Systematic Review of Public Health Branding

The authors of this research on public health branding campaigns systematically reviewed previous literature on public health brands; developed a methodology for describing branded health messages and campaigns; and examined specific branding strategies across a range of topic areas, campaigns, and global settings.

After presenting an introduction to branding as a marketing tool, the authors identify three constructs associated with branding:
• Relationship between consumer and product or service (marketing focused on the consumer and building the brand-consumer relationship)
• Value (for the consumer) added to a product or service
• Exchange (cost and benefit) between product or service and consumer

They then examine branding as a concept in public health social marketing, including branded “healthy lifestyles" and health behaviours. They searched the literature for published studies on public health branding available through all relevant, major online publication databases, initially identified 154 articles, and reviewed a final set of 37, of which 10 were from Africa, Australia, and Europe. These branded health campaigns spanned most of the major domains of public health and numerous communication strategies and evaluation methodologies. The authors sought to identify branding strategies and theories, examine previous research, and answer: "What evidence exists to suggest that public health brands are effective in changing behavior? What do we know about mechanisms by which brands affect health behavior?"

This paper provides a framework for examining branding as a public health strategy. Among its tools, it includes a quality scale and coding procedure. The authors found that most, but not all, existing studies provided clear information on planning, development, and evaluation of the branding effort. They use their framework to analyse theory, topic, brand development, marketing execution, and evaluation and outcome.

In the area of evaluation and outcome, they found:
"Among the 37 studies included in this review, 33 reported information on the outcome or evaluation of the branding effort... [summarised in a table in the document]. In terms of research designs represented in this review, we see that 3 of the studies reported the results of randomized experiments and 5 reported outcomes from quasi-experimental designs. The majority of the studies (n = 25), however, were based on observational designs. We found that 31 of the studies provided information on the study sample, with 21 providing information on sample characteristics and 15 reporting response/follow-up rates. Measures of aided (n = 20) and unaided (n = 18) awareness were the most common brand measures."

Further, they found that "[t]hese types of communication efforts typically differ in many respects from mass media, often using messages and channels tailored to local community and cultural norms, and using local staff and community members to build source and message credibility." Branded health messages, as stated here, typically are theory based, and there is a body of evidence on their behaviour change effectiveness, especially in nutrition, tobacco control, and HIV/AIDS. "Marketing theories cited in the literature typically dealt with promotional or placement strategies (4 Ps of marketing) used to deliver the brand to target audiences... Psychological theory appeared less often (16 of 37), and more frequently appeared in the reports on large, well-funded campaigns with more fully articulated behavior change objectives... Psychological theories were typically behavior change theories about the causal sequence from message exposure to behavior (through mediating variables) such as the Theory of Planned Behavior and Social Cognitive Theory.... For example, the truth® campaign used a strategy, based in part on Social Cognitive Theory, in which teens in campaign ads modeled independent, rebellious, anti-tobacco industry attitudes and behaviors to promote audience emulation. [Footnotes removed by editor] The loveLife brand was based on promoting a holistic lifestyle choice that valued abstinence, delayed initiation of sexual activity, monogamy, and condom usage. Branded behaviors and supporting values included open communication about HIV/AIDS, sex and relationships, gender relations based on informed choice and shared responsibility, and healthy lifestyle and aspirations".

Techniques adapted from commercial marketing, such as audience segmentation, were found to rank high among the strategic uses of public health branding. Audience segmentation identifies and focuses its branded message on a specific socio-demographic group. Tailored messaging was not found frequently in the branding campaign strategies, due to its newness, the authors speculated.

As stated in the document, more rigorous research is needed on how branded health messages impact specific populations and behaviours. For example, the authors found very few randomised experimental studies, or studies using sophisticated measures and analyses of the effects of branding associations or attributes on behaviour, as have been used in advertising research (e.g., multi-dimensional scales of brand equity). They found that there are issues about the standardisation of reporting, terminology, and measurement - for example, an absence of well-recognised keywords that can be used to identify literature on public health branding and social marketing.


They conclude that "[a]s a social marketing strategy, public health branding, needs to be situated within the larger context of health promotion and disease prevention. The authors view social marketing as one of a family of social ecological strategies that can influence individuals exposed to health messages at multiple points in the social environment."