How Public Health Campaigns Promote Public Health Disparities

ABSTRACT

It is often claimed that interventions aimed at promoting healthy behaviors tend to be most effective among people whose behavior least needs to change and least effective among those most in need of change. If true, the inevitable result would be widening disparities in health engagement between these groups. Using a between-subjects experimental design, this study examined the effects of a directive advocacy message based on the theory of planned behavior (TPB) on groups with different preexisting levels of engagement in healthy behaviors. The results confirmed that, compared to effects of a non-persuasive control message, the TPB-based message produced greater disparities in engagement between the group lowest in preexisting health engagement and groups with greater preexisting levels of engagement. The study suggests well-intended public health initiatives may seem to provide a net benefit to society but, in fact, actually contribute to the persistence of the disparities they attempt to address.

KEYWORDS:

• Boomerang effects
• health disparities
• patient engagement
• health engagement
• health communication
• public health campaigns
• theory of planned behavior (TPB)

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. The Levene statistic tests the null hypothesis that variance is equal across all groups in the analysis. A significant finding (i.e., of p < .05) indicates that variance is not equal across the groups (Field, 2009), a condition that can increase the chance of Type 1 error (Tabachnick & Fidell, 2007). Review of the SDs in Table 3 suggests the violation reflects the differences in variance between the Low, Mid, and High PEX groups, with the Low group exhibiting markedly greater SDs than the High group.

2. Notation: TPB = posttest engagement produced by TPB-based messages. CTRL = posttest engagement produced by non-persuasive control messages. Subscripts are used to differentiate between PEX group levels (i.e., _L = Low PEX group, _M = Mid PEX group, _H = High PEX group.