Health Education Research Advance Access originally published online on January 17, 2008
Health Education Research 2008 23(3):522-542; doi:10.1093/her/cym084
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Effectiveness of health-promoting media literacy education: a systematic review
1 Health Promotion Sciences Division, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
2 Department of Health Sciences, New Mexico State University, Las Cruces, NM 88003, USA
* Correspondence to: L. J. Bergsma. E-mail: lbergsma{at}u.arizona.edu
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Abstract |
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Media literacy education to promote health among youth involves them in a critical examination of media messages that promote risky behaviors and influence their perceptions and practices. Research on its effectiveness is in its infancy. Studies to date have been conducted with more or less rigor and achieved differing results, leaving many questions about effectiveness unanswered. To elucidate some of these questions, we conducted a systematic review of selected health-promoting media literacy education evaluation/research studies, guided by the following research question: What are the context and process elements of an effective health-promoting media literacy education intervention? Based on extensive analysis of 28 interventions, our findings provide a detailed picture of a small, 16- to 17-year (1990 to July 2006) body of important research, including citation information, health issue, target population/N/age, research design, intervention length and setting, concepts/skills taught, who delivered the intervention and ratings of effectiveness. The review provides a framework for organizing research about media literacy education which suggests that researchers should be more explicit about the media literacy core concepts/skills they are including in their interventions, and should more carefully address who delivered the intervention with what fidelity, in what setting, for how long and utilizing what pedagogical approach.
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Introduction |
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In recent decades, health professionals have increasingly recognized that the media have a significant influence on the health of young people. In their review of research on the media's influence on health, the Committee on Public Education of the American Academy of Pediatrics stated: ‘Research has shown primary negative health effects on violence and aggressive behavior; sexuality; academic performance; body concept and self image; nutrition, dieting, and obesity; and substance use and abuse patterns’ [1, p. 423].
Some researchers estimate that youth spend 33–50% of their waking hours with some form of mass media [2]. According to the Kaiser Family Foundation [3], children and teens are spending an increasing amount of time using ‘new media’ like computers, the Internet and video games, without cutting back on the time they spend with ‘old’ media like television, print and music. Their Generation M: Media in the Lives of 8-18 Year-olds study found that the total daily media exposure of young people increased from 7:29 to 8:33 hours between 2000 and 2005, counting time as double when multi-tasking with two different forms of media. The large amount of time youth spend with media makes it critical to address related health concerns.
Public health professionals have used many strategies to address the effects of media on health. Regulating media content, limiting children's media use and social marketing are approaches that have been used traditionally, but media literacy education has emerged in the last 20 years as a promising alternative to the censorship of regulating ‘unhealthy’ programming or limiting media use [4]. Media literacy has been defined as ‘the ability to access, analyze, evaluate, and create media in a variety of forms’ [5, p. 21]. Rather than trying to protect youth from potentially harmful messages, media literacy education to promote health involves them in a critical examination of media messages that influence their perceptions and practices. It is designed to give youth the critical thinking skills necessary to ameliorate the influence of these messages and make healthy choices. Media literacy has been recommended as an effective health promotion strategy by a number of respected organizations, including the American Academy of Pediatrics, the Office of National Drug Control Policy and the Centers for Disease Control.
Even though the field of media literacy education effectiveness research is in its infancy, several studies have tested the ability of various media literacy curricula to teach young people how to analyze media messages and to improve their choices on a variety of health topics. Because these studies have been conducted with more or less rigor and achieved differing results, however, many questions remain. ‘In spite of research, policy and advocacy centers, Web sites, and a movement largely among educators, there is little evidence to suggest that media literacy efforts are either widespread or effective’ [6, p. 205]. To date, there has been no comprehensive review of the research literature on media literacy interventions with a health promotion purpose, nor has there been an attempt to analyze the research to determine components that make such interventions effective.
For these reasons, we conducted a systematic review of recent publications about health-promoting media literacy interventions, with the intent of developing a framework for analysis of components that may make such interventions more or less effective. The conference report on Setting Research Directions for Media Literacy and Health Education stressed the need to document the different contexts, processes and outcomes of health-focused media literacy education [7]. To initiate this, we analyzed selected interventions to identify four dependent variables relating to context and process (intervention setting, intervention length, concepts/skills taught and who taught the intervention) and assigned a rating of effectiveness based on outcomes. Our review was guided by the following research question: What are the context and process elements of an effective health-promoting media literacy education intervention?
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Methods |
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The methodology used was a systematic review in which we examined the evidence regarding health-promoting media literacy education, using explicit methods to identify, appraise and select relevant primary research and to extract and analyze data from the studies selected for review. ‘Systematic reviews provide information about the effectiveness of interventions by identifying, appraising, and summarizing the results of otherwise unmanageable quantities of research’ [8, Phase 1, p.4]. While statistical methods (meta-analysis) may be part of a systematic review, the heterogeneity of the studies reviewed, particularly with regard to outcome measures, precluded statistical comparison [9], although we used rudimentary quantitative measures, such as percentages, where appropriate.
Literature search
Given the multi-disciplinary nature of the media literacy field, we searched the following indexes: CINAHL Plus, Communications Abstracts, Communication and Mass Media Complete, Dissertation Abstracts, ERIC, Expanded Academic ASAP, Health and Safety Science Abstracts, MEDLINE, PsycINFO and Social Sciences Abstracts. Studies were identified by using the following keywords: media literacy, media education, television education and media analysis. For indexes not health related, the keyword ‘health’ was also used. Studies were also located by reviewing the references of primary studies considered, in addition to some articles and reports published about media literacy in recent years [7, 10, 11]. To further locate appropriate studies, a preliminary list of sources being considered for inclusion was circulated to several experts in the field, resulting in some additional recommendations.
The literature search was conducted initially by the first author. All publications found were given to the second author who did her own search and found several additional studies for a total pool of 65 publications that were reviewed and considered for inclusion. Only 26 met the study selection criteria detailed below.
Study selection
The criteria we used to determine study inclusion or exclusion were as follows:
- Studies were published in English from 1990 through July 2006.
- Studies were peer reviewed (including journal articles, conference proceedings and dissertations) and were publicly available through a searchable index.
- The sample, study design, intervention, evaluation measures and analysis were described.
- Studies included an experimental media literacy intervention of 25 or more minutes in length, designed to improve the health of youth.
- The study focused primarily on teaching critical media literacy skills and did not use media literacy as a small part of a larger curriculum.
The time frame for study inclusion was selected because there have been no comprehensive reviews of media literacy interventions since 1990 [12], although the research has continued to advance. Studies that were available to us but were in press as of July 2006 were excluded from the analysis [13].
The sample was limited to peer-reviewed publications due to concerns that non-peer-reviewed sources would describe less rigorous experimental procedures and data. We debated this decision, however, because the youth of the field of media literacy education research and the small number of studies that met our criteria made it seem useful to include sources that had not undergone peer review but were readily available publicly and seemed to contribute to the field [14–16], including a study [17] that was reported in a chapter of an edited book.
Some studies were excluded because they did not describe a rigorous experimental evaluation of a specific intervention [18, 19]. One article was excluded because, while it provided information about the qualitative evaluation conducted, none of the quantitative evaluation measures were described and results were not reported [20]. Another study was excluded because the media literacy intervention it used was only 3–5 minutes in length [21]. Interventions less than 25 minutes in length were deemed to be too short to teach critical media literacy skills and allow students to practice them using an inquiry approach, which is an essential pedagogical tenet of media literacy education [22]. While most of the selected studies focused the intervention directly on youth, one study was selected in which the intervention was given to adult caregivers with a focus on improving the home nutrition environment to promote the health of preschoolers [23].
As stated in the fifth criterion above, interventions needed to focus on teaching ‘critical media literacy skills’ which were operationalized as the following abilities, based on the Center for Media Literacy's definition [5, p.21]:
- To access useful information in the media.
- To analyze media messages using critical thinking skills (being able to identify bias and credibility of a source, differentiate fact from opinion, determine if a message is unrealistic, understand a message's purpose).
- To evaluate a message (to determine its truth, applicability).
- To create media messages which achieve specific goals.
To be included in this review, the intervention needed to teach at least one of the four skills listed above. Although critical media literacy skills may have been taught in three studies reviewed, they were excluded because it was not clear that this was the case [24–26]. Several studies that focused on teaching youth the skills to resist advertising pressure to smoke cigarettes were excluded for the same reason. Criterion 5 above also stated that the intervention must focus ‘primarily’ on teaching critical media literacy skills. This distinction was made because some studies incorporated a small media literacy component in their intervention as part of a larger curriculum that taught other knowledge or skills which may have influenced effectiveness findings [27, 28].
Some studies were excluded because they focused mainly on reducing television use instead of teaching critical media literacy skills [29–31]. Although one of the sources selected did include the concept of reduced television use in its intervention, it was included because it allowed participants to make informed decisions about media use, rather than simply teaching them that media use should be avoided [32]. Most of the study inclusion or exclusion decisions were made independently by the second author, based upon the criteria established by both authors, and reviewed by the first author. Where there was any question, the authors discussed their conclusions and a final decision was made by consensus.
During peer review of the manuscript, five additional studies were recommended for inclusion. Upon review, we found that one study [33] did not meet selection criterion 3, and two studies did not meet criteria 4 and 5 [34, 35]. Two of the recommended studies were included [36, 37].
Twenty-three studies in 26 publications met the inclusion criteria [23, 32, 36–59]. The same data from two of the 23 studies were reported in two publications, and two articles reported on different measures and analyses extracted from the same research study. Data from these publications were grouped and considered as one study.
Data extraction and analysis
To enable extraction and analysis of a large quantity of data, we developed an extensive database of information for each of the selected studies. The following sections detail first, general descriptive data, and second, data that were extracted and analyzed for each measure.
General descriptive data
Table I contains descriptive data about the selected sample. Twenty-eight interventions were detailed in the 23 studies because two studies employed multiple experimental groups that experienced different media literacy interventions: Austin and Johnson [40] (two interventions) and Byrne [43] (three interventions). In addition two studies had multiple interventions but only some of them were judged to be media literacy interventions: Wilsch, Tiggemann, and Wade [37] three of five and Irving and Berel [48] one of three.
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Health issues included nutrition (two studies), nutrition/eating disorders prevention (nine), body image (one), substance abuse prevention (five) and violence prevention (six). Eighteen studies recruited participants from schools, two from both schools and community groups and three from non-school locations. Participant sample size ranged from 17 to 723.
Studies were categorized according to target age as follows: children (aged 11 and below/Grade 6 and below), adolescents (aged 12–19/grades 7–12) and college students (mean age 22 and below). When a study targeted youth in different categories, it was categorized according to the larger number of participants. Thirteen studies targeted children, seven adolescents and three college students.
Each study's research design is included in Table I. While in most cases the research design was stated explicitly, in some instances it was inferred from the methodology description. Because all the studies used a quasi-experimental design, this descriptor was omitted from Table I. Most of the studies selected utilized quantitative measures, a few utilized some qualitative measures as well and one utilized qualitative measures only [36]. Nineteen studies had one control group, one study employed two different control groups [52] and three studies had no control group [37, 39, 50].
Intervention setting
Intervention settings were grouped into the following categories: (i) in-class (intervention took place in class during regularly scheduled class time), (ii) in-school (intervention took place at a school, outside of the regular classroom), (iii) community groups or (iv) location not specified (Table II). Analysis revealed that 19 interventions took place in-class, one both in-class and in community groups, three in school outside of a regular class or after class, three in community groups and two studies did not specify the intervention setting.
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Intervention length
This measure was defined as the number of minutes allotted to the intervention, excluding time for pre-tests, post-tests and re-tests. When the intervention took place in a specified number of class sessions, based on analysis of K-12 and college class length, we assigned an average value of 45 minutes to a class session. When it was clear that the pre-test or post-test had been given during the time designated for the intervention but the pre-test/post-test time was unspecified, we assumed that each evaluation measure took 15 minutes. When a range was provided for the intervention length, we computed an average. Analysis revealed that intervention length ranged from 25 minutes to 24 hours. To better compare these lengths with intervention effectiveness, we grouped them into the following categories: short (60 minutes or less), average (1–5 hours) or long (more than 5 hours). There were 11 short interventions, nine average, and eight long (Table II).
Concepts/skills taught
Because the Center for Media Literacy's ‘Core Concepts of Media Literacy’ [5] has been used widely in the United States, where most of the selected studies were published, we used this framework to assess concepts and associated skills taught. Determining core concepts and associated skills taught required reviewing the publication multiple times and making many interpretations because most studies did not specifically state whether they taught any core concepts. The following guidelines were used to categorize interventions:
- All media messages are ‘constructed’. Intervention taught about how the media differs from reality, evaluating what is shown compared with real life experiences, or the producer/production of media messages.
- Media messages are created using a creative language with its own rules. Intervention taught about recognizing advertising/production techniques or creating/producing media messages.
- Different people experience the same message differently. Intervention explored how media affect people, what people can do to avoid negative effects of media or that people can take action to change the media.
- Media have embedded values and points of view. Intervention taught how to identify stereotypes, myths, biases, values, lifestyles and/or points of view represented in or omitted from media messages.
- Most media messages are constructed to gain profit and/or power. Intervention taught about the purpose of advertising or marketing strategies, skepticism toward advertising or creating counter-advertising.
Analysis revealed that the core concepts and associated skills were taught with the following frequency: one (in all 28 interventions), two (17), three (19), four (28) and five (13) (Table II).
Because our decision to investigate the presence of the core concepts in the selected studies was based on prior knowledge of media literacy, rather than a selection of themes that would emerge from analysis of each text, we analyzed the publications for additional types of knowledge taught. Table II documents the two themes that emerged from this analysis: how media affects health (17) and knowledge about the targeted health issue (14).
Who delivered the intervention
Analysis of each intervention revealed that the person who most frequently delivered the intervention was the researcher (11). In one study, the researcher was assisted by the class instructor. In six studies where the person who delivered the intervention was not specified, we assumed it was a member of the research staff. Other modes of delivery included teen peers (four), some by themselves and some in teams of two. Two interventions involved the use of college students: one utilized a trained undergraduate student and another utilized the classroom teacher assisted by a graduate student. Classroom teachers were the primary person delivering the intervention in three cases, although one intervention utilized a series of school television broadcasts facilitated by teachers using a guide. In one study, the intervention was delivered by Girl Scout troop leaders (Table II).
Intervention effectiveness
‘Intervention effectiveness’ was difficult to assess, due in part to the many different health issues addressed and research designs, theoretical models and outcome measures used. Effectiveness was defined very differently in each of the studies, which made it impossible to impose a common framework upon them. In an attempt to find elements by which to compare the studies, the following information was compiled for each intervention: health issue, research design, theoretical approach, intervention outcomes (Table III), results at pre- and post-test, results at re-test (delayed post-test) and elaborated results. In addition, we recorded how much significant change the intervention achieved on its measures at post-test and re-test.
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This method of standardizing each study's evaluation excluded considerable information. For example, in the research by Austin and Johnson [38–40], analyses were conducted to compare each measure's success in predicting outcomes on other measures, as hypothesized in their Message Interpretation Process Model. By choosing to focus only on the media literacy intervention's direct effect on each of the selected measures, a great deal of useful information was excluded. For this reason, we included an elaborated description of each study's results in the database that was developed from which to determine the effectiveness ratings.
As we reviewed the outcome evaluation measures to identify ways in which they might be grouped, we found that all of them fell into one of the following categories: knowledge, attitudes, behaviors, risk factors for the health problem, intentions, skills or process evaluation. Then we re-reviewed the measures and their results and recorded which measures corresponded with each category and the amount of statistically significant change that the intervention achieved for each category at post-test and re-test.
Using all of the information compiled about the results of each study, as well as background knowledge about each theoretical approach and the strengths/limitations of each research design, we attempted to make an unbiased rating of each intervention's effectiveness. Given the diversity of the data available for comparison, we determined that each study's rating of effectiveness would primarily be a function of whether the intervention appeared to achieve a significant change on evaluated measures that were of importance according to the selected theoretical approach. Interventions were rated for short-term effectiveness (outcomes at post-test) and long-term effectiveness (outcomes at re-test), on a scale of one to five, with five being the highest effectiveness. All 24 interventions rated included a post-test and 12 included a re-test yielding a total of 36 assigned ratings (Table II). Note that the two studies recommended for inclusion during peer review could not be assessed using the same procedures and raters due to the fact that the research team was no longer intact. These studies are included in Table II, but are marked NR for not rated.
Several measures were taken to insure the reliability of effectiveness assessment. First, each intervention was labeled with a number and interventions were sorted randomly so that each reviewer got a differently ordered data set. Second, the two authors independently made their ratings at different times with little conversation about how to do it and provided only with the data described above for each study and some basic information about theoretical models used. Finally, two public health graduate students independently rated the interventions based on the same information. In two cases where the reviewers were evenly split, the rating of the senior researcher was used.
Using Cohen's kappa, inter-rater statistics were calculated to measure agreement on assigning the interventions to effectiveness categories. A kappa statistic of >0.61 indicates a substantial strength of agreement [60]. When the rating was 1, the kappa statistic was 0.91; when the rating was 5, the kappa statistic was 0.80 and when the rating was 2–4, there was more variability in the kappa statistic. Overall, all four raters had a kappa statistic of 0.63 for all ratings. The effectiveness ratings were entered into a database (Table II) and used as an independent variable against which to analyze each of the four dependent measures.
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Results |
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Results of our systematic review were as follows.
Intervention setting
Table II illustrates the relationship of intervention setting with short-term and long-term effectiveness. Because the majority of the interventions occurred in classrooms, in-class interventions were well represented at every level of effectiveness. Insufficient numbers of the other intervention settings prevented detection of a clear relationship.
Intervention length
Table II shows that short interventions were somewhat more likely to be rated as ineffective (rated 1–2), whereas longer interventions were more likely to be rated as effective (rated 3–5), although several interventions did not follow this pattern. For example, two interventions of Austin and Johnson [40] were only 45 minutes, but they were given the highest effectiveness rating. Conversely, the Neumark-Sztainer et al. [51] intervention and the Sprafkin et al. [54] intervention were both long (540 and 420 minutes, respectively) but were given a rating of 2.
Concepts/skills taught
When examining the media literacy core concepts/skills taught, effective interventions seemed somewhat more likely than ineffective interventions to have taught all the core concepts. Table IV gives percentages for the amount that each core concept was taught in short-term and long-term effective and ineffective interventions.
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Because core concepts one and three were taught in 100% of all cases, it is impossible to determine how they contributed to the effectiveness or ineffectiveness of the interventions. Differences between effective and ineffective interventions were evident for core concepts two and five when these variables were compared with the measure of short-term effectiveness. For core concept two, 73% of effective interventions taught this concept, as compared with 44% of ineffective interventions. For core concept five, 73% of effective interventions taught this concept compared with 33% of ineffective interventions. Differences in the same direction were found for core concept five when compared with long-term effectiveness ratings, but the same did not hold for core concept two. For core concept three, the relationship was in the opposite direction with more short-term ineffective interventions (88% ineffective versus 73% effective) and more long-term ineffective interventions (86% ineffective versus 40% effective) teaching this concept.
Effective interventions appeared to be somewhat more likely to have taught knowledge about the targeted health issue: 73% effective compared with 22% ineffective at short term. Interestingly, ineffective interventions appeared to be more likely to teach participants about how media affect their health: 77% of ineffective compared with 53% of effective interventions at short term and 86% of ineffective compared with 20% of effective interventions at long term.
Who delivered the intervention
There seemed to be some association between who delivered the intervention and effectiveness at short term, with 10 (73%) of the 15 effective interventions and four (44%) of the nine ineffective interventions being delivered by research staff (Table II).
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Discussion |
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Media literacy education has the potential to be a useful health-promoting strategy for ameliorating a number of harmful health behaviors. To date, however, evidence for its potential is based more on theory than on rigorous demonstrations of efficacy or effectiveness. In this review, we have documented a selection of peer-reviewed studies in which media literacy education has been used to promote health among youth, and have taken a first step toward developing a framework for research that will ultimately determine the effectiveness of this health promotion strategy. The research question that guided this effort was ‘What are the context and process elements of an effective health-promoting media literacy education intervention?’
Because this field of research is relatively new, there is a limited pool of studies that have been reported, and those that are available vary greatly with respect to intervention, methodological precision and outcome measurements. As a result, we conducted a systematic review of a small sample of studies with no statistical analysis of results that can lead to correlations of context and process variables with effectiveness ratings. The most definitive trends in this review emerged around the variables concerning the intervention setting (context) and who taught the intervention (process).
Our review shows a clear trend that most health-promoting media literacy programs are conducted in classrooms. Although it is interesting to speculate on why this is so, the data provide no reason to believe that health-promoting media literacy education programs conducted in community or other non-school settings would not be effective.
More of the short-term effective interventions were delivered by research staff than by others. It seems reasonable to assume that research staff would be more familiar with the concepts and more facile with the pedagogical techniques of the intervention than someone who had received a limited amount of training (e.g., others who were trained to deliver the educational program in some of the studies received anywhere from an hour to a day of training). This finding is also corroborated by many observations of the first author in her own work and discussion with others who train people to incorporate media literacy education into their curricular areas. It often takes teachers, who are trained in the concepts and skills of media literacy education, at least a year of consistent practice to become skilled enough that they can readily identify and facilitate media literacy teachable moments in which they feel confident with allowing students to discover concepts for themselves [5, 61].
Although we would like to draw more global conclusions from the data regarding intervention length and concepts/skills taught, our review does not provide definitive trends with regard to these variables. What the data do tell us is that there has been a number of both effective and ineffective health-promoting media literacy education programs that have varied widely with regard to length and concepts/skills taught. Both effective and ineffective interventions may be short or long. Although it makes intuitive sense that education provided for a longer period of time should result in greater change, because the participants have more opportunity to learn media literacy concepts and practice associated inquiry skills, we cannot draw this conclusion from our review. Although the most effective interventions seemed somewhat more likely to have taught all of the core media literacy concepts as well as knowledge about the targeted health issue, because of the small sample size, the data on concepts/skills taught in each intervention is inconclusive as to whether certain core concepts may have more or less impact on effectiveness.
Our review results outline characteristics of the majority of the important health-promoting media literacy studies that were conducted from 1990 through July 2006, including health issues addressed (nutrition, body image and eating disorders; violence and alcohol and tobacco abuse). We were unable to locate studies about media literacy education interventions focused on prevention of unsafe sexual behaviors, even though this is a key health concern. There is some evidence that this type of education is taking place [62], but we could find no peer-reviewed research on media literacy curricula that address this issue. This may be due to the human subjects protection concerns involved with children under 18, as well as the fact that many educational settings shy away from dealing with this controversial issue.
Limitations
Despite our methodological efforts to minimize bias and errors, it is important to note that this review relied on many subjective judgments. For example, the literature search was a collaborative effort of both authors and could have been done more systematically to improve yield. Even though we utilized numerous methods to identify studies that met our selection criteria, we inadvertently omitted studies that would have contributed to this research, as evidenced by study inclusion recommendations emanating from peer review.
Systematic reviews are also biased by the amount of textual, table and figure information allowed by the journals in which the studies are published. For example, studies describing lengthy media literacy curricula are often forced to omit important details about methodology used, such as specific skills taught or pedagogical approach used. Contacting the primary investigator of each study would probably clarify some questions about methods used, but was beyond the scope of this study. An example of this bias can be found in our own reporting of this review. Spatial limitations for tables prevented us from including several additional columns of data that we extracted and textual limitations prevented us from citing every study considered and the reasons for excluding each one.
Our assignment of intervention effectiveness ratings could also be biased by several factors. For one, the ratings were influenced by the number and type of outcome measures in each study. This made results difficult to compare because some studies demonstrated significant change on all of the variables they measured, but did not investigate many factors. Conversely, other studies that measured more variables found significant change on several important factors, but were portrayed as having a low percentage of change overall because a difference was not detectable on many variables.
Another limitation of the present review is that the methodology used cannot determine if the four selected measures are the main factors responsible for effectiveness of health-promoting media literacy education. In fact, media literacy education proponents maintain that successful media literacy education results not so much from ‘what’ is taught as ‘how’ it is taught [58, 63]. Although intervention setting, length and who taught the intervention provide some information about how these health-promoting media literacy interventions were taught, investigating the pedagogical approach used would more significantly inform the ‘how’ question. Media literacy education is grounded in inquiry-based, process-oriented pedagogy. Unfortunately, whether the pedagogical approach used in the sample studies was one of inquiry or indoctrination was unclear. Only curriculum review and observation of its teaching can provide reliable data on pedagogical approach.
Implications and recommendations
Systematic literature reviews that identify both what we know and do not know can help in planning new research [8]. The main benefit of this review is that it provides a detailed picture of the health-promoting media literacy education research that has been conducted and published in the years from 1990 through July 2006. This information can help future researchers interested in investigating both what context and process elements make a health-promoting media literacy education intervention effective and what are the outcome measures that best demonstrate effectiveness. It should also provide support to health educators wanting to implement media literacy education as a health promotion strategy, but facing questions from others about its effectiveness.
Likewise, the effectiveness analysis of intervention outcomes provides some insights that may help to improve the health and media literacy outcomes of such efforts. The majority of outcomes involved knowledge and attitudes and revealed less about actually preventing or changing risky health behavior which would demonstrate an effective intervention. This has implications for the fact that we need to design studies which measure more behavioral outcomes such as amount of smoking, or clinical outcomes such as BMI change. Our review did succeed in quantifying effectiveness to allow for analysis of four variables across many different types of studies. We hope the current review will inform the work of other researchers to clarify the outcome measures that best demonstrate health-promoting media literacy education effectiveness.
Future research is needed to examine other aspects of media literacy education that could be responsible for effectiveness. For example, researchers could analyze the pedagogical style used, the amount/type of training provided to the instructor, the key concepts and skills taught, the health behavior theory used to guide the intervention, etc. Studies could also be analyzed specifically for variations among participants of different ages, genders, races/ethnic groups, socioeconomic status or other demographic variables.
This review provides a framework for organizing research about media literacy education. Our analysis and discussion of the dependent measures suggest that researchers should be more explicit about the media literacy core concepts/skills they include in their interventions, and should more carefully address who delivered the intervention with what fidelity, in what setting, for how long and utilizing what pedagogical approach. Although it was not published at the time this review was conducted, the Alliance for a Media Literate America's (AMLA) Core Principles of Media Literacy Education [64] served as an implicit foundation for developing our inclusion criteria and determining what variables to explore since the lead author of this review was one of 10 authors of the Core Principles, published in April 2007. The AMLA's Core Principles document now provides a significant foundation for developing media literacy education research frameworks in the future.
Overall more research evaluating the effectiveness of media literacy education to address a variety of relevant public health concerns is greatly needed. The small size of the sample that met the criteria for inclusion in this review is indicative of the lack of peer-reviewed research on health-promoting media literacy education. Additional rigorous research, carefully reported using the measures established in the framework for this review, and those additional measures recommended in the discussion, especially pedagogical approach and more definitive outcome measures, will help to improve media literacy education and advance it as a useful health promotion strategy.
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Acknowledgements |
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Many thanks to Sue Forster-Cox, Assistant Professor, New Mexico State University, for her help in preparing the thesis that led to this article. Thanks also to Jennifer Peters, Mel & Enid Zuckerman College of Public Health, University of Arizona, for her help in preparing the tables.
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References |
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. References marked with an asterisk indicate studies included in the systematic review.
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Received on October 23, 2006; accepted on October 16, 2007
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