Evidence-based campaigning

Background: When promoting public health measures, such as reducing smoking, there are many different approaches, for example providing information, imposing legal restrictions, taxing products, and changing cultures. By analogy with evidence-based medicine, different approaches to campaigning for health promotion can be compared by obtaining evidence of effectiveness. However, evaluating the effectiveness of campaigning approaches is far more difficult than evaluating drugs or medical procedures, because controls are seldom possible, endpoints are difficult to specify, multiple factors influence outcomes, and the targets of campaigns are people or organizations that may resist. Methods: Ten ideal campaigning types are proposed: positive and negative approaches to the five categories of information, attitude, arguments, authorities and incentives. To illustrate the ideal types and the complexities of evaluating approaches to campaigning, three contrasting Australian strategies to promote vaccination are examined. Results: Each of the three vaccination-promotion strategies showed the presence of several ideal campaigning types, but with distinct differences in emphasis. With available evidence, it is difficult to assess the relative effectiveness of the three strategies. Conclusion: Because of the difficulty in obtaining evidence, claims about the effectiveness of general approaches to health promotion should be treated with scepticism, especially when presented by partisans. There are inherent difficulties in making campaigning evidence-based.