Development and Evaluation of a Research-Driven Health Communication Campaign to Increase Fruit and Vegetable Consumption Among SNAP-Eligible Ohio Adults
Authors: Hofer Rebecca , Wilkin Margaret K. , Mayers Elizabeth , Wolford Brenda K. , Butler Brian , Beavers Blaire , Zubieta Ana Claudia 
Published: September 2021

Background: Despite evidence of the protective effects of a diet high in fruits and vegetables, intake among Ohio adults remains low. A health communication campaign is an attractive behavior change intervention due to its potential to reach a large audience. Focus of the Article: This study aims to examine the development of a state-level health communication campaign and to assess outcome measures relative to fruit and vegetable intake. Research Question: Two research questions were evaluated: (1) How did Ohio State University Extension use formative research to inform the campaign’s development? and (2) Was campaign exposure associated with increased fruit and vegetable consumption or readiness to increase fruit and vegetable consumption among the target audience comprising Ohio adults eligible for the Supplemental Nutrition Assistance Program (SNAP)? Program Design/Approach: Ohio State University Extension conducted extensive formative evaluation prior to developing the Celebrate Your Plate health communication campaign. The campaign was designed to increase the target audiences’ fruit and vegetable consumption, reinforce messages taught in nutrition education classes, and reach a larger segment of the population with messages promoting healthy behaviors. The campaign was implemented statewide through a multi-year phased rollout and comprised a mix of printed and digital communication channels and an accompanying website. Supportive individual- and community-level programming was also implemented by Ohio State University Extension as part of a multilevel approach to increasing fruit and vegetable intake. Importance to the Social Marketing Field: The limited existing research on the effectiveness of health communication campaigns to increase consumption of healthy foods largely focuses on national campaigns and this study examines effectiveness of a locally tailored campaign. Methods: This study comprised a mixed-methods multi-stage evaluation: qualitative data were collected in four pilot counties to assess the target audience’s awareness and reception of the campaign and recommendations for future efforts. Cross-sectional post-implementation outcome evaluation data were collected and analyzed to assess campaign exposure and behaviors of the target audience. Results: During the pilot evaluation, the target audience responded positively to campaign materials and identified the perceived cost of healthy recipes as a main barrier to changing eating patterns. After the campaign was rolled out statewide, approximately 18% of the target audience indicated exposure to Celebrate Your Plate in aided recall. Campaign exposure was significantly associated with higher fruit ( p < .001) and vegetable ( p < .001) consumption. The Stages of Change model was used to conceptualize readiness to increase fruit and vegetable consumption; campaign exposure was significantly associated with readiness to increase fruit ( p = .001) and vegetable ( p = .027) consumption. Recommendations for Research or Practice: Results of this study show that campaign exposure is significantly associated with higher fruit and vegetable consumption and readiness to consume more fruits and vegetables among the target audience, though more rigorous evaluation is needed to determine causality. Limitations: This study included cross-sectional data and lacked a control group and consequently cannot be used to determine if behavioral observations resulted from campaign exposure. Additionally, this study relied on self-reported data and is susceptible to response biases.