Health promotion actions in mass-media for seniors in selected European countries

Background: The main aim of the paper is to describe the role of mass-media as it pertains to health promotion for older people (HP4OP) in 10 selected European countries of the ProHealth 65+ project. This paper identifies, describes and analyses good practices in the mass-media sector to answer the questions of how active the media sector is in HP4OP and what kind of health promotion functions and activities are generally used by media institutions to communicate to older individuals about health related issues Methods: The paper is based on literature review of scientific papers and on analysis and evaluations of EU programmes and official reports and research studies focused on the impact of mass-media on health. The study for this paper also included documents describing realisations of mass-media initiatives, identified good practices in media in HP4OP and searches based on using PubMed, Web of Science, Google Scholar, Google and base CRODIS and in a very limited part through of experts and partners in project ProHealth 65+. Results: Analysis of the gathered data and good practises showed that the mass-media influencing knowledge, attitudes and behaviours about health related topics through activities directed at HP4OP. In practice, the mass-media as a sector is used in this process occasionally without consolidated strategies on the regional, national or European level which leads to difficulties in evaluating the real power of media in HP4OP. Conclusions: This paper has presented the significance and functions of media in societies as a tool of information and a source of education and raising awareness in the context of healthy ageing strategy in Europe. However, the sector of mass-media appears not to be used to its full potential in the HP4OP process. The conclusion can provide material for further discussion and finding solutions how to strengthen the engagement of mass-media in HP4OP.


INTRODUCTION
Demographic changes in European countries over the last several years have shown a significant increase in elderly individuals in the EU total population.The continued growth in the number of elderly people has caused inevitable increase of needs for health services as well as new challenges in ageing European societies and their access to professional information specially targeted at health promotion.Research has been done to determine if mass-media has been employed to disseminate information of the EU strategy of healthy ageing as a response to these demographic changes.
Currently, mass-media plays various functions in society; providing information, monitoring issues of general interest, social integration and entertainment.The role of the media is adaptive and changing according to the processes occurring throughout Europe [1].Information about wellness and individual lifestyle choice conveyed to the public through media can influence and facilitate healthy life styles [2] [3].Mass media can foster and build knowledge and awareness in two main areas: health promotion (including functions of health promotion: health advocacy, primary prevention, health screening, health education and health information) and strategies of healthy ageing [4] [5] [6].
The main aim of health communication is to improve the health status of individuals and populations.[7] Its effectiveness is related to the following elements: health literacy, health education, social marketing, risk communication, crisis communication, and health advocacy [7] [8].
In the area of public health promotion, mass-media has become an especially important tool for programmes which are focused on the prevention or control of disease, injury, disability and death.To maintain a continued increase of public health solutions, an area of cooperation is necessary among key stakeholders (including community members and organizations) to build a large coalition and allow for more effective solutions to health problems [9].Indicators of effectiveness in communication campaigns about health care area are aimed at changing behaviour and raising awareness [10].
Research indicates that we are currently confronted by several trends that are occurring in the media and shifts which are strongly connected with technological innovation: "interactivity" which means responsiveness between users (reactive interaction of two-way communication) [11]; "convergence" (or phenomenon of "transmediality") understood as the interaction between different media forms and platforms defined as cooperation and collaboration between previously unconnected media forms and platforms which transforms media from different platforms into digital form [12] [13] [14] [15] [16]; and "media richness" that multiplicity of cues, increased number of ways to convey information, a greater personalization and more rapid feedback [17].
It is generally accepted that new media (internet) is more effective than traditional sources of information (television, radio, newspapers) [11].However, despite the rapid development of on-line tools in EU countries, television remains a leading source of information for seniors.This does not mean that health promoters cannot take into account new media in the process of planning media campaigns for the elderly.On the contrary, because in practice, as confirmed by good practices reports, there are many examples of combining traditional and new media in HP4OP, where the internet has become a second important source of messages for elderly.It is connected with continuously increasing access to internet in this age group in EU countries [18].Among strategies that use media to promote population health are the following tools: [19] [20] [21] "media literacy", "social marketing" and "media advocacy".Communication in mass-media centrally involves tailoring information to appeal to and meet the needs of specific audiences [22].

METHODS
As the part of the project Pro-Health65+, the content of this paper was focused on a target group of older individuals at the age of 65 and over.The content has been prepared on the basis of: literature reviews on health promotion, analysis and evaluations of EU programmes and official reports, gathered studies focused on impact of mass-media for health, documents describing realisations of mass-media initiatives (interventions) and selected good practices in HP4OP and searches using PubMed, Web of Science, Google Scholar, Google and base CRODIS.One of the sources of information included the opinions of experts and partners in project ProHealth 65+.This last source is very limited because, when asked about role of mass-media in HP4OP in their countries, experts from countries engaged in project ProHealth 65+ didn't indicate mass-media as an important factor in HP4OP in the 10 countries analysed.In effect, mass-media was not included in the questionnaire in WP 6 as a separate sector and in the end, country profiles with mass-media were not created.However taking into account the leading role of mass-media in the process of providing information and promotion about healthy lifestyle the decision was made to create a few questions involving co-operation and engagement massmedia in sectors chosen by experts for further research.The questions in the questionnaires for experts of ProHealth 65+ were generally focused on identifying good practices of mass-media involvement in HP4OP and evaluating the results and efficiency of mass-media activities in the HP4OP.Interviews with experts included brief questions describing potential cooperation and its subsequent evaluation to receive knowledge about the real power of mass-media as an instrument in HP40P and create guidelines for future systemic solutions and operations.Unfortunately, it resulted in only a few indications of good practices in media with reference to HP4OP.During the collection of data for a manual addressed to health promotors (as WP 9 task), partners of the ProHealth 65+ programme sent a few more detailed examples (included in this paper) from their countries corresponding to initiatives for seniors through traditional and new media.
As a result, the paper includes examples of good practices, as identified by the author of this paper, in both traditional and new media.The paper also analyses key health EU promotion programmes and projects in HP4OP that describe a field of health promotion for older Epidemiology Biostatistics and Public Health -2017, Volume 14, Number 2, Suppl 1 Health promotion actions in mass-media for seniors in selected European countries people to find potential connections with mass-media actions or interventions.Research included: web platforms; organisations; and networks focusing on health promotion for older people in cities, small communities and institutions on the national, regional and local levels.
Activities of the mass-media sector in the 10 EU countries were analysed in two main contexts: health promotion and strategy of healthy ageing.Analyses of good practices of selected media were conducted with reference to 10 countries in the ProHealth 65+ project and included: types of mass-media, main areas of activity in the sector, role of media tools in HP4OP, functions of health promotion.Mass-media good practices were divided into tables with initiatives corresponding to a category: television (table 1), internet (table 2), radio (table 3) and press (table 4).The identified media activities provide an overview of main activities of media and their functions in HP4OP.Functions of media and functions of health promotion in television, internet, radio and press including all selected examples of good practices media in HP4OP were presented in a statistical sheet (table 5).

RESULTS
The results of mass-media findings as a sector in the analysed countries of the ProHealth 65+ project indicate the following relations and interdependences: 1. Mass-media is listed among institutions that actively deliver information about health and healthy style of life and media use different tools to reach older audiences.

The identified tools of mass-communication include:
media literacy including media education, social marketing and media advocacy.In communication with seniors, a variety of promotion functions is employed: health advocacy, primary prevention, health screening, health education and health information.3. Mass-media is used for initiatives aimed at seniors at the European level and in those situations media actions are supported, funded and co-financed supported by EU institutions with a co-operation with other sectors mainly nongovernmental and government (central, regional and local) but also with the health care sector (hospitals) and educational institutions (universities) and companies involved in projects.4.Among the main publishers/providers and co-operators, identified here as health promoters, of mass-media activities for seniors are: public media institutions

DISCUSSION
The main aim of the paper was to review mass-media initiatives across 10 countries of the ProHealth 65+ project in terms of their activity in health promotion for older people.The findings described in this paper indicates that different media tools in HP4OP are used and present different functions of health promotion media to reach older audiences and achieve an intended goal aimed at maintaining or improving of health status corresponding to EU strategy healthy ageing.
This paper addresses the role of the mass media sector in HP4OP as having considerable practical importance during processes of planning and implementation of potential strategies and polices in ProHealth 65+ countries on the local, regional or national level.This is because the results of many studies show that health communication activities can have a positive impact on health-related attitudes, beliefs and behaviours including groups of older people [8] [23] [7] [21] [24].Media campaigns can activate positive changes or prevent negative changes in health-related behaviours across large populations [25].
Conducted research shows that the role of massmedia in public health policy can have an impact in four fields: awareness change, knowledge change, attitude change and behaviour change [26].The effectiveness of campaigns using mass media in health promotion was confirmed in different studies on health promotion such as prevention programs.Mass media campaigns have shown the adoption of positive changes as well as the prevention of negative changes in health-related behaviors in society [27].
Research confirms that media can deliver promotional materials to older individuals and this kind of involvement is effective in promoting an active style of life connected with physical activity, as seen in campaigns specially directed at senior adults (50+).[28] [29] [25].Media can also be a useful tool as a reminder of the necessity of diagnostic research such as cancer screening [30].The positive impact of media tools in campaigns directed at seniors in the category of health awareness increase was evaluated and confirmed by a wide range of research [24] [31] [32].The results of media initiatives can be divided into two categories: promotion of adopting new behavior and as a tool to cease addictive behaviors [21].Media also mobilizes local participation and integration among individuals [33].Social organizations and institutions can support and sustain messages communicated by mass-media to encourage local initiatives as well as increase active transmission as institutional messages about important health problems to encourage public discussion about health issues.Media campaigns are introduced to Health promotion actions in mass-media for seniors in selected European countries change a public health policy and build a social network to spread information [34].Research confirms that massmedia campaigns play a significant role in facilitating healthy behaviour [25].Mass media has also been reported as having a diverse impact strongly connected with advertisements in media.It has been observed that advertisements impact the demand and sale of prescription drugs among both patients and the doctors.Advertisements in television are recognized as one of the most effective forms of disseminating information to increase smoking cessation among populations.Studies have shown a positive role of mass media interventions which resulted in the increased knowledge and awareness of the effect of physical activity on health [35] The influence of media in quoted research has been reported in various contexts: use of drugs, tobacco and alcohol, prevention of heart diseases, promotion of organ donation and transplantation, sex-related behaviours, liver cirrhosis, cancer screening and prevention, organ or blood donation and was observed in change of attitudes and behaviours [25].The influence of mass media can be additionally strengthened and sustained by the advantages of new trends which lead to more personalized contact Results of studies confirm the effectiveness of particular types of media: television, radio, print media and internet in health promotion for older people.As mentioned earlier, statistical data confirms television as remaining one of the most popular sources of information about health for seniors [43].Research data suggest that the effectiveness of media power is determined by a mix of program formats transmitted by television.Media experts emphasize the role of public announcements (PSA) which are noncommercial messages aimed at improving knowledge, attitudes and behaviour regarding a particular issue.The studies show that PSA may effectively influence health behaviours of the viewers although the effects are usually short-term nature [43].Public service announcements (PSA) are suggested as a highly effective method of informing people aged 65 and over.At the same time, PSAs are more expensive than those advertisements in radio or newspapers which are comparably effective [44].Findings of studies show that health related behaviours are also influenced by films and especially television series.[45] [46] [47] [48] [49].
The growing impact of internet is observable as access to on-line media among adults and elderly in EU continues to increase, allowing for actions and initiatives without geographical barriers [50].Research shows that   Results confirm that the internet can be a very useful tool in supporting self-management, prevention, rehabilitation and physical activities [53].The role of internet is also underlined in the context of having wide reach and extensive capabilities as well as increasing usage to deliver comprehensive behavioral and mental health intervention and prevention programs [54].On the other hand, it has been noted that a considerable amount websites and information about health can lead to misinformation which may be false and ultimately harmful.[53].
Radio broadcasts are also listed among traditional mass-media institutions that can impact adult (with seniors) knowledge, behaviours and attitudes related to health topics including healthy issues.One of the preferred form of health education programmes are health-related discussions.In this context, the direct possibility of contact between seniors as radio listeners and health experts who can answer for important questions concerning healthy style of life and also causes, symptoms and effects of diseases often diagnosed among elderly, should be considered an asset.A local radio station (in addition to local newspapers) can be an effective tool for media intervention including advertisements encouraging cancer screening.Compared with television, radio advertisements are less expensive and the effectiveness of this kind of advertisement, intended as public service announcements (PSA), is also high in HP4OP [55] [56] [57] [58] [59] [60] [61].
Print media (press), newspapers and magazines are included in traditional media that in recent years has been changed from only a single written form and transformed into twofold performance available in traditional written form and on-line.Newspapers that inform about health care in small communities are more effective than other forms of media and were listed just below physicians, family and relatives, in terms of effectiveness [62] [63] [64].Print media, especially local newspapers are listed among effective ways, as those earlier mentioned, to reach older audiences through public service announcements (PSA) [57].
Comparing all research data presented in the discussion with the results of study achieved in project ProHealth 65+, the following joint interdependences can be identified: •

CONCLUSIONS
The results of the gathered data allowed to conclude that mass-media can be an effective tool in enabling the promotion of health for older individuals and programmes, campaigns, initiatives and interventions directed to HP4OP.Many scientific studies confirm the significant role of massmedia in health promotion.However this role remains prospective because mass-media as sector is rarely used for institutional strategic system activities in project countries in HP4OP.The result is that mass-media institutions are still considered more as providers of information about health promotions initiatives and interventions than as generating ideas corresponding to health promotion.Conducted media analyses show that in programmes and in the internet older people are not the leading target group for media sector as compared to children, adolescents and adults under 65.The current role of mass-media in health promotion for older people is not appreciated as one of the crucial factors in building knowledge and increasing awareness in categories of healthy and active life.In particular countries of the ProHealth 65+ project, mass-media doesn't play a leading role as a health promoter.This does not mean that mass-media is not active in spreading information and educating seniors in health topics.Conducted analyses have shown that media initiatives are not limited to only occasional isolated examples of good practices with media participation but undertake cyclical programmes dedicated to seniors aimed at different aspects of health promotion.In this context, the role of mass-media as sector, in reported countries, does not end with source of information about health.As a result, it creates a situation in which massmedia institutions have become one of the active sectors contributing to health promotion actions and interventions.
However, it would be more beneficial to senior citizens if the characteristics of mass-media engagement in HP4OP were better supported by social and private institutions in 10 countries of ProHealth 65+ project.It is recommended that social and private institutions on the national, regional and local levels in ProHealth 65+ countries substantially expand and develop the use of media in planning and implementing campaigns directed at seniors that follow the European strategy for healthy ageing.

Acknowledgements
"This publication arises from the project Pro-Health 65+ which has received funding from the European Union, in the framework of the Health Programme (2008)(2009)(2010)(2011)(2012)(2013). The

content of this publication represents the views of the author and it is his sole responsibility; it can in no way be taken to reflect the views of the European Commission and/or the Executive Agency for Health and Consumers or any other body of the European Union. The European Commission and/or the Executive Agency do(es) not accept responsibility for any use that may be made of the information it contains.
Publication financed from funds for science in the years 2015-2017 allocated for implementation of an international co-financed project"

TABLE 1 .
Selected activities of television in project ProHealth 65+ countries.

TABLE 2 .
Selected activities of internet portals in project ProHealth 65+ countries.

TABLE 3 .
Selected activities of radio in project ProHealth 65+ countries.

TABLE 4 .
Selected activities of newspapers and magazines in project ProHealth 65+ countries.
Source: own elaboration based on information achieved from newspapers and magazines included in the sheet

TABLE 5 .
[52]istical sheet of applied media tools and functions of health promotion in television, internet, radio and press in all selected examples of good practices media in HP4OP (in tables 1-4).Health promotion actions in mass-media for seniors in selected European countries to maximize the positive effects of intervention, interactive capabilities of the internet as providing tailored advice and arranging follow-up contact are needed[51][52].