A healthy lifestyle campaign by-youth-for-youth: the challenge of empowerment and the potential of collaboration
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Unhealthy lifestyle choices contribute to New Zealand’s highest risk factors for causes of death (Maddison, Turley, Legge, & Mitchelhill, 2010; Ministry of Health, 2004; World Health Organization, 2009a), and youth are particularly prone to unhealthy behaviours (Adolescent Health Research Group, 2008; Gerritsen, Stefanogiannis, & Galloway, 2008; Maddison, Turley, Legge, & Mitchelhill, 2010; University of Otago & Ministry of Health, 2011). While social marketing and the use of social media are widely recognised as a practical way to create societal change, they have received little attention from academics (Bandura, 2001a; Chou, Hunt, Beckjord, Moser, & Hesse, 2009; Evans & Hastings, 2008; Ledford, C. J. W., 2012; Thornley & Marsh, 2010). Action research provides a participatory, democratic, and collaborative methodological framework (Cardno, 2003; Greenwood & Levin, 1998; Reason, 2006), which is recommended for health promotion in general (Chui, 2007; Naidoo & Wills, 2009; Ridgley, Lombardo, Morrison, Poland, & Skinner, n.d.; World Health Organization, 1986, 1997) and social marketing in particular (Thornley & Marsh, 2010). This study is novel as it tests the potential of these aforementioned features in combination, while building on the established knowledge base in health promotion and social marketing for youth. The research question of this study is “How can a social marketing campaign by-youth-for-youth promote change in lifestyle attitudes and behaviours in a secondary school setting?” A secondary school provided the research setting and Year 12 and 13 students became the participants and co-researchers. Employing the action research cycles as suggested by Coghlan and Brannick (2014), participants collaboratively constructed the issues (Phase 1) and planned the action in a design thinking workshop (Phase 2). Focus groups provided validation and deepening of the qualitative findings. A large-scale survey resulted in quantitative data, representing the student body. In the action phase (3), a steering group engaged in leading the intervention, which contributed to mini-cycles. The concluding evaluation phase (4) comprised interviews with student participants and the contact teacher, a health and campaign survey, and a media analysis. Continuous reflections helped to translate findings into evidence to analyse research themes and answer the four subsequent research aims. Results hence included - the current status quo regarding health and wellbeing attitudes and behaviours, - the understanding how we can develop and implement a social marketing campaign by-youth-for-youth, - what this campaign needs to look like, and - what effect it can have on the target group’s health attitudes and behaviours. Students were capable of thinking big and considering the necessary mid-stream (i.e., peer communication) as well as up-stream (i.e., collaboration with policy-makers) factors, as noted in recent publications (Andreasen, 2006; Carrigan & Dibb, 2013; Evans & Hastings, 2008; Thornley & Marsh, 2010). The participants’ passion, enthusiasm, and agreement in Phase 1 and 2 indicated strong potential and support for the campaign. Not all plans translated into action due to the challenge of empowerment theme, which comprised the sub-themes of responsibility and helplessness. These were interrelated with support and collaboration. Students, teachers, and management had voiced strong support, but practised collaboration was missing to enable the project. All phases hinted at misperceived norms regarding health attitudes and campaign image. This finding indicates the difficulty of health promotion to youth in general and reveals the potential of the social norms approach (Burchell, Rettie, & Patel, 2013). The analysis resulted in strong evidence for the potential of the planned concept as well as theoretical and practical implications for future projects.