A mixed methods evaluation of televised health promotion advertisements targeted at older adults

"Know your medicines, know your health"-public perspectives on medicines and health awareness campaigns

Background

Irrational medication use is likely to result in therapeutic failure and disease progression. One way to increase public awareness about appropriate medication use is to design and deliver a public health medicine awareness campaign. This study aims to assess the public's attitudes and experiences related to medication use and health awareness campaigns in Saudi Arabia.

Methods

This is a cross-sectional survey study. Participants were aged 18 or over and able to speak Arabic or English. An online survey was distributed to a convenient sample of 451 participants by email and social media via an internet link, leading to a web-based survey platform in QuestionPro. Bivariate and multivariate analyses were used to assess the associations.

Results

Three hundred and forty-seven participants (76% female, aged 18-85 years) were on a mean (SD) of two (1.86) prescription-only-medicines (POMs), and 225 were on non-prescription medicines. Seventy-one and 63 % of those surveyed consulted a doctor or a pharmacist, respectively, for advice about their medications. The participants were curious mainly about the side effects of treatment (79%), followed by drug interactions and contraindications (55%). Most participants agreed or strongly agreed that their medications were necessary to improve their condition (82%), prevent the progress of their condition (85%), and reduce the risk of complications (90%). Seventy-seven percent of participants reported seeing a public health campaign previously. TV (58%) and Twitter (55%) were reported as the most appropriate tools to help deliver a good public health campaign. Ninety-one percent believed that a public health campaign can increase people's awareness about their lifestyle, and 73% declared that medication should be part of it.

Conclusion

The findings can be a foundation for developing and implementing medicines and health awareness campaigns to enhance public understanding of health and medication use.

Emotive Media as a Counterbalance to AIDS Messaging Fatigue in South Africa: Responses to an HIV/AIDS Awareness Music Video

South Africa recorded and estimated 230,000 new infections in 2020, and low levels of AIDS risk awareness remain prevalent among the nation's youth. While public health awareness initiatives continue to be necessary, the large quantity of AIDS-related content that has permeated the media landscape since the start of the epidemic has resulted in increasing indifference to health messaging. Drawing from the concept of referent emotional responses, this article analyzes the reception of "Sing," an HIV/AIDS awareness music video characterized by emotive visual representations of AIDS. The data highlight ongoing fatigue towards HIV/AIDS messaging and the potential of highly emotive media to engage target audiences in a climate of indifference to AIDS awareness. The article recommends that future awareness and prevention campaigns consider the role of emotive content in effective AIDS-related health promotion in South Africa.

Health information source use and trust among a vulnerable rural disparities population

PURPOSE

Because rural residents, particularly those near mining sites, are susceptible to numerous environmental health hazards, it is important to gain deeper insights into their use and trust of health information, which they may employ to help recognize symptoms, learn ways to reduce exposure, or find health care.

METHODS

We surveyed residents (N = 101) of rural Kentucky, Virginia, and West Virginia to assess predictors of health information source use and trust. A project manager administered face-to-face paper and pencil questionnaires assessing demographics, health status, smoking behavior, and health information use and source trust. Bivariate correlations and ordinary least squares regressions were used to analyze the data.

FINDINGS

The data suggest that rural individuals frequently use nurses, doctors, and websites to seek health information, whereas traditional media are often not their preferred channel for health information. Media sources were not found as trustworthy as interpersonal and medical health information sources. While only 13.0% of individuals in the sample said they ever turned to county or state health departments for health information, these sources were trusted more than any media source and more than friends. Moreover, living closer to active mining sites-meaning these individuals are at a higher risk of environmental health hazards-predicted even less use of traditional media and greater trust in peer sources.

CONCLUSIONS

Not all sources of health information are equally used or trusted by individuals from a rural disparities population. The findings have implications for health campaign message dissemination and intervention designs targeting individuals in rural Appalachia.

"Then and Now": Examining the Impact of Temporal Focus on Persuasive Messages across Seniors and Young Adults

BACKGROUND

As the number of seniors around the world continues to proliferate, research devoted to enhancing our understanding of the specific needs of these individuals is warranted. The present research documents how the concept of time influences the preferences and behavioral intentions of older and younger adults in a consumer behavior context.

METHODS

Study 1 had 99 young adults (under 25) and 82 seniors (over 65) rate persuasive advertisements varying in their temporal focus (past vs future vs control). Using a forced-choice paradigm, Study 2 had 98 young adults and 74 seniors choose between a product being advertised using a past versus future frame.

RESULTS

Study 1 indicated that seniors responded more favorably to advertisements presented with a past-focus compared to future-focused and control ads, while younger adults rated the control ads higher than both the past- and future-focused ones. Study 2 reported that seniors opted for a past-focused product more frequently (68%) than a future-focused alternative (32%), with younger adults showing no pattern in their choices.

CONCLUSIONS

Seniors may respond more favorably to persuasive messages framed with a past temporal focus, in turn influencing their preferences and decision-making across several domains including consumer behavior, health promotion, and leadership.

Provision of oral hygiene services as a potential method for preventing periodontal disease and control hypertension and diabetes in a community health centre in Korea

This study aimed to evaluate the effects of a community-based oral hygiene service on general and periodontal health indicators of patients with hypertension and type 2 diabetes mellitus visiting a community health centre in Korea. The study used a one-group pretest-posttest and interrupted time-series design. A total of 151 participants (45% male), with a mean age of 63 ± 8.4 years, were included in the study; these included patients with hypertension (62%), diabetes (12%) and both hypertension and diabetes (26%). Two dental hygienists dedicated 2 days per week to this project, providing oral hygiene services to 10-13 participants per day. Four oral hygiene service sessions were provided per patient. The objective oral hygiene status and subjective self-reported periodontal status were compared before and after the service. The changes in blood pressure and glycosylated haemoglobin levels were also assessed. A lower frequency of subjective swelling was reported at the fourth session (37.9%) compared to the first (55.6%) session. Further, significantly fewer cases of calculus and bleeding were observed (p < .05), and significantly more patients reported having no gum problems at the fourth session (43.1% vs. 27.2%; p < .05) than at the first session. Finally, the participants maintained stable blood pressures at each of the four sessions, and their glycosylated haemoglobin levels were significantly lower at the fourth session. In conclusion, the findings of this study suggest that community oral hygiene services provided by dental hygienists can promote objective oral hygiene and subjective periodontal status in the local community, and may help in the control of hypertension and diabetes.

The Impact of Public Health Awareness Campaigns on the Awareness and Quality of Palliative Care

OBJECTIVE

The right to health includes a right of access to good quality palliative care, but inequalities persist. Raising awareness is a key plank of the public health approach to palliative care, but involves consideration of subjects most of us prefer not to address. This review addresses the question: "do public health awareness campaigns effectively improve the awareness and quality of palliative care"?

BACKGROUND

The evidence shows that public awareness campaigns can improve awareness of palliative care and probably improve quality of care, but there is a lack of evidence about the latter.

METHODS

Rapid review and synthesis.

RESULTS

A comprehensive public awareness campaign about palliative care (including advance care planning and end-of-life decision making) should be based on clear and shared terminology, use well piloted materials, and the full range of mass media to suit different ages, cultures, and religious/spiritual perspectives. Arts and humanities have a role to play in allowing individuals and communities to express experiences of illness, death, and grief and encourage conversation and thoughtful reflection. There is evidence about key factors for success: targeting, networking, and use of specific, measurable, achievable, realistic time-bound objectives; continuous evaluation; and complementarity to national and international policy.

DISCUSSION

Campaigns should be located within the framework of public health promotion and the synergy between short national mass media campaigns and longer term local community action initiatives carefully considered. National and local projects to raise awareness should identify and address any barriers at the level of individuals, communities, and systems of care, for example, literacy skills and unequal access to resources.

UWALK: the development of a multi-strategy, community-wide physical activity program

UWALK is a multi-strategy, multi-sector, theory-informed, community-wide approach using e and mHealth to promote physical activity in Alberta, Canada. The aim of UWALK is to promote physical activity, primarily via the accumulation of steps and flights of stairs, through a single over-arching brand. This paper describes the development of the UWALK program. A social ecological model and the social cognitive theory guided the development of key strategies, including the marketing and communication activities, establishing partnerships with key stakeholders, and e and mHealth programs. The program promotes the use of physical activity monitoring devices to self-monitor physical activity. This includes pedometers, electronic devices, and smartphone applications. In addition to entering physical activity data manually, the e and mHealth program provides the function for objective data to be automatically uploaded from select electronic devices (Fitbit®, Garmin and the smartphone application Moves) The RE-AIM framework is used to guide the evaluation of UWALK. Funding for the program commenced in February 2013. The UWALK brand was introduced on April 12, 2013 with the official launch, including the UWALK website on September 20, 2013. This paper describes the development and evaluation framework of a physical activity promotion program. This program has the potential for population level dissemination and uptake of an ecologically valid physical activity promotion program that is evidence-based and theoretically framed.

Media Outlet and Consumer Reactions to Promotional Activities of the Choose Health LA Restaurants Program in Los Angeles County

OBJECTIVE

This study sought to assess promotional activities undertaken to raise public awareness of the Choose Health LA Restaurants program in Los Angeles County, an environmental change strategy that recognizes restaurants for offering reduced-size and healthier menu options.

DESIGN

We used multiple methods to assess public awareness of and reactions to the promotional activities, including an assessment of the reach of core promotional activities, a content analysis of earned media, and an Internet panel survey.

SETTING

The study was conducted in Los Angeles County, home to more than 10 million residents.

PARTICIPANTS

An online survey firm recruited participants for an Internet panel survey; to facilitate generalization of results to the county's population, statistical weights were applied to analyses of the survey data.

INTERVENTION

Promotional activities to raise awareness of the program included community engagement, in-store promotion, and a media campaign.

MAIN OUTCOME MEASURES

Outcomes included media impressions, the number of people who reported seeing the Choose Health LA Restaurants logo, and a description of the themes present in earned media.

RESULTS

Collectively, paid media outlets reported 335 587 229 total impressions. The Internet panel survey showed that 12% of people reported seeing the program logo. Common themes in earned media included the Choose Health LA Restaurants program aims to provide restaurant patrons with more choices, represents a new opportunity for restaurants and public health to work together, will benefit participating restaurants, and will positively impact health.

CONCLUSIONS

Promotional activities for the Choose Health LA Restaurants program achieved modest reach and positive reactions from media outlets and consumers. The program strategy and lessons learned can help inform present and future efforts to combine environmental and individually focused strategies that target key influences of consumer food selection.

Interventions to promote or maintain physical activity during and after the transition to retirement: an evidence synthesis

Background

It has been argued that transition points in life, such as the approach towards and early years of retirement, present key opportunities for interventions to improve the health of the population. Interventions that may change or preserve activity levels around the time of retirement have the potential to provide benefits in terms of increased health and well-being for people in later life. Research has highlighted health inequalities in health statuses in the retired population and in response to interventions.

Objective

We aimed to conduct a systematic review and meta-synthesis of the types and effectiveness of interventions to increase physical activity among people around the time of retirement. We also aimed to identify factors that may underpin the effectiveness or acceptability of interventions, and how issues of health inequalities may be addressed.

Data sources

The following electronic databases were searched: (1) MEDLINE; (2) Applied Social Sciences Index and Abstracts; (3) The Cochrane Library (including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database); (4) Cumulative Index to Nursing and Allied Health Literature; (5) Science Citation Index; (6) Social Science Citation Index; (7) PsycINFO; (8) Evidence for Policy and Practice Information and Co-ordinating Centre; (9) SPORTDiscus; (10) Social Policy and Practice; (11) Health Management Information Consortium; and (12) Sociological Abstracts. We also searched for grey literature, checked reference lists of included papers and screened other reviews.

Review methods

A systematic review of quantitative and qualitative literature was carried out between February 2014 and April 2015. The searches aimed to identify, first, evidence of effectiveness of interventions for older adults at the point of transition to retirement and, second, data relating to perceptions of barriers and facilitators to intervention effectiveness. A meta-synthesis of the two types of evidence was also carried out to provide further interpretation of the review findings.

Results

A systematic search of the literature identified a large number of potentially relevant studies. Of these, 103 studies examining the effectiveness of interventions and 55 qualitative papers met the criteria for inclusion. A review of the effectiveness literature indicated a dearth of studies that investigate interventions that specifically examine the transition to retirement. More general studies in older adults indicated that a range of interventions might be effective for people around retirement age. The qualitative literature indicated the importance of considering the appeal and enjoyment, and social aspects, of interventions. Although there were a range of different measures in use, many were self-reported and few studies included an evaluation of sedentary time. A meta-synthesis across the data types indicated that elements reported as significant by participants did not always feature in the interventions.

Limitations

Owing to the lack of evidence relating to the retirement transition, we examined the literature relating to older adults. The applicability of these data to people around retirement age may need consideration.

Conclusions

Although the retirement transition is considered a significant point of life change, only a small volume of literature has reported interventions specifically in this period. The included literature suggests that interventions should take account of views and preferences of the target population and evaluate effectiveness by measuring meaningful outcomes and using a control group design.

Study registration

This study is registered as PROSPERO CRD42014007446.

Funding

The National Institute for Health Research Public Health Research programme.

Examining an Australian physical activity and nutrition intervention using RE-AIM

Translating evidence-based interventions into community practice is vital to health promotion. This study used the RE-AIM framework to evaluate the larger dissemination of the ManUp intervention, an intervention which utilized interactive web-based technologies to improve the physical activity and nutrition behaviors of residents in Central Queensland, Australia. Data were collected for each RE-AIM measure (Reach, Effectiveness, Adoption, Implementation, Maintenance) using (i) computer-assisted telephone interview survey (N = 312) with adults (18 years and over) from Central Queensland, (ii) interviews with key stakeholders from local organizations (n = 12) and (iii) examination of project-related statistics and findings. In terms of Reach, 47% of participants were aware of the intervention; Effectiveness, there were no significant differences between physical activity and healthy nutrition levels in those aware and unaware; Adoption, 73 participants registered for the intervention and 25% of organizations adopted some part of the intervention; Implementation, 26% of participants initially logged onto the website, 29 and 17% started the web-based physical activity and nutrition challenges, 33% of organizations implemented the intervention, 42% considered implementation and 25% reported difficulties; Maintenance, an average of 0.57 logins and 1.35 entries per week during the 12 week dissemination and 0.27 logins and 0.63 entries per week during the 9-month follow-up were achieved, 22 and 0% of participants completed the web-based physical activity and nutrition challenges and 33.3% of organizations intended to continue utilizing components of the intervention. While this intervention demonstrated good reach, effectiveness, adoption and implementation warrant further investigation.

Televised obesity-prevention advertising across US media markets: exposure and content, 2010-2011

OBJECTIVE

To examine levels of exposure and content characteristics for recent televised obesity-prevention campaigns sponsored by state and community health departments, federal agencies, non-profit organizations and television stations in the USA.

DESIGN

Nielsen television ratings for obesity-prevention advertising were collected for the top seventy-five US media markets and were used to calculate household exposure levels for 2010 and 2011. Governmental advertisements were coded for content.

SETTING

United States.

RESULTS

Average household exposure to obesity-prevention campaigns was 2·6 advertisements per month. Exposure increased by 31 % between 2010 and 2011, largely driven by increases in federal advertisements. In 2011, the federal government accounted for 62 % of obesity-prevention exposure, non-profit organizations for 9 %, community departments for 8 %, state departments for 3 %, and television station-sponsored public-service announcements for 17 %. The greatest percentage increase between 2010 and 2011 was in community advertising, reflecting efforts funded by the Communities Putting Prevention to Work (CPPW) programme. Among thirty-four state and community campaigns, the majority advocated both healthy eating and physical activity (53 %). Campaigns typically had positive or neutral emotional valence (94 %). Obesity or overweight was mentioned in 47 % of campaigns, but only 9 % specifically advocated weight loss.

CONCLUSIONS

Exposure to televised obesity-prevention advertising increased from 2010 to 2011 and was higher than previously found in 1999-2003, apart from in 2003 during the federal VERB campaign. Nevertheless, exposure remains low relative to advertising for unhealthy foods. New federal campaigns have increased exposure to obesity-prevention advertising nationally, while CPPW grants have increased exposure for targeted areas.

Who do we reach? Campaign evaluation of Find Thirty every day® using awareness profiles in a Western Australian cohort

Mass media campaigns are part of a comprehensive, population-based approach to communicate physical activity behavior change. Campaign awareness is the most frequently reported, short-term comparable measure of campaign effectiveness. Most mass media campaigns report those who were aware with those who are unaware of campaigns. Few campaigns follow awareness in the same respondent, over time, during a mass media campaign to track different patterns of awareness or awareness profiles--"never," "early," "late," or "always"--that may emerge. Using awareness profiles, the authors (a) address any demographic differences between groups and (b) assess changes in physical activity. Find Thirty every day® was a populationwide mass media campaign delivered in Western Australia. The cohort comprised 405 participants, who completed periodic telephone interviews over 2 years. Almost one third (30.4%) were "never aware" of the campaign. More than one third recalled the campaign at one or more time points--"early aware." Ten percent became aware at Time 2 and stayed aware of the campaign across the remaining time. Examining within and across the awareness profiles, only gender was significant. This article provides an approach to profiling awareness, whereby people cycle in and out and few people are "always aware" over a 2-year period. It presents possible implications and considerations for future campaign planners interested in establishing and maintaining campaign awareness with adult populations.

'Get Your Life Back': process and impact evaluation of an asthma social marketing campaign targeting older adults

Background

Asthma in older adults is underdiagnosed and poorly self-managed. This population has little knowledge about the key symptoms, the prevalence among older adults, and the serious consequences of untreated asthma. The purpose of this study was to undertake a multifaceted evaluation of a social marketing campaign to increase asthma awareness among older adults in a regional Australian community.

Methods

A cohort of older adults in an intervention region (n = 316) and a control region (n = 394) were surveyed immediately prior to and following the social marketing campaign. Campaign awareness, message recall, materials recognition, and actions taken as a result of the campaign were assessed in both regions. Asthma knowledge and perceptions, experience of asthma symptoms, and general health were also assessed in both regions at baseline and follow-up. Analyses were conducted to explore the effects of the campaign in the intervention region, and to examine outcomes among different audience segments.

Results

The survey data showed that those in the target segments (Wheezers and Strugglers) had better message recall, and were more likely to report having taken action to control their respiratory symptoms. The campaign significantly increased the number of calls to an asthma information line from the target audience in the intervention community.

Conclusions

A theory-based social marketing campaign conducted over 3-months increased the asthma information seeking behaviours of older adults in the intervention community compared to the control community. Recommendations are outlined for future community health promotion campaigns targeting older adults.

Fruit and vegetable intake among older adults: a scoping review

Older adults are the fastest growing segment of the world population. Older adults are also at heightened risk of chronic conditions (such as diabetes, heart disease, and cancer) and specific geriatric conditions (such as cognitive impairment, frailty, and falls). Research studies have examined the relationship between fruit and vegetable intake and subsequent health outcomes and the correlates of fruit and vegetable intake in the U.S. population. However, relatively few studies have specifically examined health impacts and correlates of fruit and vegetable intake among older adults, who have unique biophysical and socioeconomic circumstances. Evidence is reviewed to (1) describe findings related to consumption and chronic, geriatric, and other health outcomes among older adults and (2) describe patterns in fruit and vegetable consumption among older adults and how these patterns vary within and among populations. This review addresses specific barriers faced by older adults in obtaining and consuming fruits and vegetables in community settings. Recommendations for practice and policy are discussed.

Mixed-methods evaluation in complex programmes: the National Reading Plan in Portugal

This article highlights the evaluation strategies of a complex programme, which were essentially based on a pluralist, integrating approach founded on the use of mixed methods. The programme under analysis is the National Reading Plan (NRP), a public policy initiative that aims to increase literacy levels and reading habits among the Portuguese population. It was evaluated throughout its first phase, which lasted five years (2006-2011), using an evaluation model that made it possible to continuously and systematically monitor and analyse the way in which this programme was developed and implemented. A number of different quantitative and qualitative methodological operations gathered information from a broad range of sources and social actors, covering the vast set of projects promoted by the NRP. We particularly look at the contributions made by mixing methods to the evaluation of the programme's impacts, and point out its potentials when it comes to evaluating wide-ranging, long and complex programmes.

Increased exposure to community-based education and 'below the line' social marketing results in increased fruit and vegetable consumption

OBJECTIVE

To determine if localised programmes that are successful in engaging the community can add value to larger fruit and vegetable mass-media campaigns by evaluating the results of the Eat It To Beat It programme.

DESIGN

The Eat It To Beat It programme is a multi-strategy intervention that uses community-based education and ‘below the line’ social marketing to increase fruit and vegetable consumption in parents. This programme was evaluated by a controlled before-and-after study with repeat cross-sectional data collected via computer-assisted telephone interviews with 1403 parents before the intervention (2008) and 1401 following intervention delivery (2011).

SETTING

The intervention area was the Hunter region and the control area was the New England region of New South Wales, Australia.

SUBJECTS

Parents of primary school-aged children (Kindergarten to Year 6).

RESULTS

The programme achieved improvements in knowledge of recommended intakes for fruit and vegetables and some positive changes in knowledge of serving size for vegetables. Exposure to the programme resulted in a net increase of 0.5 servings of fruit and vegetables daily for those who recalled the programme compared with those who did not (P = 0.004). Increased intake of fruit and vegetables was significantly associated with increasing exposure to programme strategies.

CONCLUSIONS

The Eat It To Beat It programme demonstrates that an increase in consumption of fruit and vegetables can be achieved by programmes that build on the successes of larger mass-media and social-marketing campaigns.This suggests that funding for localised, community-based programmes should be increased.

Source attribution and credibility of health and appearance exercise advertisements: Relationship with implicit and explicit attitudes and intentions

The relationship of attributed source (commercial or nonprofit) and credibility of exercise advertisements to explicit and implicit exercise-related attitudes and intentions was examined. Male and female participants ( N = 227) were randomly assigned to watch health or appearance-related advertisements and then completed an implicit attitudes task and questionnaires. Health advertisements and those attributed to a nonprofit source were rated more credible. Appearance condition participants who attributed the advertisement to a nonprofit source also rated the advertisement as more credible. Participants who rated a commercial advertisement as credible reported higher implicit instrumental attitudes. Implications for exercise promotion are discussed.

Stand-alone mass media campaigns to increase physical activity: a Community Guide updated review

CONTEXT

The goal of the systematic review described in this summary was to determine the effectiveness of stand-alone mass media campaigns to increase physical activity at the population level. This systematic review is an update of a Community Guide systematic review and Community Preventive Services Task Force recommendation completed in 2001.

EVIDENCE ACQUISITION

Updated searches for literature published from 1980 to 2008 were conducted in 11 databases. Of 267 articles resulting from the literature search, 16 were selected for full abstraction, including the three studies from the original 2001 review. Standard Community Guide methods were used to conduct the systematic evidence review.

EVIDENCE SYNTHESIS

Physical activity outcomes were assessed using a variety of self-report measures with duration intervals ranging from 6 weeks to 4 years. Ten studies using comparable outcome measures documented a median absolute increase of 3.4 percentage points (interquartile interval: 2.4 to 4.2 percentage points), and a median relative increase of 6.7% (interquartile interval: 3.0% to 14.1%), in self-reported physical activity levels. The remaining six studies used alternative outcome measures: three evaluated changes in self-reported time spent in physical activity (median relative change, 4.4%; range of values, 3.1%-18.2%); two studies used a single outcome measure and found that participants reported being more active after the campaign than before it; and one study found that a mass media weight-loss program led to a self-reported increase in physical activity.

CONCLUSIONS

The findings of this updated systematic review show that intervention effects, based wholly on self-reported measures, were modest and inconsistent. These findings did not lead the Task Force to change its earlier conclusion of insufficient evidence to determine the effectiveness of stand-alone mass media campaigns to increase physical activity. This paper also discusses areas needing future research to strengthen the evidence base. Finally, studies published between 2009 and 2011, after the Task Force finding was reached, and briefly summarized here, are shown to support that finding.

Physical activity mass media campaigns and their evaluation: a systematic review of the literature 2003-2010

Internationally, mass media campaigns to promote regular moderate-intensity physical activity have increased recently. Evidence of mass media campaign effectiveness exists in other health areas, however the evidence for physical activity is limited. The purpose was to systematically review the literature on physical activity mass media campaigns, 2003-2010. A focus was on reviewing evaluation designs, theory used, formative evaluation, campaign effects and outcomes. Literature was searched resulting in 18 individual adult mass media campaigns, mostly in high-income regions and two in middle-income regions. Designs included: quasi experimental (n = 5); non experimental (n = 12); a mixed methods design (n = 1). One half used formative research. Awareness levels ranged from 17 to 95%. Seven campaigns reported significant increases in physical activity levels. The review found that beyond awareness raising, changes in other outcomes were measured, assessed but reported in varying ways. It highlighted improvements in evaluation, although limited evidence of campaign effects remain. It provides an update on the evaluation methodologies used in the adult literature. We recommend optimal evaluation design should include: (1) formative research to inform theories/frameworks, campaign content and evaluation design; (2) cohort study design with multiple data collection points; (3) sufficient duration; (4) use of validated measures; (5) sufficient evaluation resources.