The Laugh Model: Reframing and Rebranding Public Health Through Social Media Cameron Lister, MPH, Marla Royne, PhD, Hannah E. Payne, BA, Ben Cannon, MPH, Carl Hanson, PhD, MCHES, and Michael Barnes, PhD, MCHES

Objectives. We examined the use of low-cost social media platforms in communicating public health messages and outline the laugh model, a framework through which public health organizations can reach and engage communities. Methods. In August 2014, we developed an online campaign (Web site and social media) to help promote healthy family meals in Utah in conjunction with the state and local health departments. Results. By the end of September 2014, a total of 3641 individuals had visited the Web site. Facebook ads reached a total of 29 078 people, and 56 900 people were reached through Twitter ads. The per-person price of the campaign was 0.2 cents, and the total estimated target population reach was between 10% and 12%. Conclusions. There are 3 key takeaways from our campaign: use of empowering and engaging techniques may be more effective than use of educational techniques; use of social media Web sites and online marketing tactics can enhance collaboration, interdisciplinary strategies, and campaign effectiveness; and use of social media as a communication platform is often preferable to use of mass media in terms of cost-effectiveness, more precise evaluations of campaign success, and increased sustainability. (Am J Public Health. 2015;105: 2245–2251. doi:10.2105/AJPH.2015.302669)

Many public health entities continue to use social media simply to broadcast information, much like traditional media, without engaging audiences.1 Although various state and local health departments have begun to use multiple social media platforms, the majority have few followers, minimal if any comments on their posts, and overall low engagement with the public.1,2 This may be attributable to a fundamental mismatch of motivations for social media use and gratification. People are generally motivated to use social media to pass time, to seek or give affection, to be sociable, or to share problems.3,4 Conversely, public health entities attempt to communicate with consumers to gain market insights, establish and promote a brand with consumers, disseminate critical information, expand their reach to include broader and more diverse audiences, and foster public engagement and partnerships with consumers.5 To fully engage constituents, public health entities must bridge this motivational gap

between people and organizations. Evidence suggests that organizations can reach out and engage constituents through innovative social media campaigns that are beneficial and have a positive effect on behaviors.6---9 According to Neiger et al., owing to a lack of evidence supporting the use of social media to broadcast 1-way information as a stand-alone intervention to improve health status, public health entities may need to transition to 2-way communications that engage audiences.2 Social media can be used to facilitate communications that fulfill the social and organizational needs of all parties. Social media marketing leverages existing social networks and encourages people to share content with their respective networks, increasing overall reach and engagement.10 Neiger et al. suggested that engaging people through social media for health promotion purposes can increase awareness or knowledge of health-related information, feelings of belonging and social connection, and involvement with health promotion

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programs either as partners who help guide actual program development and implementation or as participants who receive direct services or products.2

This engagement between public health entities and audiences can lead to program involvement through participation or partnership.11 The #SMMStandards effort, a crossindustry venture designed to simplify and unify social media standards, identified 6 metrics for measuring social media engagement: content and sourcing, reach and impressions, engagement and conversations, influence, opinion and advocacy, and impact and value.12 By employing these standards as a guide for successful marketing, health promotion efforts can achieve broader reach, gain higher levels of engagement, and ultimately improve health by increasing program participation. A handful of studies in the area of public health have measured the overall reach of online, population-based interventions with the intent of evaluating their effectiveness in changing behaviors.13,14 These studies demonstrate the potential for using online marketing in both educating the public and influencing individual behaviors. For example, Gosselin and Poitras used online incentives and quizzes to publicize a health promotion Web site, and more than 100 000 people viewed the site’s content.13 Purdy conducted a viral marketing campaign to promote condom use in Turkey by advertising a “fun” component (messaging that portrayed safe sex as synonymous with fun sex) as a means of driving viral marketing. By using social media platforms effectively, this program increased sales of condoms and generated tens of thousands of clicks.14 Clearly, social media have considerable potential for successful public health marketing. Because of increasing cuts in public funding for preventive health services, public health must increasingly do more with less,15 attempting to elicit participation from

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communities despite working with fewer resources and personnel. Although advocacy efforts are conducted continuously to increase funding, the advocacy process is long and laborious and generally fails to lead to acquisition of resources in the short term. To address these challenges, new public health marketing efforts must be unique, appeal to the masses, and be able to generate support from communities.16 Social media are a viable option for costeffective campaigns and health promotion in the face of budget constraints and limited resources, but several barriers may exist that prevent health professionals from crafting effective messages on these such platforms, including employers discouraging social media use at work; perceived lack of ease of use, particularly among older professionals; and low performance expectancy levels.17 Given funding constraints, efforts must also be inexpensive and sustainable, a predicament that will force the rising generation of public health professionals to explore innovative techniques for reaching large audiences.18,19 The “laugh model” framework, described here, posits that social media and business-like marketing and branding strategies are costeffective tools through which public health organizations can reach and engage communities.20 The laugh model is based on the success of businesses in using entertainment, engagement of populations, and at times humorous messages to prompt simple actions and connect individuals to programs or communities. In addition to outlining this framework, we present the results of a campaign applying the model. The campaign was implemented during September 2014 in Utah to promote healthy family meals, and the results have implications for public health practice. We propose that the field of public health can achieve an effective viral marketing presence by implementing the laugh model, which is based on a combination of business, social media, and viral marketing concepts and frameworks. The laugh model was labeled as such to convey the importance of prioritizing the use of humor, content virality, and entertainment in health promotion messages disseminated to the public. This framework is unique in the area of public health because it recommends overhauling public service

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announcements (PSAs), billboards, and educational content (flyers, posters) as a means of message communication in favor of an online business marketing approach in which state-ofthe-art social media marketing strategies are used to promote programs and services available to the public. PSAs have been the traditional means of communicating information on issues or abstract concepts such as physical activity, bullying, substance abuse, domestic violence, and good nutrition, whereas businesses use marketing to promote concrete products (e.g., deodorants, cars). The laugh model proposes that public health follow the example of businesses and market concrete products such as programs and services to better reach audiences and drive positive health behaviors. The framework is based on the premise that, just as entertaining, engaging, and even at times irreverent social media material is successful in promoting commercial products, this approach can be an effective means of promoting public health programs and services. Rather than focusing media efforts on messages that are solely educational or designed to influence complex behavioral changes, the laugh model framework suggests using overtly entertaining content to create online health marketing campaigns. Content is developed to drive viewers toward public health programs that are based on sound behavioral principles. This way, the focus shifts from PSAs carrying the responsibility for changing individual behaviors to their merely influencing the “purchasing behavior” of populations, namely, marketing public health programs that are efficacious and based on an understanding of behavioral principles. This approach is supported by 2 recent studies that reviewed PSAs on YouTube with respect to incorporation of health behavior constructs. These studies both showed that PSAs lacked integration of behavioral principles and that the majority of the videos were highly educational and received a small number of views.21,22 The laugh model (Figure 1) posits that raising target audiences’ awareness and changing their health behaviors through social media channels are contingent on creating overtly entertaining content and connecting individuals to programs or communities. Connectivity and entertainment are 2 important

reasons why individuals use social media and are directly linked to content being shared and having “viral” capacity.16,23

METHOD In August 2014, we implemented an online social media campaign in the state of Utah to promote healthy family meals for the month of September 2014. September was declared “Family Meal Month” by the state’s governor, Gary Herbert. The campaign was commissioned and approved by a committee made up of health promotion directors from the 12 local health departments (LHDs) in Utah, as well as representatives from the Utah Department of Health. The committee approved a $2000 budget for the campaign. LHDs collaborated in both the funding and dissemination of the campaign, providing $100 each, and the state health department provided $1000. Two LHDs did not participate in the campaign.

Campaign Development The project included 2 elements: construction of a new Web site hosted at and construction and maintenance of a new social media presence (including Facebook, Twitter, Pinterest, and Instagram) specific to our campaign. It was decided that new social media accounts were necessary to better unify the messaging and to coordinate efforts among health promotion professionals throughout the state. A new Web site was created because of the difficulty of navigating and disseminating information on family meals through the existing state Web site ( Some underlying strategies were employed in an attempt to ensure that the content was as engaging as possible for target audiences. These strategies included the following: use of online memes (photos of timely viral images and hashtags) that were humorous or popular, use of high-quality photographs of recipes and other content in every post pertaining to family meals, creation of blog posts (labeled “family meal hacks”) pertaining to tips for making family dinner easier, and use of contests to drive user engagement, with participants submitting photos of their own family dinners (Figures A---C, available as a supplement to the online version of this article at http://www.

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Consumer Motives

Web 2.0

Entertainment Humor/Sex Emotional Appeal

Free, Unlimited

Message Development Ad, Prank, Sponsorship, etc.

Priority Health Needs Advocacy Behavior (Skills Training) Awareness


Non-Traditional Partners YouTube, Viral Channels

Public Health Impact Connect people to Web sites, causes, and programs

Social Momentum Forward-ability Viral Status

Sustainability YouTube Contracts, Ad Revenue, Sponsorship

FIGURE 1—Laugh model framework.

Campaign Dissemination During the first phase of the campaign (prior to September), we created the Web site. Whereas existing information on family meals used by LHDs and the Utah Department of Health included the benefits of family meal times, this site focused on providing quick, easy, inexpensive, and healthy recipes; implementing social media competitions with prizes; and offering helpful tips and resources for making family dinnertimes easier (Tables 1 and 2). The second phase of the campaign involved promotion of social media accounts through Facebook and Twitter. Pay-per-click ads were used to increase the numbers of followers of and visitors to the Web site and to enhance online content. Audiences for the ads were

narrowed according to age, location, and demographic interests as indicated through people’s social networks. Specifically, ads were targeted to mothers between the ages of 25 and 64 years who were interested in families, cooking, childhood education, and health. The final campaign phase involved using social media competitions to generate participation in and collaborative dissemination of LHD social media posts. Two competitions were held in which participants could submit their favorite family meal recipes or photographs of their families eating dinner to win grocery store gift cards. When information, recipes, or competitions were posted to social media sites, LHDs reposted them to their own institutional pages to disseminate the campaign more broadly.

Measures Web site and social media analytics were gathered throughout the month of September to assess the campaign. General indicators were recorded, including number of post impressions (individuals who saw the ads appear in their newsfeed or search results), number of engagements (clicks, likes, shares, and comments), and which media channels most frequently led users to the Web site. Data on other population indicators, such as the gender, age group, and location of followers on social media, were also gathered.

Data Analysis After the analytics were gathered, engagement rates (engagement volume divided by number of users) were calculated for each post,

TABLE 1—Comparison of the Messaging Strategies of Traditional Public Health With the Laugh Model Framework Social Marketing Element

Traditional Public Health Approach (LHDs and UDOH)


Family mealtimes can help families grow closer together, increase communication, prevent


Opportunity cost, prioritization of family mealtime

Laugh Model Approach Family mealtimes are incredibly difficult and cumbersome; this is how you can make them easier

substance abuse, and prevent obesity over other activities Place

Online at and selected


Press releases, posters, flyers, and independent

social media across local health departments social media posts

Provision of “meal hacks,” or tips on making family dinners more fun and healthy, less time consuming, and cheaper and unified social media platforms, namely Facebook and Pinterest, where stay-at-home mothers spend their time Pay-per-click Facebook and Twitter advertisements targeting mothers aged 25–64 years and designed to divert traffic to the Web site

Note. LHDs = local health departments; UDOH = Utah Department of Health.

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TABLE 2—Use of the Laugh Model Framework to Promote Family Meals in Utah Framework Component

Utah Family Meals Campaign

Consumer motives

Demand for cheap, easy, and delicious meals that happen to be healthy; demand for shareable content online and fresh ideas that

Priority health needs

Behavioral: fewer families are eating together at the dinner table; family dinners help prevent substance abuse, obesity, etc.

Message development

Use of compelling photos, recipes, “meal hacks,” and other shareable memes and content to drive individuals to

can be understood

Web 2.0

Use of Facebook, Twitter, Instagram, YouTube, and Pinterest; Facebook outperforms other platforms and is the subject of a larger focus

Social momentum

As more individuals respond and share content, more individuals like and follow posts because of referred advertising on Facebook; contests gather more traffic

Public health impact

Approximately 3600 visitors in 1 month, with several news stations discussing the Web site


Platform was constructed for $2000 and now requires only limited management to maintain; local health departments and the Utah Department of Health can collaborate to ensure that the initiative is up and running year round

as well as the overall campaign. Such rates are often used to assess the quality or efficiency of a campaign. In addition, we calculated the total percentage of the target population reached (i.e., the percentage of online campaign interactions involving women in Utah between 25 and 64 years of age). Finally, a cost---benefit analysis was conducted in which the total cost of the campaign ($2000) was divided separately by the total number of individuals reached through ads, the total number of post impressions, the total number of online engagements (social media engagements plus Web site engagements), and the number of engagements on social media.

RESULTS During September 2014, a total of 3641 individuals visited the Web site, an average of 121 visitors per day (the lowest daily number of visitors was 24 and the highest was 664). The most visited pages were those with competition postings, followed by the “recipes” page. By the end of the month, the number of Facebook likes had reached 1454, and the number of Twitter followers was 255. About 91% of these social media fans or followers were women between 25 and 64 years of age. In addition, by the end of the month there were 36 followers on Instagram and 30 followers on Pinterest. Moreover, a total of 29 078 people were reached through Facebook ads and 56 900 through Twitter ads. The total number of

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Facebook post impressions for the month of September was 17 377, with Twitter totaling 28 800 post impressions.

Online Engagement There were 5591 online engagements during September, representing an overall engagement rate of 5.5%. During the campaign, a humorous video promotion was created and shared through Facebook and Twitter, and this was the most successful September post, with a 9.7% engagement rate. The next most successful posts were the healthy recipe competition post, with a 6.4% engagement rate, and a post about “weight loss hacks” (tips for losing weight while having family dinners), with an engagement rate of 13.3%.

Cost–Benefit Analysis Overall, the campaign was extremely costeffective. The cost per person reached was 0.2 cents, with a cost of 0.3 cents per post impression. The overall cost per engagement was 0.27 cents, with likes and follows costing $1.14 each and each post engagement costing 0.36 cents. The total estimated target population reach, on the basis of the demographic profile of social media followers and fans, was between 10% and 12% (as noted, the target population was defined as women in Utah between 25 and 64 years old).

DISCUSSION Over the past 10 years, public health has faced significant funding cuts that have

hindered its ability to deliver effective programming. The purpose of the laugh model is to provide public health practitioners with a new framework for developing social media products that is entertaining and sustainable and has a significant impact on target audiences. The findings of our campaign illustrate the potential efficacy of the laugh model framework in addressing concerns related to sustainability and lack of funding. There are several key takeaways from our campaign. First, use of empowering and engaging techniques may be more effective than use of educational techniques. Second, use of social media Web sites and online marketing tactics can enhance collaboration, interdisciplinary strategies, and campaign effectiveness. Finally, as a communication platform, social media are often preferable to mass media in terms of cost-effectiveness, assessments of campaign success, and increased sustainability. Public health social media campaigns are often concerned with educating their target audiences.21,24 The Utah campaign promoting family meals is unique because, rather than simply educating the target audience (on the health benefits of family dinners), the program provided audience members with specific skills and resources (e.g., recipes, tips) to help them engage in the targeted behavior. In addition, the content was designed to be engaging and entertaining, with competitions and humorous posts throughout the month of September, the most successful being a lighthearted, entertaining video advertising the Web site. Using

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these practical and empowering techniques, the campaign was successful in reaching an estimated 10% to 12% of the target population in Utah. Several other studies have shown that online technological interventions have great potential with respect to affecting health behaviors, just as online marketing has the potential for greater reach at lower costs.25,26 In addition to engagement and practical information, practitioners could consider using other nontraditional techniques such as storytelling and parody to build appealing messages. Similar to the Utah family meals campaign, such messages often do not contain the educational components of traditional public health messages. Rather, their intent is to first entertain and engage audiences, and only then deliver a simple public health action point. This approach allows practitioners to emphasize their messages without extensive use of educational content. Thus, public health practitioners might consider deemphasizing the extensive use of educational messages in favor of building audience appeal and marketing specific programs and services. Other studies have shown that individuals who use social media are much more likely to share entertaining content than educational content.16 Social media and the interactive tools such platforms afford may make for more efficacious campaigns than traditional, education-focused approaches. In addition, they may be particularly effective for collaborative purposes and interdisciplinary approaches. The Utah family meals campaign achieved relatively high success in reaching its target audience; the overall campaign engagement rate was 5.5%, with some posts reaching as many as 13.3% of the target audience members (a social media engagement rate above 1% is considered successful, and rates of 13% or above are uncommon27---29). Social media also allow public health organizations to more efficiently use marketing techniques and collaborate with groups outside of the field. Marketing is a key driver of most businesses because marketing focuses on meeting customer needs. As such, organizations develop creative promotional campaigns designed to communicate perceived value and encourage consumption of various goods and services. Considerable research as well as

corporate growth and profits demonstrate the ongoing success of innovative marketing approaches. Marketing, however, is not limited to goods and services; its well-accepted definition also includes marketing of ideas. Public health, as both an idea and a range of services, is no exception in its need for marketing. In fact, researchers have readily acknowledged that public health professionals would do well to partner with marketing experts and use interdisciplinary approaches to engage consumers and promote healthy lifestyles through carefully developed public health marketing campaigns.30,31 Finally, the success of the Utah family meals campaign and other similar projects demonstrates the benefit of using entertaining forms of social media as opposed to traditional mass media in public health campaigns. In today’s competitive environment, social media have emerged as one of the most popular and cost-effective marketing approaches for reaching time-starved, Internet-savvy consumers. Hence, businesses and other entities have capitalized heavily on the rapidly changing dynamic of such media to reach consumers. Social media have unique benefits relative to mass media avenues because success in reaching the target population can be precisely measured in clicks, impressions, engagements, and so forth. However, successful use of social media in public health communication requires an understanding of both business perspectives and viral marketing. Viral marketing, which focuses on spreading information from person to person through (in general) social media and other online resources, is a highly effective means of influence in today’s online-centered world.13,32 Given the past decade of funding cuts in public health and prevention services, along with substantial programmatic and personnel cuts at the federal, state, and local levels, more effective and cost-efficient strategies are a necessity.15 Although these trends are alarming and unacceptable to many, they are not surprising. Despite the past successes, current benefits, and cost savings that public health can boast, the profession continues to have no fixed system focused on public relations, branding, or marketing.30 Successful public health practice often goes unnoticed within communities.33,34 In

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combination with the broad scope of definitions that exist to simply define the profession34---36 and the even broader list of core services and activities,37 the public as well as legislators seemingly remain unaware of the benefits of and need for prevention services and increased funding for public health. Effective marketing and communication are critical for the disruptive and radical change necessary to confront population health challenges, and entertaining social media may provide the means to a more efficient, cost-effective way of addressing these challenges. The campaign described here illustrates the effectiveness of using social media campaigns in collaborative efforts that allow public health professionals to accomplish greater goals with reduced funds and fewer resources, especially relative to PSAs and other campaigns using traditional mass media, which are generally much more expensive.38,39 Although our framework is designed specifically for health practitioners, it can be used in other fields as well; for example, any social cause, nonprofit, or socially minded business can incorporate the framework’s concepts into its practices as a means of reaching and engaging communities online. The universal appeal of an approach such as this derives from the fact that it was constructed by combining several components of other marketing frameworks used in the business and social sectors. Several key lessons learned from this campaign may inform future practice. For example, use of promoted pins may lead to Pinterest having a larger effect on a campaign. In addition, the Instagram audience could be expanded by sharing recipes through, for example, a #familymealmonth hashtag. In competitions, the strategy of using smaller sums of money for smaller actions may be more effective than using larger sums of money for larger actions. As an example, an organization would likely gain more participation by offering a $50 drawing in which people simply share their favorite way to get their kids to talk at dinner than by featuring a large prize for posting a video or photo. Future campaigns can also implement more community storytelling and opportunities to share successes as a means of promoting vicarious learning and fostering community.

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Limitations and Concerns Humor is not the only form of entertainment or the only content that engages audiences. Other types of content, such as positive messages, shocking visuals, motivational or inspirational quotes, and thought-provoking material, can attract social media consumers as well. Depending on the desires and needs of the target population, appropriate strategies must be developed to drive consumer behavior. Another issue is the credibility of organizations being hindered by overtly funny, entertaining, or irreverent messages limited in educational content. Such concerns can be addressed in the same way businesses test their messages with the public, through market research and focus groups. As long as the target audience does not feel alienated or offended, and if individuals are more compelled to participate in programs related to public health after viewing these messages, credibility will not be a concern. In addition, “viral” reach is only one measure of success and may not always be the most important. The level of reach to the target population (which in some cases may be small), as well as increases in participation in programs and services, downloads, or other measures, may be more beneficial in determining the overall effectiveness of marketing messages.

interventions are presumably valuable because they can capture the attention of viewers or readers and can be easily shared with others. The central contribution of the laugh model framework is the roadmap it offers for achieving these goals. By navigating away from traditional models of health promotion and moving toward a business marketing model, public health professionals can usher in a new era of public health practice that better engages audiences, increases program participation, and ultimately has a positive impact on the health of populations. j

About the Authors Cameron Lister, Hannah E. Payne, Ben Cannon, Carl Hanson, and Michael Barnes are with the Department of Health Science, Brigham Young University, Provo, UT. Marla Royne is with the Department of Marketing and Supply Chain Management, College of Business and Economics, University of Memphis, Memphis, TN. Correspondence should be sent to Cameron Lister, MPH, 4103 LSB Brigham Young University, Provo, UT 84606 (e-mail: [email protected]). Reprints can be ordered at by clicking the “Reprints” link. This article was accepted March 9, 2015.

Contributors C. Lister originated the laugh model framework. C. Lister, M. Royne, B. Cannon, C. Hanson, and M. Barnes contributed to the conceptualization of the framework and the creation of the original article. C. Lister, H. E. Payne, and B. Cannon carried out the campaign activities. C. Lister and H. E. Payne crafted the discussion of the campaign results. All of the authors contributed substantially to revisions of the article.

Conclusions and Recommendations


Social media were not built with the field of public health in mind, and it should be noted that not all social media sites are the same. However, unlike traditional media approaches to disseminating public health messages, social media platforms are recognized as a 2-way channel that may more fully meet the social and organizational needs of all parties (viewers, sharers, and organizations). The Utah family meals laugh model campaign was successful in reaching the target population and was extremely cost-effective. Our findings illustrate how public health professionals can improve their messaging strategies by using social media effectively. When used appropriately, social media sites can provide a novel communication paradigm with new promise for improved messages and subsequent impact. Social media public health

The campaign described in this article was commissioned and approved by a committee of health promotion directors from Utah’s 12 local health departments and representatives from the Utah Department of Health. The committee approved a $2000 budget for the campaign. The local health departments collaborated in both the funding and dissemination of the campaign, providing $100 each, and the Utah Department of Health provided $1000. These funds were used to develop the online platform and run the online ads in September 2014. Note. The authors are currently working on putting the laugh model into practice and have created a Web site and a formal LLC in the state of Utah for the purpose of improving public health practice and conducting research (see

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Human Participant Protection No protocol approval was needed because no human participants were involved in this research

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The Laugh Model: Reframing and Rebranding Public Health Through Social Media.

We examined the use of low-cost social media platforms in communicating public health messages and outline the laugh model, a framework through which ...
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