Thursday, December 16, 2010

A social science critique on the Looking Glass foundation’s campaign to raise awareness of anorexia - Ilyana Sori

Many public health interventions are created to correct an unhealthy behavior. There are many approaches that can be used to address different reasons as to why people decide to take part in a certain behavior. In the case of one specific public health campaign that helps adolescents fight anorexia, an intervention was created with the slogan “not every suicide note looks like a suicide note”. This campaign was created by the Looking glass foundation, founded in 2002, which is “a Vancouver-based, non-profit organization, whose goal is to develop Canada's first residential centre in British Columbia for the professional treatment of adolescents with eating disorders” (1). This specific public health campaign does not mean to offend or do harm to anyone who battles with anorexia, instead these advertisements where created to raise awareness of this mental and physical illness. While I do agree that awareness is important, I believe that the foundations campaign is flawed in a few ways. First, the advertisements fail to address the fact that people behave irrationally. Second, each advertisement uses techniques from theories that are out dated, such as the Health belief model and finally, large minority groups and males are excluded from the advertisements.
These flaws are especially important to correct because it is critical that more people be able to relate to this campaign. The more people who can relate the more successful the campaign and center will be and the larger the scope of awareness will be. Additionally, the delivery of the campaign should be as powerful as the slogan “Not every suicide note looks like a suicide note”, as well as the idea that “Small signs add up to reveal that girls are suffering from eating disorders.” (2) This critique shows that by using group level models we can strengthen the awareness campaign to fight this deadly disease. The arguments that follow make clear that there are other important factors to consider when creating a public health campaign not just the individual’s behavior or the facts of why the behavior is harmful.

Failure to address irrational behavior
The series of advertisements featured in this campaign range from a poster with a diary entry from a young girl about how she felt that day, to a commercial with a young girl weighing herself in a locker room and marking down the weight she has lost. Every advertisement is dark, gray, shows the extreme side of the disease, and every young girl is alone. These initial reactions to the campaign are negative ones that do not raise awareness for the issue. By using extreme images the advertisements illicit the response of fear in may viewers, which is not a value many people appreciate. This campaign as a whole does not consider certain core values that are important to adolescent girls. Each advertisement also assumes a fundamental attribution error, and labels the girls that are associated with the disease in a negative light. These missing ideas in the campaign account for the fact that people behave irrationally.
Core values are an important factor when considering why people believe what they do, and why they engage in many behaviors. A few core values include beauty, control, youth, happiness, and strength. When a person views a commercial where these values are held high, there is a positive response for that commercial and people will want to be like those featured in the commercial. Commercials that make people question their physical appearance target core values, which is another reason why campaigns like this one should also target positive core values because people with anorexia have trouble mentally dealing with the value of beauty specifically. In the commercials for this campaign none of these values are being portrayed. The extreme aspects of the disease are the only things beings portrayed. Whether this campaign is directed towards those who live with anorexia or their loved ones, positive core values will make both groups of individuals interested in learning more about the organization and getting involved.
The assumption of the fundamental attribution error is the idea that “…people are often quick to draw conclusions about the attitudes and personalities of others- even when plausible external or situational causes for behavior exist…” (8) These conclusions often lead to incorrect representations of the people who engage in a certain behavior. A lot of the stigma that is associated with anorexia is partly because the general public believes that people choose to starve themselves, but a lot of research has already been conducted that proves those stigmas are wrong (2). There is no need to continue showing images and words such as suicide that contribute to the cycle of that stigma.
Similar to the idea of core values is the idea of labeling. These commercials only portray extreme situations and not those instances where the disease is just starting. There is no indication of prevention in any of these commercials or poster advertisements. If these are the only images the public is exposed to, the early signs of the disease that many girls exhibit may not be noticed because there are no images of that stage of the illness. There is a negative portrayal in these commercials of those who have anorexia, which beings the process of labeling. Each story in the commercials shows the girls alone and exposed, images that illicit a strong emotional response from the viewers. These emotional responses may not be productive when they have already labeled girls who have anorexia the way they see these girls in the commercial. People may not see the disease in their loved ones because it may not be this extreme yet.
Use of outdated and incomplete public health methods
Each advertisement focuses on the individual, with the exception of the slogan. The health belief model and the theory of reasoned action are two ideas that are used to create these announcements. These are the most common and most used individual based models in public health. They suggest that the certain behavior a person is engaging in is planned, reasoned and then acted out. As I have previously argued, people’s actions are irrational, therefore the way these models assume people plan and reason before acting is false. This is not to say that these theories should be disregarded completely, they are a good starting point, but they also should not be the only models an intervention is based off of.
The health belief model is based on the idea that perceived severity, perceived benefits, perceived barriers (6) measure the likely hood a person will engage in a health behavior. If the perceived benefits, which are positive outcomes of the behavior, outweigh the perceived severity, which are the negative outcomes of engaging in this health behavior, and there are none or little perceived barriers, then a person will engage in a certain behavior. This is the traditional and most common way of explaining why people have negative health habits. “Over the past four decades, the Health belief model (HBM) has been one of the most widely used psychosocial approaches to explaining health-related behaviors. Initially developed in an effort to explain the widespread failure of people to participate in programmers to prevent to detect disease.” (6) If after forty years, this approach has not been very successful there is no reason to continue using it as the main model for intervention. These advertisements attempt to raise awareness that this is a dangerous disease, but of course the general public already knows that if you do not eat you will suffer health complications and eventually die. This generation is so different from past generations. Issues that were once taboo are now controversial issues that are being debated and discussed to find a resolution, which is another indication that changing times need new and improved models that take into consideration the development of a changing society.
Another theory that presents itself in this campaign is the theory of reasoned action. This theory “…is based on the proposition that an individual’s behavior is determined by the individual’s behavioral intention (BI) to perform that behavior, which provides the most accurate prediction of behavior (Fishbein and Ajzen, 1975). Behavioral intention is a function of two factors: one’s Attitude toward the behavior (A) and Subjective Norm (SN)”. (10) Attitude is generally defined as the positive or negative feelings towards a behavior, while subjective norm is the perceived attitudes other people have of you if you engage in a certain behavior. These two factors of the model are important especially for these commercials because this is a representation of young girls with the disease from the perspective of an organization, which may or may not have expert advice, but as a whole these representations may not be accurate and resonate with everyone who has anorexia. When someone with anorexia views this commercial they may be reluctant to look for help or talk about their problem because it may not be as extreme as the cases shown in these advertisements. If both attitude and subjective norms are positive then the person will consider stopping the unhealthy behavior. The negative images these commercials portray may have an adverse affect for those who have anorexia. They may believe that the general public only sees them as disfigured and dangerously skinny. It is important to label someone that is already sensitive about labels in a positive light, not in a negative one that these girls are portrayed as in these commercials and poster advertisements.
Exclusion of males and minority groups
In this particular intervention the advertisements do their best to portray the way an adolescent teen girl with anorexia would look and act. Throughout the series of advertisements there is no representation of males or a member of a minority group with anorexia. Along with acting irrationally people respond to those that are more similar to them, or situations they can relate to as stated in the idea called principle of communication theory. If the goal of the campaign is to raise awareness that this is a deadly mental illness, why should they leave out parts of the population that are also affected? There seems to be an institutional racism, and as stated in the first argument, an additional labeling problem that should be addressed in order to make this campaign more effective.
None of the advertisements featured include men or people from minority groups, therefore it is not a complete representation of the people that are effect. This exclusion brings the assumption that members of those groups do not suffer from anorexia. Research has been done that shows that people with anorexia come from all different groups in different communities. “Anorexia nervosa,[…], has one of the highest mortality rates among psychiatric disorders” (4) which means that there should be an all inclusive campaign that raises awareness of the debilitating disease. Additionally there should be a representation of the foundations mission in the campaign that it releases to the public. It is also proven that “[…] for thousands of young women and men, the mirror has a darker side. Rather than a true reflection, theirs is a distorted reality.” (9) It is the reality of how the people with anorexia feel that should be addressed in these advertisements because people already know the adverse effects and complications of not eating.
The problems of institutional racism are subconscious but apparent when the campaign is analyzed. “The Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, illustrates how the social hierarchy that exists in society plays an important role in explaining differences in the quality of care provided to People of Color in the United States.” (3) By not acknowledging that people with anorexia can also be found in communities of color perpetuates that idea that there are different diseases that affect the white community and communities of color. This idea leads to doctors and other health professionals incorrectly diagnosing or treating children who show signs of anorexia, who are not white young girls from a middle class family. They may see the acting out the result of behavioral problems or rebellion, when that is not the case.
The “We Beat Anorexia” Campaign
In order to correct these flaws I believe there should be one commercial that goes along with these current commercials which addresses all the flaws and details that were left out previously. This commercial will feature a large group of kids who have battled with the disease and won. The adolescents will represent each racial and ethnic group, as well as a range of ages and males and females. It will take place on a field where all the adolescents will be standing behind a banner that says “We Beat Anorexia and So can you”. They will also be wearing t-shirts that have a single word on them. Each word will represent a core value that each participant finds significant for them. The song Secrets by One republic will play as the camera scans the crowd showing the words written on the shirts. This is a popular song that many people can relate to along with the ability to relate to the crowd of kids. The words featured will be words such as beauty, security, happiness, family etc. After the camera is done scanning the crowd, it will focus on one of the individuals who will say “Be a part of the crowd, stand up for your right to feel comfortable in your own skin.” Each adolescent will then turn around and show the looking glass foundation logo that is located on the back of each shirt. The shirts will also be red because it is a unisex color that stands out in a crowd and makes an impression if a large group of people are also wearing the same color. A narrator will then have a similar message of hope just like the original campaign at the end of this commercial, with the music fading out. By using the ideas behind the advertising theory, the branding model, principle of commitment, and the principle of communication theory, the flaws the previous advertisements have will be closer to being eliminated.
These models focus on the effects of group behavior and the influence groups and society have on the individual, instead of focusing on the just the individual. With these flaws eliminated it will create a stronger, more effective campaign to raise awareness and increase treatment. There are many reasons why people want to be included in a group, and there are also many reasons why pointing out specific core values are an important way to get people’s attention to raise that awareness and change attitudes.
Advertising Theory to support the cause of awareness
The idea of the advertisement theory is to sell an idea not a health behavior. When a person is told repeatedly that their behavior is not healthy, not normal, they will not respond positively towards the health initiative. When they are instead told to buy into a product or an ideal that is positive and others also agree with, it will be easier to inform the consumer what the initiative is really about. By promising the consumer an ideal, supporting it with positive images and appealing to core values, people will be more receptive and listen to the message behind the flash of the advertisement. It is important to have the right support for the large promise because it is easy to send out the wrong message. In a book called Confessions of an advertising man, the author Ogilvy “[…] argues […] that advertising set within rules can be creative, and also more effective than those without rules. The rules to build a great campaign are as follows. 1. What you say is more important than how you say it: the information you give is more important to the consumer than the way you present it. 2. Unless your campaign is built around a great idea, it will flop: in order for people to be affected by the advertising, it has to be something new original.” (11) Ogilvy’s ideas further support the idea that having advertisements that just state why the health behavior is wrong will not change the bad habits of people.
In the new intervention I proposed previously the advertising theory is used by promising viewers and those with anorexia that there is a way to get help and if they do they will be able to accept themselves physically and mentally. This promise is supported by the adolescents portrayed in a serious manner, where they are not seen in an extreme light because not everyone that has anorexia is at a dangerous weight. The students also have t-shirts that have words that are core values which further. The fact that these teens have all battled anorexia and gained their confidence and health back is another positive support for the promise that others with anorexia can get help and treatment too to continue with their lives in a positive, healthy manner. This theory is the starting point in creating an effective, positive, and powerful campaign to raise awareness of the seriousness of the disease.
In addition to the promise being supported by the group, use of a popular song is also included in this advertisement. Recently One Republic was feature on the Top 40 list of popular music. This association with popular culture also creates a sense of familiarity. It is a catchy song that ties in the message of the campaign and the aesthetically pleasing image of the commercial. Instead of the gloomy, dark, and lonely portrayal of those with anorexia in the current advertisements of the Looking glass foundation, this commercial will have more light because it will be outside and that light will help embody the message of hope.
Core Values Exposed By Using the Branding Model
The second model that is featured in this new intervention campaign is called the Branding Model. In this theory the campaign and advertisements are used to create a set of associations people remember when they think of a specific campaign. “Public health brands have traditionally focused on increasing target audiences’ awareness of various health issues (agenda setting) and increasing awareness and encouraging adoption of preventive behaviours to reduce disease and injury. Following lessons from commercial marketing, public health campaigns can be even more successful by developing brand positionings that go beyond being simply informative, and begin to establish relationships with their target audiences. ” (13) There are many examples of this branding method in anti-smoking campaigns. The association could be a group, a t-shirt, a button, a slogan, or a word. People are usually interested in participating in something that is well known and respected. Core values are also involved in this theory. If the association is coupled with core values it makes the message even stronger. The goal for the branding model is to create something that people will feel they are a part of.
The “Be a part of the crowd” campaign is a brand that advertises awareness and the looking glass foundation itself. The general public will be able to associate this campaign with the slogan and the t-shirts that have the core values written on them. If people with anorexia receive treatment at the clinic they will also be able to receive one of the t-shirts. Being a part of the crowd creates a sense of belonging that patients with anorexia may struggle with. The slogan in itself includes words that hold as core values for many people. People will often associate the word “Right” with the idea of freedom, which is a very strong core value because without freedom there is no control. The positive portrayal of this side of the initiative to bring awareness to the general public will resonate more with people to want to change and create change more than just the harsh images in the original campaign and advertisements.
The general public will in turn associate the initiative towards awareness and treatment for anorexia with the core values depicted in this advertisement. Extreme images will no longer be needed to stress the fact that this is a one of the most deadly mental illnesses that adolescents face today. The brand that will now be associated with treating adolescents with anorexia will be a positive group initiative that stresses the importance of intervention and understanding of the causes and development of this mental illness. Branding this campaign will also take away some of the negative and misinformed stigma that is present when talking about anorexia. People will be more comfortable talking about treating the disease. When attacking the individual behavior, as many times is done when using the health belief model or other individual based models, we are missing a huge part of the social context that is involved in the development.
Two Additional Principles used to support Group behavior
To further support the idea that a group model is more effective than an individual based model is shown with the principle of commitment or the dissonance theory, as well as by the principle of communication. Both principles deal with the fundamental idea that people will act and keep an opinion if they feel that they are a part of a group. Even though there are specific aspects of each principle that distinguishes it from the other they work together to create a strong argument for group models. When used along with other models and theories, such as the advertising theory, the intervention is able to change the ideas of the general public without explicitly telling them to change. This advertisement does not lecture the general public to be aware of the seriousness of the disease; it is an advertisement that creates an association with the initiative, which in turn creates awareness in a positive light.
The idea behind the principle of commitment or dissonance is based on “one of the most fundamental states of conflict in human behavior which can be heightened by decision making is that between the need for openness and flexibility, on the one hand, and structure and consistency on the other. […] as one becomes personally involved in an issue or sees a direct relationship between his self concept and an object or person, the exact nature of this compromise may change. He may wish to interpret such objects, issues, and events in a manner consistent with important beliefs, especially following decisions in which psychological commitment and observable behavior combine to increase personal involvement.” (12) Simply put, if a person decides to engage in a certain behavior, and it turns out that that behavior is harmful, they will change their opinion and view of the situation to support their behavior because the idea of being wrong is more harmful to them than the behavior is.
Another point of the principle that is important to address is “to what extent does one approach a situation less than openly, guided by experience and expectations and recognizing, identifying and evaluating stimuli according to what one “knows” is there?” (12) People are less likely to enter a situation with an open mind when they already have preconceived notions of a situation. They stick to what they know. Along with this principle and the idea that people agree with what they think they know and understand is the principle of communication. The idea behind this principle especially in the case of making a persuasive argument, or when the need arises for awareness, people will relate to situations, if they have a similar experience or a similarity to the person that is presenting the information. It is important to note that people will not respond simply because of the way the message is portrayed, the message must also be important and powerful in itself.
These two principles are specifically used in the “Be a part of a crowd” campaign because there are so many different people involved in the campaign. The children range from different ages and they are all from different ethnic and racial backgrounds. There are many people that are now able to associate with this campaign. Males will also now be included which will raise awareness that males also have anorexia. Once the idea that there are a range of people who have anorexia the mind of a large population in the general public will change because there is now visual evidence in a campaign that the disease affects a wide range of people from different ages. The general public will now be more willing to understand the initiative and be more aware of the campaign because the can relate to a less extreme depiction of anorexia.
When considering in creating a public health campaign, it is important to consider the audience the campaign is being created for, can the act be explained using a group level model in a more effective way, is the advertisement and initiative inadvertently leaving out any members of the population that are also affected, and is message being conveyed the right one, are all important aspects of the campaign to think about. Core values are also an important aspect of gaining the audience’s attention. When people are able to associate, understand and feel comfortable with an initiative there will be a larger educational gain of the problem. That is when it is possible to gain followers and change the ideas of a population.
The looking glass foundation is an initiative that means has positive intentions with the means to change the ideas of a population. It is difficult to have a campaign that is not as effective as the foundation would like it to be. The idea of awareness is already there for the intervention but the flawed aspects of the campaign do not allow it to be a strong and effective message. They do strike an emotional cord because the images portrayed are devastating and concerning. They do not, however, appeal to a positive and hopeful message. These flaws make the campaign incomplete and therefore this campaign does not succeed in its ultimate goal of greater awareness and eventually treatment for those living with anorexia.

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