Research on media framing of public policies to prevent chronic disease: A narrative synthesis

TL;DR: Media research is crucial to understanding the complex ways in which attitudes towards policy interventions shape, and are shaped by, public discourses and can provide public health advocates with insights into strategies to successfully position policy arguments, and highlights key insights and gaps.

About: This article is published in Social Science & Medicine.The article was published on 2019-09-01 and is currently open access. It has received 24 citations till now. The article focuses on the topics: Public policy & News media.

Summary

1. Introduction

• Chronic diseases, such as diabetes, cancer, and coronary heart disease are the leading cause of death and disability globally (World Health Organization, 2014).
• Such approaches aim to effect change within the system and focus on reshaping social norms and conditions rather than relying upon individual behaviour change.

Available online 19 July 2019

• Achieving progress in chronic disease prevention and public health more broadly is therefore likely to require the active involvement and support of both the public and policymakers (Australian Public Service Commission, 2007; Frieden, 2014).
• Media coverage in turn plays a crucial role in the agenda setting process by influencing policy makers' perceptions of policy issues, their urgency and the acceptability of policy solutions (Hawkins and Holden, 2013; Russell et al., 2016; Weishaar et al., 2016).
• Katikireddi et al. (2014) demonstrated how a change in the framing of alcohol as a policy issue in Scottish media enabled policy makers to consider minimum unit pricing as a feasible policy intervention that was subsequently adopted.
• In recent years there has been a proliferation of research into the framing of issues related to chronic disease, including risk factors, causes and solutions in public discourse, particularly news media (Rowbotham et al., 2019).
• The authors aimed to identify patterns in how issues are framed across policies and risk factors and examine the potential impact of such arguments on public attitudes towards policy interventions.

2. Methods

• This study builds on an earlier scoping review of the literature on media portrayal of issues related to chronic disease prevention (Rowbotham et al., 2019).
• The authors examined a subset of articles from the original scoping review to explore in more depth how policies addressing risk factors for chronic disease have been framed within the media, and the impact of such framing on attitudes towards policy interventions.
• Full details of the original search process are reported elsewhere (Rowbotham et al., 2019) and are summarised in the Supplementary Materials.

2.1. Identification of articles

• The original scoping review contained 499 studies.
• To identify the subset of studies to be synthesised within this paper the authors first identified studies about policy interventions in news media or the impact of exposure to news media on beliefs or attitudes towards policy interventions.
• Then, the authors ran title and abstract searches using keywords (policy, regulation, tax, legislation, law) to identify additional relevant articles.
• Two reviewers (SR and MM) independently reviewed the full-texts of all identified articles against the inclusion criteria and disagreements were discussed and resolved.

2.2. Data extraction

• The authors developed a data extraction template to extract key study characteristics, research focus, sample and methods, media channel, and health topics and policies covered.
• The authors also extracted more detailed information on the findings of each study, particularly relating to sentiment (i.e. degree to which media coverage supports or opposes policy intervention) and framing of media coverage.
• As this was a secondary analysis, data extraction focused on the key findings as reported by the papers in their sample, with data being drawn from the results sections of included papers.
• The authors tested data extraction forms before use, and continually refined these during data extraction.
• One reviewer (MM or LM) extracted the details of each full-text article and another reviewer (LM or SR) checked extracted data to ensure consistency in the information extracted.

2.3. Data synthesis

• The authors took a thematic approach (see Braun and Clarke, 2006) to data synthesis, and coded data inductively to identify key themes across studies.
• In synthesising the data, the authors focused primarily on how policy issues were framed.
• The authors began with free coding of the extracted data followed by synthesis of data into key themes and sub-themes.
• In identifying key themes, the authors sought out patterns both within and across topic areas in order to capture the similarities and differences in how these issues have been framed.
• The authors refined the final set of themes through ongoing discussion with the research team.

3.1. Description of the sample

• The majority were conducted in the United States (n=26), followed by Australia (n=13), and the United Kingdom (n=5).
• The earliest study in their sample was published in 1997, and the number of studies increased steadily over time (see Fig. 1).
• The majority of studies were analyses of media coverage of policy issues (n=42) and employed content analysis to explore key themes in policy coverage.
• See Table 1 for a summary of specific policies covered by the studies in their sample for each of the three topic areas.

3.2.1. Media sentiment towards policy intervention

• Twenty-nine studies considered media sentiment, i.e. the degree to which media coverage was supportive of, neutral or opposed to policy intervention (see Fig. 2 for an overview).
• Across these studies, coverage was predominantly supportive both for regulation in general and of specific policies (see Fig. 2).
• Other alcohol policies receiving predominantly positive sentiment included general alcohol regulation (Azar et al., 2014), alcopop tax (Fogarty and Chapman, 2011), and minimum unit pricing (Patterson et al., 2015a).
• Across the studies in their sample, sentiment towards sugarsweetened beverage (SSB) tax was mixed; while Niederdeppe et al. (2013) found coverage to be more often supportive, Donaldson et al. (2015) found that most stories in their analysis framed the issue in oppositional terms.
• Sentiment towards specific tobacco control policies varied depending on policy type, with coverage of bans on smoking in cars (Freeman et al., 2008; Hilton et al., 2014; Patterson et al., 2015b), smoke-free parks and beaches (Moshrefzadeh et al., 2013), smokeless tobacco control (Wackowski et al., 2013), and tobacco tax (Thrasher et al., 2014) being predominantly supportive.

3.2.2. Framing of arguments for and against policy interventions

• The authors identified five overarching frames used to argue for and against policy interventions within the studies in their sample.
• Arguments in support of alcohol and nutrition policy often invoked the need for protection of other groups in addition to children, particularly the need for protection of low income populations and cultural minorities from being targeted as consumers and to reduce disproportionately high consumption in these groups.
• Societal framing was rarely used in arguments opposing policy interventions, except in discussions of taxation of tobacco and SSB, where a frequent argument was that the tax would disproportionately affect vulnerable groups, particularly those with low income.
• Economic arguments centred on the potential impacts of policy on businesses, health revenue, and the general economy, and were invoked across all three policy areas (smoking, alcohol and nutrition), particularly in arguments opposing policy interventions.
• Lima and Siegel (1999) found that 24% of articles identified smoking as a problem due to costs in healthcare and lost productivity, while McLeod et al. (2009) found that 10% of articles framed smokers as a drain on the economy.

3.2.3. Impact of framing of policy issues on public attitudes

• A small number of studies (n=9) considered the influence of media framing on public attitudes towards policy interventions.
• Barry et al. (2013) found that regardless of how the causes of childhood obesity were framed, participants were more likely to support obesity prevention policies when news reports identified an individual obese child than when the problem was described in more general terms.
• Only one study directly examined the impact of frames which supported versus opposed a specific policy initiative; the New York transfat ban policy (Wise and Brewer, 2010).
• The findings suggested that exposure to a pro-ban frame with a public health focus (negative effects of trans fats on health) increased support for banning trans-fat, while exposure to an anti-ban frame with a business focus (policy will harm business) reduced policy support.
• Another study found that alcohol legislation which received little or no press coverage were more likely to be successfully passed into law than those that received high press coverage (Harwood et al., 2005).

4. Discussion

• Policies which seek to address key risk factors at the population level are crucial to tackling the growing burden of chronic disease.
• To appropriately position arguments for policy interventions, public health advocates need to anticipate the arguments they will face and be equipped with the skills to position their arguments most strongly (Champion and Chapman, 2005).
• A key finding from this review however, was while a relatively large number of studies have examined how policy issues are framed within the media, comparatively few have considered the impact of such framing on public attitudes towards policy intervention.

5. Conclusions

• Understanding how the five dominant argument frames identified in this study are applied within discourses around prevention policy may equip public health advocates with additional strategies to consider in the media to effectively promote health policies.
• The findings of this review indicate that while there is growing interest in this field, there is a need to explore new approaches and questions if the authors are to move beyond describing how arguments are framed to understanding how framing influences attitudes and opinions about public health policy.

Figures

Table 3 Synthesis of key arguments used in framing debates about alcohol, smoking and nutrition policies.

Fig. 2. Frequency of supportive, neutral or opposing sentiment of media coverage in three policy intervention areas from included sample (n= 29).

Table 1 Overview of specific policies covered by studies within our sample.

Fig. 1. Cumulative frequency of included studies of media framing of policy issues over time from 1997 to 2016.

Table 2 Characteristics of included studies.