionary measures been taken beforehand (2). This paper will address the important potential impact that injury prevention programs have in preventing head and spinal cord injury among populations who are affected most. However, in addressing a health issue that relies heavily on the behavior and actions of individuals within a population, complexities arise which mediate the effectiveness of prevention programs. Carefully examining health behavior theory is necessary in order to effectively target health choices in the context of a person's environment, and meeting the public health goal of making safer behaviors also the easier behaviors to achieve. Critical evaluation of ThinkFirst for Teens (TFFT), a program of the National Injury Prevention Foundation, will demonstrate that often prevention programs overlook fundamental behavioral influences and create assumptions to explain certain risk-taking behaviors. This review will identify weaknesses to TFFT, as well as suggest alternative approaches that may provide stronger influence for adolescents to make safer driving decisions before injury occurs.

HEALTH PROBLEM: Head and spinal cord injury among adolescents

Motor vehicle crashes cause over one out of three deaths among teenagers in the U.S., the leading cause of death for this age group (1). Additionally, millions of drivers and passengers are treated each year for injury as a result of motor vehicle crashes, most of which are teenagers and young adults (3). Nearly half of all traumatic head and spinal cord injuries are caused by motor vehicle accidents, 50-70% of patients between the ages of 15 and 35 years old (4). Among all age groups, males are approximately 1.4 times more likely than females to sustain a traumatic brain injury (5); teenage males are nearly twice as likely to die of a motor vehicle accident than teenage females (1). The economic burden of lifetime costs of fatal and nonfatal head and spinal cord injuries in medical care, treatment, rehabilitation, and lost work productivity costs accumulates to an estimated $99 billion annually in the U.S. (6).

Many current injury prevention programs aim to increase driver and passenger safety by addressing risky driving behaviors widespread among adolescents. Active approaches to reduce head and spinal cord injuries are promoting the consistent use of safety belts and increasing driver safety. Seat belts are the most effective intervention for protecting motor vehicle occupants, reducing the risk of serious injuries from motor vehicle crashes by approximately half (7). However, teenagers, especially males, are least likely to wear seat belts (8). Other safety measures include leaving adequate headway between vehicles, not speeding, and not driving while intoxicated (2).

CURRENT APPROACH: “Use your mind to protect your body” (9)

ThinkFirst for Teens (TFFT) is an educational injury prevention program that is nationally and internationally recognized as a leader in injury prevention through education, research, and policy (10). The program's goal is to decrease the prevalence of preventable head and spinal cord injury among teens by reducing associated high-risk behaviors, and encouraging safer choices toward safety belt usage and safe driving behavior (9,10,11). The program, which focuses on good decision making skills and the consequences of risk taking, aims to reduce risk-taking among youth by educating middle and high school students on the dangers of risk taking and increasing their understanding of their risk of possibly fatal injury from motor vehicle accident (11).

TFFT is implemented in a middle/high-school assembly environment, and consists of a short video, lecture, guest speaker, and discussion (10,11). The video shows clips of youth who have been affected by a head or spinal cord injury: details about how the injury occurred, how the injury has permanently changed their life, and how it could have been prevented. The guest speaker, a young person who has sustained a head or spinal cord injury, gives a personal testimony about their experiences and challenges since the accident. Together, the program elements present real people who have lived to tell their real experiences. Consistent throughout each program component, emphasis is placed on the devastating and irreversible consequences that may occur as a result of a brain or spinal cord injury, and how, through risk-reduction, these consequences may be avoided (10).

Despite positive reviews on ThinkFirst's national website, several evaluation studies have produced results which question the effectiveness of TFFT in actually changing behaviors among adolescents exposed to the program. One evaluation of TFFT by Wright et al. (1995) found no significant changes in attitude scores between pre- and post-test assessments in schools that had implemented TFFT (12). Results showed a significant increase in knowledge among middle school students, but not high school students, and no significant impact was observed for seat belt use among all age groups (12). The evaluation further measured that self-reported behavior had significantly changed in the direction toward unsafe behavior after intervention, rather than safer behavior, for eight out of nine schools in the study (12). Similar findings from an evaluation of TFFT in Oregon reinforce the conclusion that students exposed show changes in knowledge, but no change in self-reported seat belt use (13).

Based on the findings of these evaluation studies, TFFT's program effectiveness may be legitimately questioned. Several arguments arise, which provide possible explanations as to why the program is flawed, according to the previous studies. Foremost, TFFT is based on the Health Belief Model (HBM) (11). The HBM theorizes that a person's value and expectancy beliefs guide their behavior (14). TFFT rests on the idea that increasing student knowledge of the serious effects of brain and spinal cord injuries and actual likelihood of sustaining such an injury will induce behavioral change toward less risky driving-related activities. Review of behavioral literature supports a challenge to this theory, arguing that the HBM is not an effective strategy for injury prevention among youth (14).

Relying on assumptions of human behavior such as those associated with the HBM and similar behavioral health theories (Theory of Reasoned Action and Theory of Planned Behavior) creates barriers to the effectiveness of health programs such as the TFFT. Three main critiques of TFFT will identify larger themes that often persist in other health behavior programs: 1) TFFT is individually-focused; 2) TFFT assumes that adolescents think and act rationally; and 3) TFFT uses ineffective motivators to produce behavior change.

RECOMMENDATION: Modify approaches

Elements that are required for a health program to be successful include comprehensiveness, social and cultural-sensitivity, appropriate timing, incorporation of varied techniques, having a sufficient dosage, ensuring positive relationships with its patients, and using theory-driven methods (15). Overall, TFFT has good intentions and meets most programmatic standards, but has a weak approach. TFFT lacks appropriate theories that explain adolescent behavior and their decision-making processes. Modifying the approaches used by TFFT to overcome challenges of injury prevention among adolescents through behavioral change may be done in three ways: 1) Use a social-ecological model; 2) Recognize that knowledge alone will not produce behavior change; and 3) Evaluate what motivates adolescents to influence behavior. Strategically incorporating these recommendations into a new head and spinal cord injury prevention program for youth, based off of TFFT, will likely result in a much more effective intervention.

CRITIQUE 1: ThinkFirst for Teens is individually focused

The HBM, the theory that TFFT is based on, is individually focused and does not address interpersonal, social, or overall contextual factors surrounding behavior (14). TFFT aims to change beliefs each teenager has toward his or her own susceptibility to injury from vehicle crash, so that in the future when placed in a risky situation, the teen will make the right decision and “think first” before acting. By framing the issue so that the decision to be safe or not is up to the teenager alone limits the program’s scope of influence to only intrapersonal mediators, such as knowledge. Because people actually behave and react within the context of their broader socio-cultural environment, TFFT ignores many powerful external influences which may affect the program’s ultimate effectiveness (16).

Research supports the theory that contextual social factors strongly influence adolescents’ likelihood of engaging in high-risk behaviors. In general, teens are more likely than older drivers to drive recklessly (speeding and allowing shorter headways), but in the presence of other passengers this behavior is shifted (17). Peer influences, whether intentional or unintentional, act as either risk or protective factors toward driving behavior, depending on the way that the driver perceives that the passenger views the driving behavior as desirable or expected (17). In the presence of a male teenage passenger, teen drivers typically engage in more risky driving than the general traffic; in the presence of a female, teens drive more carefully by allowing greater headway in-between cars (17). Across all teenagers of both genders, safety belt use has been found to decrease as the number of passengers increases (18).

Lastly, assuming that behavior is determined by only individual beliefs and values implies that decision making is a static process which occurs, under any circumstance, as a simple “right” or “wrong” decision. In reality, not all situations that adolescents find themselves in contribute equally to the likelihood of risky driving (19). Strong emotional responses to certain stimuli may make the application of concrete decision-making and good driving skills extremely difficult when caught in the moment.

HOW TO STRENGTHEN 1: Use a social-ecological approach

Social-ecological models of behavior are comprehensive behavioral theories that emphasize the interactions between individuals and their family, organizations, communities, and society as a whole in understanding the multiple levels of influence of a health behavior (14). Evidence supports the concept that in order for health programs to be successful in helping people adopt, change, and maintain a positive behavior, programs must be multifaceted and address socio-structural determinants of health as well as personal determinants (16,20). Adolescents are highly influential, particularly to strong social influences from peer groups, and behave in ways that they perceive to be expected by their peers, based on social norms that they are exposed to in their external environment (21,22). Incorporating social influences into injury prevention theory addresses not only teenagers’ perceptions of their own driving skills and risks which contribute to their behavior, but equally addressing the importance of the perceptions they have toward passengers they ride with.

Patterns of adolescent risk behaviors reinforce the theory that ecological models are useful in systematically targeting group-level trends of behavior. Teens that have been exposed to one risky driving behavior have likely been exposed to others (23). Approaching risky-driving behavior from a group-level perspective may provide a more useful method of targeting the health problem of head and spinal cord injury than from an individual-level perspective.

CRITIQUE 2: Thinking first is not rational

The premise of ThinkFirst for Teens is that by teaching teens to rationally “think first” before engaging in risky behavior, they will be able to avoid serious harm. This mentality in itself is not rational. People in general, even those equipped with rational decision-making skills, often act irrationally (24). Adolescents face many environmental and developmental hurdles that affect the activities they decide to engage in on a daily basis, but no solid evidence is found which supports the suspicion that adolescents are at a particular cognitive disadvantage in understanding the risk and consequences of risk taking behavior, compared to adults (25). Therefore, rather than view irrational behavior as a flaw of adolescent mentality, irrationality must be recognized as a common human characteristic. Injury prevention programs that rely only on decisions made from a well-reasoned weighing of positive and negative outcomes, such as TFFT, will encounter difficulties due to a limited scope of behavioral explanation (26).

A weakness of traditional theory that emphasizes rational decision processes is that rational behavior often is missing the important behavioral element of emotion. Emotions, whether positive or negative, directly affect attitudes, values, beliefs, coping mechanisms, and the ultimately the behaviors that produce a health outcome (14). Emotional involvement is a strong contextual influencer of how an individual responds to a given situation, and may be effectively utilized to further promote adolescent behavior after a health program’s educational component proves insufficient (27).

A second challenge of thinking that adolescents will always make safe and rational choices after increasing knowledge and risk-awareness is that gaps may persist between increased knowledge, intention, and behavior change. Consistent with the findings of the Wright et al. (1995) evaluation previously mentioned, increased favorable attitudes and behavioral intentions as a result of a risk-prevention program do not always translate into actual behavioral change (28).

HOW TO STRENGTHEN 2: Knowledge is not enough

Broadening TFFT’s mechanism of influence to encompass intrapersonal emotions and habitual modes of thinking will produce lasting and internalized behavioral outcomes (29). Rather than influencing behavior by increasing knowledge and awareness of injury, a new approach must capitalize on emotional and contextual factors common to teen drivers. Emotional engagement in a non-threatening manner will ensure that improvements in beliefs, attitudes, and intentions then lead to actual behavioral change. Successes of other youth prevention programs, such as anti-tobacco campaigns, may be attributable to the creative ways in which health-effects information is presented that emotionally engages and mobilizes viewers (30).

CRITIQUE 3: ThinkFirst for Teens uses ineffective motivations

A final critique of TFFT’s approach is that the mechanism of motivation which is thought to produce a positive reaction may be inappropriate for youth. The video and guest lecture in all TFFT school assemblies uses scare tactics to emphasize what could happen to teens if they continue to choose risky diving behaviors (i.e. Paralysis due to head or spinal cord injury). Terror management creates a negative reaction to the behavior that causes an unwanted outcome, and in theory it is the role of this aroused fear that activates behavioral change (31). This threatening strategy is usually ineffective at reducing risk-taking behaviors, except among audiences who are unaware of the problem and its associated behaviors (31,32). Lack of knowledge of motor vehicle accidents is typically not an issue among adolescents of driving-age.

Although the benefits to utilizing emotions to produce an intrinsic response were discussed previously, this method must be approached cautiously. Health messages that are overly aggressive and threatening, communicated through personal testimonies and graphic depictions of negative health effects, may cause an over-reaction among adolescent viewers and result in more risky behavior (30). This over-reaction is demonstrated through the Wright et al. (1995) evaluation of TFFT, which showed changes in self-reported behavior among exposed adolescents toward the direction of increased risk-taking (12).

HOW TO STRENGTHEN 3: Frame risky behavior differently

Rather than framing the problem of risky driving behavior as a character flaw shared by most adolescents, intervention strategies should counteract negative outlooks. Blaming adolescents for the reckless behaviors that they engage in, such as risky driving, will produce negative labels. Instead, highlight adolescence as a period of growth and development, and identify true motivators as positive gains. Behavioral persuasion that is communicated through gain-framed appeals is found to be statistically significantly more persuasive than loss-framed appeals (33). Emphasizing positive goals is a recognized strategy for simultaneously optimizing health and counteracting negativity, which works well in the context of injury prevention among youth (29).

CONCLUSION

To summarize, ThinkFirst for Teens is a well established educational injury prevention program aimed at reducing head and spinal cord injury among adolescents by building on health decision-making skills and reducing risky behaviors. However, many challenges arise in the implementation of a program based on the Health Belief Model due to individual, rational and negatively focused motivations, which often prove to be ineffective. This report addressed weaknesses of the ThinkFirst for Teens program and proposed recommendations to broaden its approaches toward successful behavioral change. Incorporating a social-ecological model that includes external influences, in addition to knowledge-based change, and framing the issue in a manner that highlights positive gain will more effectively persuade adolescents to alter their risky-driving behaviors.

REFERENCES:

1. CDC. WISQARS (Web-based Injury Statistics Query and Reporting System). Atlanta, GA: US Department of Health and Human Services, CDC; 2010. Available at http://www.cdc.gov/injury/wisqars. Accessed December 2, 2011.

2. National Highway Traffic Safety Administration. Trends in non-fatal traffic injuries: 1996-2005. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration; 2008. Available at http://www-nrd.nhtsa.dot.gov/pubs/810944.pdf. Accessed December 2, 2011.

3. CDC. Vital signs: nonfatal, motor vehicle-occupant injuries (2009) and seat belt use (2008) among adults, United States. MMWR 2011; 59. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5951a3.htm.

4. Skehon LHS, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 2001; 26: S2-12

5. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control 2010.

6. Naumann RB, Dellinger AM, Zaloshnja E, Lawrence BA, Miller TR. Incidence and total lifetime costs of motor vehicle-related fatal and nonfatal injury by road user type, United States, 2005. Traffic Injury Prevention 2010; 11: 353-60.

7. National Highway Traffic Safety Administration. Lives saved in 2009 by restraint use and minimum-drinking-age laws. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration; 2010. Available at

8. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance, United States, 2007. National Center for Chronic Disease Prevention and Health Promotion 2009.

9. Dunn P. Shawnee Mission East High School uses ThinkFirst to prevent teen crashes. KansasCity.com Press Release Central 9 Feb. 2011.

10. ThinkFirst for Teens. National Injury Prevention Foundation: ThinkFirst Foundation 2011. Available at http://thinkfirst.org/About/Teens.asp.

11. Gerhardstein DB. ThinkFirst for Teens injury prevention program: evidence-based practice – are we making a difference?. American Association of Spinal Cord Injury Nurses 2007; 24.3

12. Wright M, Rivara FP, Ferse D. Evaluation of the Think First head and spinal cord injury prevention program. Injury Prevention 1995; 1: 81-85.

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A Critique of the United State’s Approach to Single Payer Financing Based on Advertising Theory – Caitlyn Nystedt

Introduction:

We have a problem. A big problem. We spend more money per capita in this country on health care and have subpar health outcomes to show for it. (10) On average, each American spent approximately $8,000 in 2008, which is astronomically high as compared other developed countries like Germany and the United Kingdom who spent $3,737 and $3,129 per person in 2008 respectively. This is a serious issue, especially in this economic crisis. Our ever expanding health care costs not only are 16% of the Gross Domestic Product (GDP), but also continue to be increasing over time. It is expected by 2015 that health care costs will consume 20% of the GDP. (10) That means for every $1,000 Americans spend, $200 is on health care costs. Or another way of looking at it is that for every $10 spent, $2 is spent on health care costs. Unlike other countries, the United States does not have single payer financing for health care costs like our other fellow developed nations.

Single payer financing is when health care is paid for by one large insurance pool. For example, Medicare is finance by single payer through the Medicare tax in which every employee and employer contributes a percentage of income to the large insurance pool which funds medical care for citizens 65 years of age and older. (4) Another example is the United Kingdom where every citizen pays a tax, which is then collected in a large insurance pool which funds their country’s health care costs through the National Health Service. The difference between every developed country and the United States is that the United States has it’s citizens pay for their health care costs primarily through private insurance companies, mostly through benefit plans from employers. It is this policy approach that has caused the exceedingly high costs of health care in this country. If the United States adopted single payer financing to pay for its health care costs, we would see a dramatic decrease in spending from administrative costs alone. For decades, there has been a push for a centralized single payer financing for health care for every citizen, but such campaigns have failed. They have failed because they often fall back on the Health Belief Model to convince citizens, citizens fall victim to the Small Numbers Theory, and that most, if not all campaigns for single payer financing have failed to address the perceived threat of personal freedom of American citizen have towards single payer financing.

Argument 1:

Campaigns for a universal single payer financing have mostly used the Health Belief Model to try to convince Americans that single payer financing is in their best interest. It is important to mention the nucleus of the model, which is that health and health seeking behavior is motivated by four factors. These four factors are (1) Perceived susceptibility, (2) Perceived severity, (3) perceived benefits of an action, and (4) Perceived barriers to taking that action. To other important components of the model include Cues to Action, where an external event motivates a person to act, and Self-Efficacy, which is a person’s belief that they can take action. (2) The Health Belief Model has been shown to have serious flaws. (1,5) In a study conducted by Ogden found that the Health Belief Model is too unspecific to use, but also practitioners should not use the Health Belief model because they cannot be tested. (5) If a theory cannot be tested, it cannot be proven to be true. In the debate for health care reform, many cite the figures I mentioned above. These numbers are useful, but they do not convince people that it is an issue that directly affects them. Campaigns like “Physicians for National Health Program” and information released by the Kaiser Foundation, follows the Health Belief Model by the logic that Americans are unaware of their perceived threat and perceived seriousness of high health care costs. By using informative cues to action, bulletins and mass media campaigns, that use primarily statistics and financial information regarding the nation as a whole, they are only appealing to the rational not the irrational decision making of humans.

Another flaw of the Health Belief Model use in motivating Americans to take action to direct the United States toward single payer financing is its focus on the individual. This model is wholly devoted to the individual not taking into consideration the influence of group level behavior. It is crucial to incorporate group level behavior models, such as Marketing Theory and Advertising Theory, for a campaign at the national level. A campaign at the national level is what is needed to make a serious attempt to alter the United States’ approach on health care financing and to direct it towards single payer.

Argument 2:

Americans understand that the health care costs are high, but do not see it as something they are affected by. This effect of unrealistic optimism about future health care spending is relatable to the study published by Weinstein in the Journal of Personality and Social Psychology. In his study, he was able to show that people have an optimistic bias about many future life events. The subjects were found to believe that they were more likely to experience positive future life events than their peers, and in contrast, they believed that they were less likely to experience negative future life events than their peers. (11) The important aspect to take from this research is that people tend to count themselves out of the population that is susceptible to unfortunate life events. This unrealistic optimism was also seen in a study conducted by Ayanian and Cleary in the Journal of American Medical Association. This their study they found that most smokers do not view themselves as having an increased risk of cancer even though they are aware of the risks of smoking. (1) This unrealistic optimism can be extended to many life events concerning public health, including events such as going bankrupt due to personal high health care spending, being dropped from your private insurance coverage, having too expensive prescriptions to pay for food, etc. It is these life events that campaigns for single payer financing should focus on with stories, music and visual images that appeal to the irrational side. Using these stories, music and visual images will enable the view to try to place themselves in that situation, making the situations (bankruptcy due to high health care bills, uninsurance, etc.) a real possibility.

Argument 3:

The most pertinent flaw in the campaigns that have been directed towards steering the United States towards single payer financing for health care is that they do not address Americans’ perceived threat of their freedom associated with socialized medicine. In the 1970s, organizations like the American Medical Association with the help of Ronald Regan, created advertisements that directly targeted Americans’ values of freedom and autonomy in regards to their health care. (8) These advertisements along with others put a stigma on the term “socialized medicine” where socialized medicine is seen as a threat to the freedom of choice and autonomy within the American population. Americans are not particularly fond of government involvement. For any campaigned aimed at promoting a single payer finance system for health care in the United States, the campaign must address the stigma that is associated with any form of socialized medicine.

Not only do these campaigns not address the stigma around single payer financing in health care as a treat to their freedom, but they also do not create the large promise needed in great advertising. Like Ogilvy mentions in “Confessions of an Advertising Man,” the promise is the soul of an advertisement. (6) Like most public health campaign, the promise is often over looked and/or overshadowed by statics and facts. What use are the statistics and facts if the promise is not of interest to the target population, or worse if the promise is absent? It is absolutely crucial that the promise is relevant and connected to a strong core value that resonates with everyone.

Proposed Intervention:

In attempt to try to attack the stigma surrounding the single payer financing of our health care system, I would propose launching a mass media campaign with the ultimate goal to begin branding a National Health Program that is financed by a single payer system. We would hopefully be able to partner with an organization such as Physicians for a National Health Program. Such partnership would prove extremely useful in having a key player of the health care system and the most trusted player of the health care system, the physicians.

The campaign would include primarily television and web advertising. This proposed intervention would need to have a very large budget and be able to afford the expensive ad time and ad placement for the highest viewership possible. Like the Truth Campaign, a large budget for mass media marketing will be the most significant factor in a successful campaign. (3) How effective is an advertisement if no one sees it? Instead of using statistics and factual information in a Health Belief Model, we would use Advertising Theory to develop our campaign.

The campaign would strive to follow Advertising Theory by adhering to its three main elements of effective ads, which are Promise, Core Values, and Support. The campaign’s primary promises would include you are not alone, together we can fight the system, and we deserve more. The core values would include togetherness, unity, patriotism, freedom and autonomy.

The Support of the campaign is where the message is seen, heard and felt. Through the use of visual stories, actual stories told and accompanying music, the promise of togetherness and unity through a National Health Program would be conveyed. Television advertisements would have music that is marketable by itself (so it could be the iTunes free song of the day or posted free on the campaign’s website). The music would also have to be selected very carefully making sure it has a matching emotion and feeling to the advertisement so the promise and core values are conveyed.

The visuals of the support would have to include the “everyday” American. These would be people who represent all the demographics from across the nation. Some advertisements wouldn’t need much besides the music and the visual of a chain of good deeds being done, whereas some advertisements would include a story from an “everyday” American about their struggle with the current health care system. One story could be how a family became bankrupt because a family member was diagnosed with cancer and wasn’t covered by his or her insurance. Another story could be how a family member died because of an administrative error. These stories would enable the view to see him or her in these scenarios, which would attempt to avert the unrealistic optimism that the view is not at risk for these types of situations. The campaign would also include series of positive, simple advertisements. The more positive advertisements would include a story of caring for one another. This story wouldn’t necessarily need a person talking, but instead a chair on kind acts that ends at the beginning person. This ad would convey the idea of togetherness and unity. At the end of every commercial there would be the logo of National Health Program and a link to the website.

The campaign could also feature another set of advertisements that would give a strong call to action. Assuming it tested well with focus groups, an advertising campaign that asks the question, “Why is our health care system not working?” could potentially reverse the stigma surrounding socialized health care for its advantage. By focusing on the ways that the consumer is being manipulated by the system, (adverse selection, cherry picking, disparate health care costs for same services, etc.), a call to action could really make a difference in the campaign for single payer system. With the current economic crises, we could use the distrust of Wall Street and the large corporations to our advantage. We could market single payer health care system as a transparent, accountable system that the consumer get’s a say in the rules. The advertisements would look like one person writing a check to the health insurance company, then following that check to the health insurance company where it gets placed in a cart which is then rolled into a closed door meeting with a sign, “Corporate America Only.” Another advertisement would highlight the cruel rules of pre-existing conditions and the benefits of not insuring the sick. These advertisements would emphasize that they are playing a game and losing, they are losing because they don’t get a say in the rules. This would evoke a strong emotion that their freedom and autonomy are being infringed.

It is important to note that all these advertisements would need to be thoroughly tested before focus groups before release. As many have said, the most effective advertisements and brands come from extensive research. It is crucial that we don’t just guess at what might work and send it out to the public without any testing. (6, 3) We need to know our audience; otherwise we won’t know what language to use to be effective at spreading our message.

The advertisements would prompt the viewers to visit the website of the campaign, which would clearly show ways to show support for a single payer health care system. These ways would include firm political supporters of single payer financing, petitions to sign, videos to post on Facebook and Twitter, handouts with short quick information about our system compared to others. Information is a key aspect of any campaign. As Oligvy mentions, give the facts, but do not bore people. (6) We cannot campaign with zero facts or statistics, but we can campaign using them with the best strategy. Using facts that would strike a chord on a personal level would be the most beneficial. For instance, the fact that the average American spent $8,000 on health care in 2008 isn’t very personable. If instead say the average American spent $8,000 in 2008, which means I spent $8,000, your mom spent $8,000, your sister spent $8,000, your best friend spent $8,000, etc. Then follow with a simple question, “Did you get your money’s worth? Did they?” Using the facts in a way that follows the message will be most impactful.

Conclusion:

We’ve sure got a problem, and we need change now. Hopefully, there will soon be a campaign like the one mentioned above. Striving for a paradigm shift in the American population on how we view single payer financing for our health care system. It would need an incredible amount of support both financially and administratively. Support for serious change in our health care system would need to come from all key players. These key players include physicians, hospitals, government, communities, employers, employees, and consumers. The shift towards single payer health care system is a group level, a national level, behavior that needs to happen together. The old way in the Health Belief Model concerning just the individual is not effective, especially for a campaign of this nature. By adhering to the basic elements of Advertising Theory, we could create a national campaign that could make a real impact on how Americans view a single payer health care system. This change in perspective could then evoke actions that prompt serious changes in our policies and approaches to our devastatingly high health care spending.

References:

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