The concept of secular social change in health communication studies emanates from the findings of quasi-experimental community and group randomized trials of health promotion campaigns. Specifically, many longitudinally designed intervention studies have discovered that outcome variables of interest (e.g., knowledge, beliefs, behaviors) often show changes over time trending in the same direction both in the intervention groups – where the campaigns have been introduced – and in the “control” communities or groups, though often stronger in the former than the latter (Finnegan & Viswanath 2002).
Findings suggest therefore that secular change is continuous though not constant. Because of this, the goal of health intervention trials often is to demonstrate that change can be accelerated beyond the secular trend in control communities or groups. This has important ramifications for health communication theory and application through intervention and study design and measurement.
Context of Secular Social Change
Many fields of study regularly examine secular trends to explain and sometimes predict large-scale cycles of human activities, events, and outcomes. Thus economists have observed long-term trends in such complex areas as the relationship between population savings and consumption in order to understand the dynamics of economic growth. A field such as epidemiology examines trends in diseases such as cardiovascular diseases and the associated factors that cause or ameliorate them. Sociologists and communication scientists often examine phenomena such as diffusion of innovations to understand the adoption or transformation over time of social and behavioral habits, practices, and policies, or the spread of new technology (Rogers 2003).
Historians, too, examine long-term trends to understand the development of societies and nations across centuries, often using statistical models. Whatever the field of study, the concept of secular social change depends critically on longitudinal measurement across some period of time to produce a meaningful trend. However, the interpretation and significance of the trend will depend importantly on the theoretical framework propelling the analysis and the hypothesized pathways and dynamics of how change is thought to occur.
Theory and Application in Health Communication
According to the Oxford English Dictionary, the Latin word for “secular” in the early Christian west referred to the world outside the structure of the Roman church. By analogy, the concept has been adapted in health communication intervention studies to refer to the world “outside” the domain (defined, for example, as a group or community) of intervention for change. So the analysis of change or difference is by way of comparing what happens over time to a group or community that experiences an intervention or campaign and what happens to those not so exposed. A key question arises: does the intervention produce a change in outcomes measured over time that exceed the secular trend in unexposed groups or communities? In this sense, secular change includes all the factors, variables, and dynamic interactions that shape the health outcomes of groups, communities, or societies.
In broad strokes, health communication theories encompasses dynamic models that seek to explain and predict dependent variable outcomes across a wide range of objects of study – from the individual to groups, organizations, communities, and whole societies and cultures. Theories group around different levels in this micro-to-macro continuum, reflecting different change outcomes, processes, and dynamics appropriate to each level of analysis (Finnegan & Viswanath 2002). In the field of social and behavioral health, these are depicted as spheres of influence in the social ecological model (Coreil et al. 2001). That is, human behavior is understood to be shaped and channeled in the context of social dynamics at different levels of associative relationships: interpersonal, family, affiliations, organizations, social institutions (such as the communication media), communities, and whole societies.
These dynamic relationships socialize us preferentially to behave in some ways and not others. How change in mass behavior may be stimulated will differ according to the sphere of influence within which change is sought. For example, health behavior campaigns relying upon mass education strategies seek generally to stimulate mass voluntary behavior change by providing information about healthier behaviors, emphasizing benefits over barriers, building self-efficacy to adopt changes in the context of relevant values and expectations. Other change strategies address mass behavior only indirectly by focusing, for example, on decision-makers and their policymaking roles (e.g., bans on smoking in work places or seat-belt laws).
Secular Social Change and Health Campaigns
In the 1970s and 1980s, several large US federally funded intervention studies sought to reduce cardiovascular disease (CVD) risk factors and to promote heart health in whole communities. Five factors distinguished these studies from previous such campaign efforts. These studies: (1) sought to improve health outcomes among generally healthy populations at the community level; (2) used quasi-experimental designs in which communities were randomized to intervention or “control” conditions; (3) used longitudinal designs including comparative baseline and intervention effect measures over multiple years; (4) tested a wide variety of intervention strategies, including media and other channels; and (5) also included multiple nested studies examining the effects of intervention strategies on specific sub-groups in the communities (e.g., school children, smokers).
Although each study showed significant but modest positive risk factor changes, these were ultimately overtaken by strong secular changes in the reference communities. That is, while the campaigns produced significant change in intervention communities for a time, secular trends in the reference communities often closed the gaps by campaigns’ end (Winkleby et al. 1997). In contrast to the overall analysis, many strategy-specific experimental sub-studies nested within the larger community trials demonstrated strong effects in changing heart disease risk behaviors and factors (Fortmann et al. 1995).
In seeking to account for the strength of secular trends, Finnegan and Viswanath (2002) identified the central role of the mass media. (1) Significant secular improvement in heart disease had been occurring in the United States since the 1960s and accelerated during the period of the large community trials. This was likely due to improvements in clinical diagnoses and treatment and increasing adoption by the healthy persons of preventive behaviors. (2) The expansion of media systems and coverage of heart disease accelerated these changes. (3) The agenda-building activity of federal and state government agencies, private health groups, public health advocates, and scientists were key influences in turning the media’s interest toward more and better news coverage of heart disease prevention research. (4) From a design and analysis perspective, the power to detect difference hinged in part on relatively stable reference community trends. In a highly dynamic secular trend, the models lacked power to detect difference as a function of the limited number of assigned units (communities) and the limited number of measurement points over time (community-by-year means). (5) The campaign intervention models of the large American community trials were framed also in the expectation of relatively little change in reference communities, especially in exposure to heart disease prevention information and programs. They did not anticipate either major growth in community media systems or the increased dissemination of heart disease prevention news, information, and programming. They were thus unable to sustain a significant difference in exposure over time.
CVD campaign studies also demonstrated that socio-economic groups do not benefit equally from either the forces of campaigns or the power of secular change. In the realm of the CVD prevention campaigns, studies have demonstrated the differential impact between higher and lower socio-economic scale (SES) groups in secular trends including smoking, exposure to CVD prevention information; prevention knowledge, campaign effects, and improvement in heart disease outcomes (Winkleby 1997).
Health Campaigns, Secular Social Change, And The Future
Findings about secular change and public health campaigns suggest that researchers focus more attention on implications of change theories; study design and analysis; and robust campaign planning, implementation, and evaluation management and monitoring. Theory importantly shapes and informs health campaign research. However, the research itself sometimes suffers from a lack of clarity in how change is hypothesized to occur (e.g., pathways and dynamics), or how it may create effects differentially across population subgroups, as in the case of lower SES groups, which typically change more slowly. The impact of this is that there can be disparities in the alignment of theory, research goals, and campaign or program composition designed to achieve the ends of the research. This can be a particular problem where campaign research is large-scale, complex from a behavioral and social change standpoint, and multidimensional from the standpoint of usable intervention strategies. It requires careful planning to create the necessary alignment and to assure that a robust intervention is delivered consistently and with appropriate strength over the designated period of time.
In the area of study design and analysis, researchers suggested that an appropriate power analysis driving quasi-experimental study designs should consider models better able to detect smaller differences, as well as pay attention to important indicators of secular social change in progress or with the potential to overtake the campaign effect difference (Murray 1998). Along these same lines, Fishbein (1996) noted that public health campaigns using controlled designs are usually powered to detect medium-to-large effect differences in outcomes. In comparison to effect sizes commonly achievable and regarded as successful in the commercial realm (e.g., a 1–2 percent increase in market share), he argued that public health expectations of achievable behavior change are unrealistic and unwarranted. Unrealistic expectations of social and behavioral change and underpowered study designs unable to detect difference beyond secular social change can combine dangerously to undermine the public’s and policymakers’ commitment to and support for the importance of public health and health promotion.
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- Winkleby, M. A. (1997). Accelerating cardiovascular risk factor change in ethnic minority and low socioeconomic groups. Annals of Epidemiology, 7(S7), S96–S103.
- Winkleby, M., Feldman, H. A., & Murray, D. M. (1997). Joint analysis of three US community intervention trials for reduction of cardiovascular disease risk. Journal of Clinical Epidemiology, 50(6), 645–658.
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