What awareness campaigns can tell us about health behavior change
What campaign evaluations measure, and what their findings can tell us
A poster goes up. A hashtag spreads. A public service announcement airs. Afterward, a report says millions of people saw it.
That is useful information. But it leaves a quieter question open: did anyone do something differently? Researchers who study health campaigns keep returning to the gap between knowing about a message and acting on it.
A recent look at how campaigns are evaluated
In February 2026, Zandonai and colleagues published a systematic review in Health Education Research. They examined 21 evaluations of public health campaigns on health promotion, substance use prevention and physical activity. They reported that only four of the 21 studies clearly stated their process-evaluation objectives. In other words, most of the reviewed studies did not clearly state what their process evaluations aimed to examine.
Two limits matter here, and we want to state them plainly. First, this review looked at how campaigns were evaluated. It did not estimate how often campaigns change health outcomes, and it does not tell us that campaigns without clear objectives failed. Second, the count is the authors' own coding of the studies they selected. The authors recommended clearer evaluation goals and stronger links between implementation evidence and campaign improvement. They also noted limits of their own, including English-only selection and very different study designs. The review was funded by an Italian government health ministry committee.
Older evidence, read with care
The studies below were published more than a year ago, so we present them as background, not as new findings. Each is a review of other people's studies, and each covers a specific topic.
Mental health on social media. A scoping review by Plackett and colleagues, published in the Journal of Medical Internet Research on 23 May 2025, looked at social-media mental health campaigns in high-income countries. Only one of eight before-and-after studies showed positive change in the review's behavior category, which included intentions as well as service use and other activities. All 12 comparisons of campaign-aware and unaware participants found positive associations. These two results come from different designs and should not be compared directly. Neither shows that a campaign caused the differences, because people who notice a campaign may differ from those who do not.
Antibiotic use. A rapid systematic review in BMC Public Health, published on 6 February 2024, covered 41 studies of campaigns about antimicrobial resistance. It found some evidence of improvements in knowledge and antibiotic-use measures. Because many studies were observational, causal conclusions were limited.
Tobacco. A 2017 Cochrane review (21 November 2017) found evidence that comprehensive tobacco-control programs that include mass-media campaigns can change adult smoking behavior. The studies varied and other influences were present at the same time, so the media component's separate contribution was difficult to isolate. The evidence was rated very-low certainty. A companion Cochrane review of youth smoking, published on 2 June 2017, found mixed results, also with very-low-certainty evidence.
What the pattern suggests
Put these together and a careful reader can draw modest conclusions. Evidence on campaigns is mixed. Awareness, attitudes, intentions, behavior and health outcomes are different things, and a study that measures one does not speak for the others. Reach and recall are not the same as better health, and engagement numbers should not be read as health results. And many studies cannot separate the effect of a campaign from everything else happening around it.
We are not saying campaigns do not work, or that most fail. None of these sources estimates a failure rate, and we will not invent one.
A better question to ask
When you see a campaign, a useful question is not only "how many people saw it?" but also "what did the organizers say they wanted to change, and how did they plan to find out?"
Clear objectives, honest measurement and open reporting of limits make a campaign easier to learn from, whatever the result. Without them, even a well-run campaign leaves its audience, its funders and its own staff guessing about what actually worked, and why. This is the same habit behind sound evaluation in any community health effort.
Where GIHEW fits
GIHEW's programs are in development. As they take shape, we want to plan communication and evaluation together from the start: say plainly what we hope will change, measure it carefully and share what we learn, including what did not work.
Join the conversation
If you work in health communication or community health, we would like to hear from you. How do you tell whether a campaign did more than raise awareness? Reach out through the GIHEW website and share your experience.
Sources
| Source | Date | Publisher | Link |
|---|---|---|---|
| Zandonai et al. Evaluating public health campaigns on health promotion, substance use prevention and physical activity: a systematic review | 27 Feb 2026 | Health Education Research 41(2):cyag008 | https://doi.org/10.1093/her/cyag008 (full text: https://pmc.ncbi.nlm.nih.gov/articles/PMC13017709/) |
| Plackett et al. Social media mental health campaigns: scoping review | 23 May 2025 | Journal of Medical Internet Research 27:e68124 | https://pmc.ncbi.nlm.nih.gov/articles/PMC12144482/ |
| Gilham, Pearce-Smith, Carter, Ashiru-Oredope. Antimicrobial resistance campaigns: rapid systematic review | 6 Feb 2024 | BMC Public Health 24:396 | https://doi.org/10.1186/s12889-024-17766-w |
| Bala, Strzeszynski, Topor-Madry. Mass media interventions for smoking cessation in adults | 21 Nov 2017 | Cochrane Database of Systematic Reviews CD004704 | https://pmc.ncbi.nlm.nih.gov/articles/PMC6486126/ |
| Carson-Chahhoud et al. Mass media interventions for preventing smoking in young people | 2 Jun 2017 | Cochrane Database of Systematic Reviews CD001006 | https://pmc.ncbi.nlm.nih.gov/articles/PMC6481357/ |
Global Wellbeing Institute is a new organization and its programs are in development. We do not report program results.