Strengthening the engagement of mass media stakeholders in community-based health promotion interventions - The Danish Project SoL

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Winkler, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5454860/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background : The potential positive effects of mass media stakeholders in health promotion have long been recognized. Health promotion interventions may benefit from exposure in mass media by attracting public attention and political support. More formal and partnership-based engagement of mass media may have even larger impact potentials. Nevertheless, few projects have included mass media as formal partners in health promotion interventions. The aim of the present study is to identify potentials and barriers for the engagement of mass media stakeholders in health promotion Methods: Project SoL, a community-based health promotion intervention carried out in two municipalities in Denmark, applied the supersetting approach to establish a formal partnership with local mass media, supermarkets, childcare centres, and primary schools in efforts to promote healthier eating and physical activity among families with young children. Six semi-structured in-depth interviews with mass media stakeholders involved in Project SoL were carried out to identify barriers and drivers for engagement of local mass media in health promotion. Results: Thematic data analysis revealed that engagement of mass media stakeholders was promoted by potentials for 1) exercising corporate social responsibility, 2) adopting a broad and positive understanding of the concept of health and 3) attracting the attention of a large audience. In contrast, barriers for their engagement included 1) inflexible organizational structures of mass media, 2) lack of financial and human resources and 3) a demand to maintain a disseminating and neutral role in the mediascape. Conclusions: The findings suggest that engagement of mass media stakeholders as formal partners may strengthen health promotion interventions and aid the development of new health promotion strategies in local community settings BACKGROUND For decades mass media have been valued for their importance in promoting health (Head et al., 2015 ) and the abundance of intervention studies investigating the effects of mass media on health behaviours signifies its potentials. Based on its various communication channels mass media can 1) inform, provide, and interpret health information (Andsager et al., 2015 ), 2) place health issues on the local and public agendas (Dixon et al., 2014 ) and 3) allow people to create their own knowledge-based opinions or to encourage people to take responsibility for their own health (Berridge, 2009 ). Thus, mass media can directly or indirectly influence opinions, attitudes, norms, and behaviours. Mass media campaigns can by themselves or in combination with other intervention components ensure broad outreach, maximize effects and minimize selective exposure, and they are widely used to influence health behaviour of larger populations (Abroms and Maibach, 2008 ; Kahn et al., 2002 ; Snyder et al., 2004 ; Snyder and Hamilton, 2002 ) e.g. by altering knowledge, attitudes and behaviours related to healthy diet and physical activity (Beaudoin et al., 2007 ; Wakefield et al., 2010 ; Cavill and Bauman, 2004 ; Randolph et al., 2012 ) as well as other health health-risk behaviours e.g. use of tobacco, alcohol, heart disease risk factors, sex-related behaviours, road safety, cancer screening and prevention, child survival, and organ or blood donation (Wakefield et al., 2010 ). Lately, mass media campaigns have proven useful in promoting health and hygiene practices during the Covid-19 pandemic (Anwar et al., 2020 ). Inclusion of mass media in multi-component community-based health interventions e.g. to reduce violence in schools (Swain and Kelly, 2008) or to encourage healthy eating (Glasson et al., 2013 ; Pollard et al., 2008 ) and physical activity (DeBate et al., 2009 ) have demonstrated larger effects compared to single-component interventions (Swain and Kelly, 2008). The large community-based intervention program “ Choose Health LA Restaurants” found that a “paid” media campaign combined with community engagement and in-store promotion positively promoted the healthier choice of restaurant (Gase et al., 2016 ). Interestingly, the program “earned” 33 free media articles indicating a strong public support for the program and a potential for restaurants and public health partners to collaborate on health promotion agendas (Gase et al., 2016 ). The media industry is increasingly engaging in corporate social responsibility activities including health promotion interventions (Ralston and Maignan, 2002 ) to legitimate themselves and to improve their reputation in a world of increased journalistic and economic competition (Ingenhoff and Koelling, 2012 ). Therefore, successful collaboration in which health professionals and researchers provide evidence-based health information that is communicated to the public through mass media platforms may offer great potentials for developing new and more effective health promotion strategies. Interventions that are community-based may particularly benefit from partnering with local mass media stakeholders as they broadcast to a smaller audience and have a special focus on regional news. Bell et al., ( 2013 ) described one of few multicomponent health promotion interventions that partnered with regional media stakeholders within TV, radio, and print media to increase outreach to the audience, to double the advertising activities and to brand the campaign materials. Other studies have also communicated a need for forming partnerships with local mass media to promote health (Yoo, 2011 ). Project SoL (in Danish “Sundhed og Lokalsamfund” meaning “Health and Local Community”) partnered with local mass media stakeholders (Toft et al., 2023 ) to optimize the impact of a multi-component community-based health promotion intervention implemented in two Danish municipalities. The aim of the present study is to identify potentials and barriers for the engagement of mass media stakeholders in health promotion. Findings from interviews with mass media stakeholders of Project SoL were discussed with a view to identify factors to support the establishment of conducive environments for mass media engagement in health promotion. METHODS Project SoL Project SoL originated from a wish among a team of journalists at a local TV station (TV2 Bornholm) on the Danish island and municipality of Bornholm to promote healthy diet and physical activity in the local communities. Different research institutions were therefore contacted, and a formalised partnership was established when project funds were obtained in 2011. Project SoL implemented a 19 − month multicomponent intervention to promote healthy shopping, cooking, and eating behaviours and to increase physical activity levels among children aged 3 to 8 years and their families in Bornholm. A detailed description of Project SoL can be found elsewhere (Toft et al., 2018 ). Project SoL applied the supersetting approach to mobilise local communities for public health action (Bloch et al., 2014 ). In accordance with the supersetting approach, project activities were coordinated and conducted more or less simultaneously across the settings of everyday life (e.g. day-care centres, primary schools, supermarkets and local mass media). This took place in three target communities in Bornholm (Allinge, Hasle and Nexø), which were selected based on their similar size, presence of relevant settings, and community readiness to actively engage in the project. Odsherred, a Danish municipality with similar demographic, socio-economic and health characteristics as Bornholm, including high prevalence rates of risk factors for non-communicable diseases, functioned as a non-intervention control site involving three communities (Højby, Asnæs and Egebjerg) for the overall evaluation of Project SoL (Mikkelsen et al., 2018 ). However, best practices from Bornholm were implemented in target communities in Odsherred during a 10- month post-intervention period. The current study focuses on the mass media intervention that was an integrated part of the multicomponent project (Toft et al., 2018 ; Winkler et al., 2023 ). Mass media stakeholders in Bornholm and Odsherred Table 1 presents characteristics of the six mass media stakeholders, which were involved in Project SoL in Bornholm and Odsherred. Two of these were local TV stations (TV2 Bornholm and TV2 East), two were local radio stations (DR Radio Bornholm and DR Radio Zealand), and to were newspapers (Newspaper Bornholm and Newspaper Odsherred). TV2 Bornholm was the only formal mass media partner in the project. The other mass media stakeholders were referred to as non-formal mass media collaborators as they were involved in the project but not bound to it. Table 1 Characteristics of the mediascape and factors influencing the engagement of local mass media stakeholders involved in Project SoL in the Danish municipalities of Bornholm and Odsherred. Bornholm Odsherred The mediascape in the target areas* TV2 Bornholm DR Radio Bornholm Newspaper Bornholm TV2 East DR Radio Zealand Newspaper Odsherred Interviewee Editorial Director Editorial Secretary Journalist Editor in Chief Producer Editor Staff involved in Project SoL • Editorial director • 2 program organizers • Photographers • Technical staff • 1 editorial secretary • 3–4 journalists • 3–4 local editors in target communities • 3–4 photographers • Editor in chief • Editorial manager • 2 journalists • Camera staff • 2 reporters • 2 reporters Organisation Independent company (1 in 8) connected to a parent TV2 channel Integrated part of the bigger common consortium DR, DK Owned by media company (25%) and foundation (75%) Independent company (1 in 8) connected to a parent channel TV2 Integrated part of the bigger common consortium DR, DK Own by the parent company “Zealand media A/S” Subscription Free Free Paid Free Broadcasts/in press Daily Daily Daily Weekly Regional staff in total 70 20 51–201 93 26 + freelancers 2.5 Target group Broad Broad, “family Dk”, adults between 40 and 60 years Broad, elderly Broad, adults with families Broad, “family Dk”, adults above 35 years Broad, adults with families Experiences with health promotion - - - The health improving programs “Live life” targeted adults in the region - Framing health Avoid being paternalistic None, due to different editors and interest in outcomes of healthy lifestyle None, agree with a broad concept of health, interest in outcomes of healthy lifestyle None, prioritize a broad range of health issues daily due to health problems in the region None, agree with broad concept of health Engaging factors** Communication • Too academic, too much talking • Project coordinator as bridge for positive communication, planning, feedback, and idea generation • Contact with researcher and local coordinator via press releases and phone calls • Bad timing of press releases Positive communication via e-mail correspondence, phone calls from local coordinator Positive communication with editors (many different) via phone calls from local coordinator • Positive communication with local coordinator - • Ok communication, E-mail correspondence, phone calls • Bad timing of press releases Communication • Too academic, too much talking • Project coordinator as bridge for positive communication, planning, feedback, and idea generation • Contact with researcher and local coordinator via press releases and phone calls • Bad timing of press releases Positive communication via e-mail correspondence, phone calls from local coordinator Positive communication with editors (many different) via phone calls from local coordinator • Positive communication with local coordinator • Ok communication, E-mail correspondence, phone calls • Bad timing of press releases Collaboration • Active partner • Two TV programs • Felt ownership • Influence on media practice • Ad hoc – coverage • Two radio programs • Ad hoc – coverage No influence on media practices due to lack of commitment/SoL perspectives • No collaboration • Ad hoc – coverage (fun parts) • Lack of involvement, commitment and SoL perspectives • No collaboration • Ad hoc • Lack of involvement • No collaboration • Ad hoc – coverage • No ownership • No influence on media practices Media coverage • Planned Coverage (conclusion, what work, what didn’t work, the good example/reality) • “Just a little healthier” (n = 22) • Debate “The panel” • “Just a little healthier” tips • News (n = 16) • Web (n = 39) • Coverage of news, conclusions, what worked, what did not work • Project SoL themes • “Sunday guest’ and ‘What’s the point’ • Radio (n = 19) • Web (n = 4) • Project SoL themes • News (events), interviews with local key stakeholders, recipes, and ideas on how to live “a little healthier”, took pictures of activities • Articles (n = 125) • Web articles (n = 30) • Coverage (fun parts, conclusions) • News (n = 3) • Coverage • Radio (n = 3) • Web (n = 1) • Coverage like other news (interesting/fun news, Conclusion, what work, what didn’t work) • Used press releases, • Project SoL logo, took pictures of activities • Articles (n = 2) * The information was obtained from interviews, e-mail correspondence, personal communication, and web-based searches. ** The information was obtained from interviews and e-mail correspondence. The mass media intervention of Project SoL The mass media intervention aimed to raise public awareness about Project SoL's multicomponent initiative, promoting healthy living among children and families in Bornholm and Odsherred. Initially, efforts were made to gather all partners, including the local project coordinator, public sector practitioners, project researchers, and local media representatives, to jointly develop and implement the intervention. However, media stakeholders struggled to participate in joint meetings, so regular bilateral meetings between researchers and media stakeholders were organised to ensure their engagement. The local project coordinator managed action planning and implementation with TV2 Bornholm through monthly meetings, frequent phone calls, and email correspondence. Interaction with non-formal mass media collaborators occurred on an ad hoc basis during specific project activities, events, and campaigns. The intervention included various broadcasts on local TV, radio, and newspapers (Table 1 ). TV2 Bornholm created two programmes on lifestyle, wellbeing, and health, resulting in around six hours of relevant content for Project SoL. The series “Just a Little Healthier” aired monthly from 2013 to 2016, discussing health promotion with project implementers and local stakeholders. The debate programme “The Panel” engaged the local project coordinator and other local health ambassadors e.g. from hospital or food schools discussing health topics e.g. the dietary guidelines. “Just a Little Healthier Tips” provided health promotion practices from residents over two months. DR Radio Bornholm included the local project coordinator in two debate programmes on health issues e.g. healthy breakfast and lunch and offered a media workshop for schools, which failed due to lack of resources and timing. An attempt to organise a similar massive mass media intervention in Odsherred failed due to insufficient time to build trust. The intervention also included items on the Project SoL website, Facebook, printed materials (e.g. bus banners, action guidelines, food recipes), and merchandise (e.g. posters, t-shirts, flags, magnets). Numerous press releases were disseminated through the project partnership’s media platforms. Interviews with representatives of local mass media stakeholders Qualitative interviews were organised with representatives of all six (formal and non-formal) mass media collaborators in Bornholm (in month 16 of the intervention) and Odsherred (in month 10 of the intervention). This was done to capture their individual perceptions and experiences of engagement in community-based health promotion interventions, including Project SoL. The interviews were inspired by the concept of mediascape, which refers to both the platform for producing and providing information as well as the images of the world created by the media stakeholders (Appadurai, 1990 ). The images-centred mediascapes tend to be narrative-based accounts of reality. They provide elements like characters and plots, enabling people to create scripts of imagined lives for themselves and others (Appadurai, 1990 ). These scripts often evolve into complex metaphors that shape perceptions, aspirations, and desires for acquisition and movement (Appadurai, 1990 ). The interview guide addressed mediascape as organisational structures of mass media stakeholders, previous experiences in health promotion, and understanding of the health concept, and it was adjusted to the specific contexts and roles of mass media stakeholders in Project SoL (e.g. formal partner or non-formal collaborators). In addition, the interview guide included a combination of 20 semi-structured and open-ended questions addressing the following five themes: 1) the expectations and motivations of media stakeholders to engage in Project SoL, 2) their perceptions of the target group for the intervention, 3) their roles in the project, 4) their health promoting contributions in the project, and 5) their perceptions of mass media integration and sustainability of the project. Face-to-face interviews were conducted with TV2 Bornholm, TV2 East, Newspaper Bornholm, and Newspaper Odsherred. One phone interview was conducted with DR Radio Bornholm while DR Radio Zealand answered questions through e-mails. The interviews had a duration of 22–60 minutes. Oral informed consent to participate in the interviews was obtained from all interviewees and the recordings of the interviews were transcribed verbatim, stored anonymously, coded, and analysed by the main author using the qualitative data analysis software NVivo (Nvivo 10, QSR International Pty Ltd., 1999–2013). Thematic analysis was conducted to find repeated patterns of meaning that were valid across interviewees within the specific aspects of interest (Braun and Clarke, 2006 ; Brown et al., 2013 ), namely, to understand the barriers and potentials for engaging mass media stakeholders in community-based health promotion interventions. All quotes were translated from Danish to English and are presented anonymously. The interviews were supplemented with information on organizational structures of the mass media stakeholders gained through the interviews and internet searches. RESULTS In the following sections we analyse the mediascape, including the organisational structures, previous experiences, and perceptions of health among the six mass media stakeholders involved in Project SoL, which was found to influence the ability of mass media stakeholders to formalise their engagement in the project (Table 1 ). Furthermore, we point to both common barriers and drivers for engagement of mass media stakeholders in health promotion. The influence of mediascape - barrier or facilitator for mass media stakeholder engagement. First, lack of time, financial resources and inflexible organisational structures were found to hinder the engagement of mass media stakeholders. The two newspapers found lack of time and resources as main barriers for their engagement in Project SoL, while DR Radio Bornholm mentioned limited resources and organizational obligations to the bigger DR consortium, as main obstacles for making long-term and formalised commitments to Project SoL. The Editorial Secretary of DR Radio Bornholm explained: “We don’t feel that we can commit to a two or three-year project with obligations to do this in October and then do that, because there are so many other things we have to take into account, not just holiday periods with staff shortages, but also elections and things like that, as well as internal issues like, for example, DR as a corporation has campaigns in various areas.” [Editorial Secretary, DR Radio Bornholm] The Editorial Secretary of DR Radio Bornholm further noted that TV2 Bornholm was a relatively independent regional TV station under the TV2 corporation: “One of the major differences between TV2’s regions and DR’s regions is that we are an integrated part of a national corporation, whereas TV2 is organised around independent companies connected to a parent channel.” [Editorial Secretary, DR Radio Bornholm] The Editorial Secretary of DR Radio Bornholm assumed that organisational independency of the regional TV2 channels gave TV2 Bornholm more flexibility to formally engage in projects like Project SoL. Secondly, previous experiences with health promotion limited engagement among some mass media stakeholders, while the potential for exercising corporate social responsibility incentivised other media stakeholders to engage. TV2 East had previously developed and broadcasted a TV programme series on health promotion. With financial support from Trygfonden, a Danish philanthropic funding agency, “Live life” targeted adults in the region of Zealand via TV and radio (DR Radio Zealand ) and this made TV2 East reluctant to also engage in Project SoL. The Editor in Chief of TV2 East explained: “So that means, well, we have kind of taken a big step there …in the health area …and therefore you could say…when we hear about this initiative, we do not think we should join and do that again." [Editor in Chief, TV2 East]. The Editor in Chief of TV2 East elaborated that they had invested substantial amounts of resources in “Live life” and successfully broadcasted the programme for two seasons. On that basis, TV2 East felt they had fulfilled their corporate social responsibility in relation to health promotion engagement. Contrary to TV2 East, TV2 Bornholm had no previous experience with health promotion programmes and were eager to get started. Prior to launching of Project SoL, TV2 Bornholm therefore developed a TV program series on health promotion. “Well, before the project started, we had developed [the TV programme] ‘Just a bit healthier’ and we had already started [broadcasting] but found that we lacked fuel in the programme ...but then slowly it [the material] emerged.” [Editorial Director, TV2 Bornholm] According to the Editorial Director of TV2 Bornholm, the launching of Project SoL came at the right time to ensure alignment with the efforts of TV2 Bornholm to engage in health promotion in Bornholm. Previous successes with the development and broadcasting of a health promotion programme were not a driving factor for TV2 East to establish a formalised engagement with Project SoL. However, the right timing and alignment with existing agendas appeared to be a driving factor for TV2 Bornholm to formalise the engagement with Project SoL. Thirdly, alignment with a broad and positive understanding of health facilitated the engagement of mass media stakeholders in Project SoL. It was important for the mass media stakeholders not to be paternalistic when communicating health to the public. The Editorial Secretary of DR Radio Bornholm said: “We sometimes have discussions in the editorial office about whether it is our job to tell people what to do, and if so, how we should go about doing it, so that it is not just us saying, ‘Eat more broccoli.” [Editorial Secretary, DR Radio Bornholm]. Most interviewees expressed a positive and broad understanding of the concept of health. The Editorial Director of TV2 Bornholm explained: ”Our philosophy has been that this [health promotion] is about making small adjustments to many…’Just a bit healthier’ is a good name, right? If it is going to change the bigger statistics, it is important to get a lot [of people] to do a little bit rather than a few to do a lot. [Editorial Director, TV2 Bornholm] TV2 East emphasised the importance of being positive and solution-oriented in health promotion: “You could say that we focus on where there are problems and where there are discussions…on being solution-oriented…Some people call it constructive news…like, when people see us, they do not feel they are being told off …they feel that, yes, there is hope for life tomorrow, right?” [Editor in Chief, TV2 East] Health topics were also met with scepticism. The Editorial Secretary of DR Radio Bornholm questioned if health information is beneficial to people or whether it makes them more confused and the Editor of Newspaper Odsherred expressed scepticism about the commercial focus in health: “…and in 99.99% of all cases there is some manufacturer that has produced something that you are supposed to drink or eat or put in your hair or on your nose or whatever, and which is really, really healthy (ha-ha). So, when we see the word ‘healthy’, it is always with a very high degree of scepticism” . [Editor, Newspaper Odsherred]. Although interviewees did not deliver a specific definition of health, most of them expressed a positive and broad understanding of the concept, but also a certain scepticism and critical view on it. These somewhat contrasting perceptions could both favour and disfavour the engagement of mass media stakeholders in health promotion interventions. Child focus and a broad reach to engage mass media stakeholders in Project SoL Health promotion was a hot topic in the public and among the media stakeholders, especially when involving children, and the project was expected to bring inspiration for healthy living into the everyday lives of families in the targeted municipalities. The mass media stakeholders in Bornholm and Odsherred of Project SoL had high expectations towards Project SoL and thematic focus was regarded as a motivational factor for the engagement of mass media stakeholders. A journalist at Newspaper Bornholm said: “For my part, it [Project SoL] is something that I have welcomed. As I said before, it is good material. “ [Journalist, Newspaper Bornholm] Contrary to these motivations, TV2 Bornholm was disappointed about the narrow scope of the project. In accordance with the stipulations of the public service agreement for Danish mass media, TV2 Bornholm anticipated that Project SoL would be targeting all citizens living in the targeted municipalities. The narrow focus on families with young children living in selected communities came as an unpleasant surprise to them. ”You could say that the narrow geographical and age-related focus affected our expectations…and the potential to make good TV out of it. It (the intervention) was not as broad as we thought.” [Editorial Director, TV2 Bornholm] The Editor in Chief of TV2 East also found Project SoL to be too local and selective, and decided not to give the project full media coverage: “ Here [in Project SoL] you have really tried to do something very local and therefore, of course, it is not the same. But in that case, that just means that maybe we were not completely ready to say ‘let us join in and give it the whole programme’, you know ?” [Editor in Chief, TV2 East]. Contrary to this, the two newspaper stakeholders were pleased to note that the project reached out to a broad target group, including parents, families, grandparents, those who know the children, people involved in schools and day-care institutions as well as shop owners. The Editor of Newspaper Odsherred explained: “It is one of those [health projects] where we would say ‘that really sounds good’. It reaches out to the families, and it reaches out to those who are also our customers, namely, the business owners…” [Editor, Newspaper Odsherred] Newspaper Odsherred had their expectations fulfilled on being contacted upfront by phone or e-mail with information and press releases about project activities as this would ease their prioritization and selection of news material. The child focus, the non-commercial focus and the positive health messages motivated the stakeholders to cover the news from Project SoL. “So, when this [project] showed up, I thought [with a clap], oh, finally, ha-ha. Here is something with a bit of flesh and blood on it, something interesting, you know? That is also why we have used your press releases, I would almost say in their entirety”. [Editor, Newspaper Odsherred] Partnership between mass media stakeholders and researchers – the importance of communication and relevance TV2 Bornholm was the only formal mass media partner in Project SoL and its engagement in the project therefore differed from the engagement of the other mass media stakeholders. Initially, TV2 Bornholm found the communication with project researchers to be too academic and this negatively affected the collaboration. “We cannot make TV based on research studies…and talking. It needs to be real, because otherwise it serves no purpose…so we have been really focused on the reality part and the collaboration part, you know”? [Editorial Director, TV2 Bornholm] The academic design of Project SoL challenged the initial communication and collaboration with TV2 Bornholm. The project was found to be heavy, slow, academic, and detached from reality. To improve the situation, problem-solving meetings between the mass media stakeholders and senior project researchers were organised. The decisive turning point came with the recruitment of a local (native) project coordinator. The Editorial Director of TV2 Bornholm expressed it this way: “Well, after hiring the local project coordinator with lots of local knowledge and competence to do everything, then it [the project] became really, really good.” [Editorial Director, TV2 Bornholm]. The local project coordinator allegedly improved the communication between Project SoL and TV2 Bornholm by organising monthly planning meetings and inviting TV2 Bornholm to review planned project activities and propose improvements if they were suboptimal for TV production. TV2 Bornholm had a genuine interest in contributing to the promotion of public health and characterised themselves as a real project partner with co-ownership of the intervention. The commitment of the TV station manifested itself through massive engagement in developing and broadcasting health promotion activities of the project (Table 1 ). “ One thing is what the pastor preaches. It is what he actually does that is important…and that is what we want to show in the TV programmes, you know?” [Editorial Director, TV2 Bornholm] The Editorial Director of TV2 Bornholm elucidated that they constantly sought a practical angle in their TV programmes in efforts to document the reality of healthy living in the settings of people’s everyday life, while communicating healthy tips of real people and panel discussions among local health professionals. This was all broadcasted from different geographical locations and settings in Bornholm to make health promotion omnipresent and meaningful for everyone. Project activities carried out in day-care centres and primary schools were favoured by TV2 Bornholm because they very concrete (e.g. cooking, gardening, sensing, playing, caring) and easy to communicate and visualize on TV. Also, project activities carried out in partnering supermarkets were strongly supported by TV2 Bornholm because this was (to TV2 Bornholm) a new and interesting stakeholder with much more to offer than profit-thinking. TV2 Bornholm found the supermarkets to be surprisingly collaborative and willing to experiment, contribute, and break the news on TV. The Editorial Director of TV2 Bornholm elaborated: “They [partnering supermarkets] think it is fun to join in. We can sense it, too, when we visit the supermarkets, there is a lot of goodwill out there, you know? So, for sure, some of the things that have been done out there as part of the project have certainly given us ideas and inspiration. ” [Editorial Director, TV2 Bornholm]. As stated above the collaboration with local stakeholders in supermarkets and day-care institutions created win-win situations and promoted the engagement of TV2 Bornholm in health promotion. The traditional media role of non-formal mass media stakeholders The non-formal mass media collaborators of Project SoL never made any attempts to formalise their engagement in Project SoL and felt no ownership of the project at any point in time (Table 1 ). They covered Project SoL activities in a traditional way and could not see that the project had contributed to their media practices. DR Radio Zealand perceived its role in society to be descriptive: “ Our approach is mainly journalistic, not activistic. So, to the extent that there is interesting news to talk about, we would of course be happy to do it. ” [Producer, DR Radio Zealand] Newspaper Bornholm expressed the same position in the following way: “So, I see us only to be placed on the side line in the sense that we tell people what it [the project] is about, but we are not a part of it.” [Editor, Newspaper Bornholm]. Newspaper Bornholm found the project activities easy to communicate due to the positive messages and meaningful content e.g. on children’s involvement in health promotion. The newspaper therefore published numerous press releases and created public awareness about the project and its activities in a very positive and constructive manner. TV2 East acknowledged and appreciated the existence of Project SoL but would not fully commit to the project’s health promotion agenda, mainly because the scope and focus was perceived to be narrow in terms of selected target groups and geographical coverage. The Editor in Chief said: “It is like we have not been …you could say, we have not committed ourselves to embrace the whole message, but just to subscribe to something when there was something that was a bit fun in itself”. [Editor in Chief, TV2 East]. TV2 East’s limited commitment to Project SoL negatively affected the collaboration and caused frustration on both sides in relation to the planning for press coverage of project activities. The Editor in Chief explained: “She [the local project coordinator] was a bit frustrated, too, because she felt a bit that…, then she wrote to us and then it was, like, a new editor she met, and some people didn’t know about it [the project] and things like that. And then I just said to her but, of course, it’s a bit the ‘rule of the game’ when we are not part of it, because that’s how we work. We work a bit from day to day and we look at, well, what is on the agenda today ?” [Editor in Chief, TV2 East]. Whereas mass media coverage of project activities was rather limited by TV2 East, it was very intense by Newspaper Odsherred and Newspaper Bornholm. They eagerly announced upcoming project events in their newspapers and reported from all of them to strengthen the publicity and recognisability of the project in the local community. A journalist at Newspaper Bornholm elaborated: “Yes, so basically, we cover it [project activities] to the extent that we can. Sometimes it is only a photographer going out and taking some pictures …and then I have talked with [name of the local project coordinator] on the phone. At other times, I have gone out there myself, if, for example, it has taken place at a school, and spoken with a teacher and a couple of students, maybe.” [Journalist, Newspaper Bornholm]. The journalist further explained that public interest in the topic, time constraints, and the volume of other news stories influenced the coverage of project activities in the newspaper. The Editor of Newspaper Odsherred mentioned the struggle for public attention, tough prioritization of news stories, and timing of announcements and press releases as critical factors influencing the level of collaboration with Project SoL. The editor elaborated: “It sounds a bit like we are saying: ‘we want it all handed to us on a silver platter’. Hmm, actually we would really like that (smile). Also, because we’re pretty busy making these newspapers, so we cannot just set aside an afternoon, three hours or so, and go to the mall and create the story”. [Editor, Newspaper Odsherred] DR Radio Bornholm also found the timing of receiving information about project activities to be a critical factor in the communication and collaboration with Project SoL. They had observed that they received press releases from the project after TV2 Bornholm, as the formal media partner, received them and this decreased the newsworthiness, motivation, and willingness to cover project activities. The Editorial Secretary of DR Radio Bornholm explained: “We have actually been invited to some meetings and could maybe also have engaged more actively with it [the project], but we felt excluded from the beginning and also during the project, and that is the way it is, it is common human behaviour, when we feel excluded, we may choose to opt out”. [Editorial Secretary, DR Radio Bornholm] The Editor in Chief of TV2 East touched upon the difference in expected levels of commitments between formal project partners and non-formal collaborators: “We are also just people and obviously, the moment you have crossed a line and said, we are part of this [project] now, we are going to try now, then you go in and take ownership of it and…engage more actively in it. Rather than if you are just receiving press releases, and then at some point in time, ‘Argh, no, …it is them writing again, I cannot be bloody bothered now”. [Editor in Chief, TV2 East] The influence of local mass media on shaping public opinion and practice was believed to be very high in the targeted municipalities, especially in Bornholm, as elucidated by the journalist of Newspaper Bornholm: “Well, I think that the media are hugely important here on the island, I mean, there is massive media coverage relative to the size of the island and the size of the population. So, I think it has a really big impact and there are lots of people who follow [the local mass media]”. [Journalist, Newspaper Bornholm] All interviewees expressed a readiness to cover and perhaps even engage actively in future health promotion activities and projects. Even TV2 East, as perhaps the most sceptical mass media stakeholder in Project SoL, acknowledged the potentials of engaging more actively and formally in a research-based project like Project SoL because of its action-oriented nature. The Editor-in-Chief of TV2-East explained: “We wanted to pass on some experiences that everyone would be interested in, you see? Participate in discussions that everyone might debate with themselves at home in the living room. So yes, yes, yes, you could say that this is applied science, right”? [Editor in Chief, TV2 East]. A summary of the barriers and drivers for creating a conducive environment for the engagement of mass media in health promotion are given in Table 2 . Table 2 Facilitators and barriers for the engagement of mass media stakeholders in health promotion. Data was obtained from interviews (n = 5) and e-mail correspondence (n = 1) with mass media staff involved in Project SoL. Engagement Facilitators Barriers Mediascapes Organisation • Flexible organizational structure • Editorial independence • Inflexible organizational structures • Dependence and obligations as part of National consortium • Poor staffing and resources Framing of health • Broad and positive concept of health • Commercial focus Target group and reach • Broad reach to the target group • Narrow reach (age and geographical) • Lack of possibility to fulfil public service agreements Perceived role in society • Problem solving • Active role • Descriptive role of mass media Content • News value • Attractive topics (practical activities, children, health) • The non-commercial focus • Corporate social responsibility • Output conclusions, what worked; what did not work • Skepticism towards the abundance of health information • Academic approach • Abstract and repetitive nature of health activities • Lack of news value • Lack of project resources (lack of intensity) • Lack of content for mass media Communication • Matching expectations • Clear roles • Plan ahead • Use a local coordinator to bridge academia and mass media Communication plan (e-mails, phone, press releases, meetings) • Choose the right communication and media channel • Access to relevant local stakeholders • Accept input from media stakeholders • Create ownership • Create win-win for media and local stakeholders • Human factors (interest, relationship) • Diverse expectations and interests • Unclear roles • Lack of resources (struggle for attention, the tough prioritizing) • Changing staff • Bad timing of sharing news • Choose the wrong media channel (e.g. repetitive activities in radio) • Previous experiences • No ownership, lack of involvement and commitment • Human factors (interest, relationship) DISCUSSION This study shows how mass media stakeholders successfully can be engaged in health promotion by creating potentials for exercising corporate social responsibility, adopting a broad and positive understanding of the concept of health and focusing on relevant themes e.g. children and health to attract the attention of a large audience. Barriers for engagement in health promotion within the mediascape were found to be inflexible organizational structures of mass media, lack of financial and human resources and a demand to maintain a disseminating, descriptive and neutral role in the mediascape. Furthermore, a narrowly selected target population and geographical outreach of project activities limited the engagement of mass media stakeholders. Other studies have identified lack of time and resources alongside difficulties in mobilising other stakeholders as major barriers for communicating health (Wilkinson et al., 2022) The successful engagement of mass media stakeholders may be attributed to the close collaboration, the focus on planning the communication, the use of role models and creating win-win situations among mass media, supermarkets, day-care centres, primary schools, and other local stakeholders. This novel partnership approach provided mass media with good news material, access to key persons, and new target groups like young people and their parents. Supermarkets and day-care centres benefited from media exposure, presenting their organisations as responsible and dynamic. Researchers effectively communicated their messages, enhancing awareness and advancing the local health agenda. It has been documented that collaboration between health organisations and mass media may increase professionalism of the mass media and strengthen the reporting of health issues to the public as well as influence public perceptions of the involved health organisations (Berridge, 2009 ). Successful collaboration can thus support and strengthen the engagement of the mass media in promoting a health agenda, informing and steering public opinion, and influencing expectations and beliefs of the public (Benelli 2003 ). Factors within the mediascape identified as drivers for the engagement of mass media stakeholders in health promotion include embracing a broad and positive understanding of the concept of health, taking a problem-solving responsibility in society, and actively exercising corporate social responsibility. Local mass media may more easily than national mass media base their operations on social responsibility principles and advocacy (Atton, 2003 ; Kolandai-Matchett, 2009 ). In Project SoL, mass media stakeholders generally endorsed the broad and positive understanding of health and strived to communicate health issues in a constructive and inspiring way. This is consistent with the findings of a survey carried out in seven European countries, which identified enthusiasm about the topic in question, and a desire to educate and counter misinformation as key drivers for mass media to engage in communication of health (Wilkinson et al., 2022). Other drivers of local mass media engagement have been defined, including having a broad public appeal with news that is locally relevant, informative, and satisfying to the local community (Fogarty, 2011 ; Pauly and Eckert, 2002 ). Local mass media stakeholders in Project SoL enthusiastically covered many of the health promotion activities of the project because they fulfilled the main criteria of having high news value and good potential to influence the behaviours of citizens. These activities were relevant to the local context of everyday life, practice-oriented, amusing, inspirational, and easy to communicate through pictures and words. Practice-oriented issues related to active living and healthy eating have previously been recognized as salient topics for mass media (Andsager et al., 2015 ; Zhang et al., 2016 ), which signifies that it is both possible and realistic to communicate health promotion interventions through mass media. In Project SoL, TV2-Bornholm developed health promotion programs using local role models to demonstrate and discuss health behaviours. The use of local health ambassadors rather than experts signifying the importance of differential prestige of news source (Scheufele 1999 ). Other mass media studies used role models to which the target group could identify to overcome barriers related to healthy eating (Dale and Hanbury, 2010 ; Finlay and Faulkner, 2005 ). Watching fellow community members participating in health promotion activities may motivate others to comply with the media ‘messages’ (Renger et al., 2002 ). Moreover, the ability to identify oneself with a role model may further enhance the ability to remember the advice that has been communicated (Dale and Hanbury, 2010 ). Using role models is also a way for mass media to target social networks, which have proven successful in stimulating interpersonal communication to positively influence awareness, attitudes, and behaviours (Dunlop et al., 2008 ; Abroms and Maibach, 2008 ; Viswanath et al., 2006 ). The engagement of mass media stakeholders in health promotion was however hampered by the application of an academic project approach, which entails numerous meetings and workshops, long and intellectual processes of developing and agreeing on activities, bad timing and lack of news value due to a repetitive nature of activities. Similarly, the involvement of supermarket staff in health promotion was challenged by the academic approach of researchers (Winkler et al., 2023 ). In Project SoL, the news value of project activities received substantial attention by mass media stakeholders. This is consistent with the observation that news value in terms of proximity, significance, novelty, relevance, and applicability is important in the constant struggle of mass media to attract public attention (Zhang et al., 2016 ). The collaboration between mass media and research institutions may be further challenged by differences in objectives and perspectives, including expectations and interests, roles and functions, and working and communication practices. In Project SoL, TV2 Bornholm merely wanted to relate to everyday life of citizens by momentarily satisfying their needs and demands for news. There was no need for lengthy academic processes to satisfy this purpose. This signifies the importance of norms of generalisation and simplification for the mass media stakeholders (De Brun et al ., 2013) and confirms the existence of a gap between the practical perspective of the mass media world and the intellectual perspective of the academic world; a gap which has been referred to as a division of “arenas” of internal scientific and public communication of everyday knowledge (Peters, 2013 ). Finally, mass media stakeholders may not commit themselves to the health promotion agenda simply because they consider active engagement to be beyond their mandate and responsibility. The reluctance to commit to health promotion was also observed among the supermarket store managers(Winkler et al., 2023 ) indicating a general trend among commercial stakeholders. In Project SoL, this argument was mainly noted among stakeholders from radio stations and newspapers, and it is consistent with previous observations that the function of mass media is not to lead or drive public opinion, but to communicate it (De Brun et al ., 2013). Limited commitment may also reflect personal rather than organisational considerations among mass media stakeholders, including experiencing unfulfilled expectations, being overlooked or lacking interest in public health. Previous studies have suggested that the production of news may not only be influenced by the structural and organisational pressures and economic constraints of the mediascape, but also by pressure from interest groups as well as individual attitudes, social norms and values, media and working routines, ethics, prejudice, and ideology (Shoemaker and Reese, 2013 ; Tuchman, 1978 ; Scheufele, 1999 ; Andsager et al., 2015 ). This signifies the importance of securing good communication and strong relationships with media partners in health interventions (Bell et al., 2013 ). In Project SoL the engagement of mass media was thereby strengthening by carefully matching expectations and clarifying roles of partners and by having local representation, communications plans, and different channels for communication. A growing production of, and public demand for, knowledge and information on health and medical issues may force mass media stakeholders to take hasty and perhaps irrational or emotional decisions on news to be communicated by mass media (Benelli, 2003 ). Large mass media organisations may be in a better position than small organisations to allocate resources to recruit health science journalists who can cover complex health issues more deeply and objectively (Bradshaw et al., 2005 ; McCaw et al., 2014 ; Zhang et al., 2016 ; Lee, 2009 ). Small mass media organisations rarely have such opportunities as they struggle with inflexible work schedules and limited resources that may result in inadequately researched and sketchy news stories (Fogarty, 2011 ; Arnold, 2004 ; Freedman and Fico, 2004 ; Lee, 2009 ; Pribble et al., 2006 ). Such organisations would benefit from engaging in professional and trusting partnerships with health promotion stakeholders (Zhang et al., 2016 ). This is what occurred in Project SoL. Interestingly, regional differences in the engagement of mass media stakeholders were observed. Mass media stakeholders in Bornholm were much more engaged in Project SoL than mass media stakeholders in Odsherred. Mass media stakeholders in Bornholm engaged in activities that were quite unusual for such kind of organisations and included allocation of programs and arial time to the project, active participation in project meetings, setting up and organising workshops and interviews, and publishing guidelines and recipes on their websites and social media platforms. The likely explanation for this excessive engagement is that the media landscape in Bornholm had a very good contact with citizens, allegedly due to the rather limited geographical size of the island and strong social cohesive forces. CONCLUSION This study identified factors supporting a conducive environment for engaging mass media stakeholders in health promotion interventions. Drivers and barriers of engagement were related to the mediascape, the content of activities, human factors, the communication and the collaboration between mass media stakeholders and health promotion professionals. The findings suggest that it is both possible and realistic to communicate health promotion interventions through mass media, and that engagement of mass media stakeholders as formal partners may strengthen health promotion interventions and aid the development of new health promotion strategies in local community settings. Declarations Ethics approval and consent to participate The study adhered to all aspects of the Helsinki Declaration. Informed consent to participate in the study was obtained from all study participants. Study participants were briefed about the study, the use of data and their rights to withdraw from the study and retract their data. Oral informed consent was obtained from the mass media stakeholders as written consent was not required according to the Danish Data Protection Agency or other national legislation at the time. In Denmark, approval from the Research Ethical Committee was not required according to Danish law, as the research project was based on interview data and therefore did not contain human biological material (cf. Section 14 no. (2) in Act on Research Ethics Review of Health Research Project https://www.nvk.dk/forsker/naar-du-anmelder/hvilkeprojekter-skal-jeg-anmelde). The study was approved by the Danish Data Protection Agency according to the Danish Act on Processing of Personal Data (2007-58-0015). Consent for publication Not applicable Availability of data and materials The corresponding author has full access to the data reported in the manuscript. Data will be made available on request Competing interests The authors declare no conflict of interest. Funding The Project was supported by the Nordea-Fonden, which had no involvement in preparation of the article. Authors' contributions HCR, UT, BEM and PB drafted the initial Project SoL research protocol. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5454860","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379337025,"identity":"d747a5cc-76eb-4138-a329-4a1c81a7ee25","order_by":0,"name":"Helene Christine Reinbach","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIie2QsUrEQBCG5wiYZjbXboicr7BHIOeh4KskWKTx0PKKFDkCsVmw1acxYWBtVmxTCHoIVhYHNoIot5pKSe4sLfYrlhmYj/lnASyWf4gAJ28rB3bMW41c03OoTK37lMFPJcTqzwq0SiK3KRN3sXg6m8Pp0GXq8S27T6Vb1A1oAk9XncpU1kV4qWF6VXjpWKrnmUR1vA8NgX+bdyqiScqAlSAEYcRZTrNrfhJxWBGIu55bHpbn7+wTxJFR/I+cUtyqNIPSYbnZ4mAUmC1xq5hgoi+YTooAFReccBLuKhp/3xLrFP2e88UN1a+YHYrhhY6WLxnt4dePrdTByNNxd7IW/qs3w7hp3mKxWCybWQOQ4WE53xrCoQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Copenhagen","correspondingAuthor":true,"prefix":"","firstName":"Helene","middleName":"Christine","lastName":"Reinbach","suffix":""},{"id":379337026,"identity":"332ed1c3-5f94-423b-9790-c60c64b815d3","order_by":1,"name":"Tine Buch-Andersen","email":"","orcid":"","institution":"Bispebjerg and Frederiksberg Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tine","middleName":"","lastName":"Buch-Andersen","suffix":""},{"id":379337027,"identity":"a585452d-8e95-449f-a215-52128c4dd8b8","order_by":2,"name":"Lise L. Winkler","email":"","orcid":"","institution":"Bispebjerg and Frederiksberg Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lise","middleName":"L.","lastName":"Winkler","suffix":""},{"id":379337028,"identity":"377f3abb-9aef-4253-ab55-5ad1e1556926","order_by":3,"name":"Ulla Toft","email":"","orcid":"","institution":"Bispebjerg and Frederiksberg Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ulla","middleName":"","lastName":"Toft","suffix":""},{"id":379337029,"identity":"4b5eeaed-9314-4db6-8255-0729018a3089","order_by":4,"name":"Bent Egberg Mikkelsen","email":"","orcid":"","institution":"University of Copenhagen","correspondingAuthor":false,"prefix":"","firstName":"Bent","middleName":"Egberg","lastName":"Mikkelsen","suffix":""},{"id":379337030,"identity":"f3c26355-db78-4e49-97a4-1632b50225aa","order_by":5,"name":"Paul Bloch","email":"","orcid":"","institution":"Steno Diabetes Center","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Bloch","suffix":""}],"badges":[],"createdAt":"2024-11-14 14:53:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5454860/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5454860/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70315883,"identity":"4660c01a-09e1-4f7d-b045-bfa58d401891","added_by":"auto","created_at":"2024-12-02 05:39:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":821458,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5454860/v1/e9881256-6f01-4d3b-b598-98f83b4cd0b2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Strengthening the engagement of mass media stakeholders in community-based health promotion interventions - The Danish Project SoL","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eFor decades mass media have been valued for their importance in promoting health (Head et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and the abundance of intervention studies investigating the effects of mass media on health behaviours signifies its potentials. Based on its various communication channels mass media can 1) inform, provide, and interpret health information (Andsager et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), 2) place health issues on the local and public agendas (Dixon et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) and 3) allow people to create their own knowledge-based opinions or to encourage people to take responsibility for their own health (Berridge, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Thus, mass media can directly or indirectly influence opinions, attitudes, norms, and behaviours.\u003c/p\u003e \u003cp\u003eMass media campaigns can by themselves or in combination with other intervention components ensure broad outreach, maximize effects and minimize selective exposure, and they are widely used to influence health behaviour of larger populations (Abroms and Maibach, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Kahn et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Snyder et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Snyder and Hamilton, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) e.g. by altering knowledge, attitudes and behaviours related to healthy diet and physical activity (Beaudoin et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Wakefield et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Cavill and Bauman, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Randolph et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) as well as other health health-risk behaviours e.g. use of tobacco, alcohol, heart disease risk factors, sex-related behaviours, road safety, cancer screening and prevention, child survival, and organ or blood donation (Wakefield et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Lately, mass media campaigns have proven useful in promoting health and hygiene practices during the Covid-19 pandemic (Anwar et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInclusion of mass media in multi-component community-based health interventions e.g. to reduce violence in schools (Swain and Kelly, 2008) or to encourage healthy eating (Glasson et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Pollard et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) and physical activity (DeBate et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) have demonstrated larger effects compared to single-component interventions (Swain and Kelly, 2008). The large community-based intervention program \u0026ldquo;\u003cem\u003eChoose Health LA Restaurants\u0026rdquo;\u003c/em\u003e found that a \u0026ldquo;paid\u0026rdquo; media campaign combined with community engagement and in-store promotion positively promoted the healthier choice of restaurant (Gase et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Interestingly, the program \u0026ldquo;earned\u0026rdquo; 33 free media articles indicating a strong public support for the program and a potential for restaurants and public health partners to collaborate on health promotion agendas (Gase et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe media industry is increasingly engaging in corporate social responsibility activities including health promotion interventions (Ralston and Maignan, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) to legitimate themselves and to improve their reputation in a world of increased journalistic and economic competition (Ingenhoff and Koelling, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Therefore, successful collaboration in which health professionals and researchers provide evidence-based health information that is communicated to the public through mass media platforms may offer great potentials for developing new and more effective health promotion strategies.\u003c/p\u003e \u003cp\u003eInterventions that are community-based may particularly benefit from partnering with \u003cem\u003elocal\u003c/em\u003e mass media stakeholders as they broadcast to a smaller audience and have a special focus on regional news. Bell et al., (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) described one of few multicomponent health promotion interventions that partnered with regional media stakeholders within TV, radio, and print media to increase outreach to the audience, to double the advertising activities and to brand the campaign materials. Other studies have also communicated a need for forming partnerships with local mass media to promote health (Yoo, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eProject SoL (in Danish \u0026ldquo;Sundhed og Lokalsamfund\u0026rdquo; meaning \u0026ldquo;Health and Local Community\u0026rdquo;) partnered with local mass media stakeholders (Toft et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) to optimize the impact of a multi-component community-based health promotion intervention implemented in two Danish municipalities. The aim of the present study is to identify potentials and barriers for the engagement of mass media stakeholders in health promotion. Findings from interviews with mass media stakeholders of Project SoL were discussed with a view to identify factors to support the establishment of conducive environments for mass media engagement in health promotion.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eProject SoL\u003c/h2\u003e \u003cp\u003eProject SoL originated from a wish among a team of journalists at a local TV station (TV2 Bornholm) on the Danish island and municipality of Bornholm to promote healthy diet and physical activity in the local communities. Different research institutions were therefore contacted, and a formalised partnership was established when project funds were obtained in 2011.\u003c/p\u003e \u003cp\u003eProject SoL implemented a 19\u003csup\u003e\u0026minus;\u003c/sup\u003e month multicomponent intervention to promote healthy shopping, cooking, and eating behaviours and to increase physical activity levels among children aged 3 to 8 years and their families in Bornholm. A detailed description of Project SoL can be found elsewhere (Toft et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eProject SoL applied the supersetting approach to mobilise local communities for public health action (Bloch et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). In accordance with the supersetting approach, project activities were coordinated and conducted more or less simultaneously across the settings of everyday life (e.g. day-care centres, primary schools, supermarkets and local mass media). This took place in three target communities in Bornholm (Allinge, Hasle and Nex\u0026oslash;), which were selected based on their similar size, presence of relevant settings, and community readiness to actively engage in the project. Odsherred, a Danish municipality with similar demographic, socio-economic and health characteristics as Bornholm, including high prevalence rates of risk factors for non-communicable diseases, functioned as a non-intervention control site involving three communities (H\u0026oslash;jby, Asn\u0026aelig;s and Egebjerg) for the overall evaluation of Project SoL (Mikkelsen et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). However, best practices from Bornholm were implemented in target communities in Odsherred during a 10- month post-intervention period. The current study focuses on the mass media intervention that was an integrated part of the multicomponent project (Toft et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Winkler et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMass media stakeholders in Bornholm and Odsherred\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents characteristics of the six mass media stakeholders, which were involved in Project SoL in Bornholm and Odsherred. Two of these were local TV stations (TV2 Bornholm and TV2 East), two were local radio stations (DR Radio Bornholm and DR Radio Zealand), and to were newspapers (Newspaper Bornholm and Newspaper Odsherred). TV2 Bornholm was the only formal mass media partner in the project. The other mass media stakeholders were referred to as non-formal mass media collaborators as they were involved in the project but not bound to it.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the mediascape and factors influencing the engagement of local mass media stakeholders involved in Project SoL in the Danish municipalities of Bornholm and Odsherred.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBornholm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eOdsherred\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe mediascape in the target areas*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTV2 Bornholm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDR Radio Bornholm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNewspaper Bornholm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTV2 East\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDR Radio Zealand\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNewspaper Odsherred\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterviewee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEditorial Director\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEditorial Secretary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournalist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEditor in Chief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eProducer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEditor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaff involved in Project SoL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Editorial director\u003c/p\u003e \u003cp\u003e\u0026bull; 2 program organizers\u003c/p\u003e \u003cp\u003e\u0026bull; Photographers\u003c/p\u003e \u003cp\u003e\u0026bull; Technical staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; 1 editorial secretary\u003c/p\u003e \u003cp\u003e\u0026bull; 3\u0026ndash;4 journalists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; 3\u0026ndash;4 local editors in target communities\u003c/p\u003e \u003cp\u003e\u0026bull; 3\u0026ndash;4 photographers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Editor in chief\u003c/p\u003e \u003cp\u003e\u0026bull; Editorial manager\u003c/p\u003e \u003cp\u003e\u0026bull; 2 journalists\u003c/p\u003e \u003cp\u003e\u0026bull; Camera staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; 2 reporters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026bull; 2 reporters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganisation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent company (1 in 8) connected to a parent TV2 channel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntegrated part of the bigger common consortium DR, DK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOwned by media company (25%) and foundation (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIndependent company (1 in 8) connected to a parent channel TV2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntegrated part of the bigger common consortium DR, DK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOwn by the parent company \u0026ldquo;Zealand media A/S\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubscription\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBroadcasts/in press\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eWeekly\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegional staff in total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u0026ndash;201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26\u0026thinsp;+\u0026thinsp;freelancers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTarget group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBroad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBroad, \u0026ldquo;family Dk\u0026rdquo;,\u003c/p\u003e \u003cp\u003eadults between 40 and 60 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBroad, elderly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBroad, adults with families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBroad, \u0026ldquo;family Dk\u0026rdquo;, adults above 35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBroad, adults with families\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperiences with health promotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eThe health improving programs \u003cem\u003e\u0026ldquo;Live life\u0026rdquo;\u003c/em\u003e targeted adults in the region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFraming health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAvoid being paternalistic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone, due to different editors and interest in outcomes of healthy lifestyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNone, agree with a broad concept of health, interest in outcomes of healthy lifestyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone, prioritize a broad range of health issues daily due to health problems in the region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNone, agree with broad concept of health\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEngaging factors**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Too academic, too much talking\u003c/p\u003e \u003cp\u003e\u0026bull; Project coordinator as bridge for positive communication, planning, feedback, and idea generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Contact with researcher and local coordinator via press releases and phone calls\u003c/p\u003e \u003cp\u003e\u0026bull; Bad timing of press releases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePositive communication via e-mail correspondence, phone calls from local coordinator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePositive communication with editors (many different) via phone calls from local coordinator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Positive communication with local coordinator\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026bull; Ok communication, E-mail correspondence, phone calls\u003c/p\u003e \u003cp\u003e\u0026bull; Bad timing of press releases\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Too academic, too much talking\u003c/p\u003e \u003cp\u003e\u0026bull; Project coordinator as bridge for positive communication, planning, feedback, and idea generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Contact with researcher and local coordinator via press releases and phone calls\u003c/p\u003e \u003cp\u003e\u0026bull; Bad timing of press releases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePositive communication via e-mail correspondence, phone calls from local coordinator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePositive communication with editors (many different) via phone calls from local coordinator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Positive communication with local coordinator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026bull; Ok communication, E-mail correspondence, phone calls\u003c/p\u003e \u003cp\u003e\u0026bull; Bad timing of press releases\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCollaboration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Active partner\u003c/p\u003e \u003cp\u003e\u0026bull; Two TV programs\u003c/p\u003e \u003cp\u003e\u0026bull; Felt ownership\u003c/p\u003e \u003cp\u003e\u0026bull; Influence on media practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Ad hoc \u0026ndash; coverage\u003c/p\u003e \u003cp\u003e\u0026bull; Two radio programs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Ad hoc \u0026ndash; coverage\u003c/p\u003e \u003cp\u003eNo influence on media practices due to lack of commitment/SoL perspectives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; No collaboration\u003c/p\u003e \u003cp\u003e\u0026bull; Ad hoc \u0026ndash; coverage (fun parts)\u003c/p\u003e \u003cp\u003e\u0026bull; Lack of involvement, commitment and\u003c/p\u003e \u003cp\u003eSoL perspectives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; No collaboration\u003c/p\u003e \u003cp\u003e\u0026bull; Ad hoc\u003c/p\u003e \u003cp\u003e\u0026bull; Lack of involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026bull; No collaboration\u003c/p\u003e \u003cp\u003e\u0026bull; Ad hoc \u0026ndash; coverage\u003c/p\u003e \u003cp\u003e\u0026bull; No ownership\u003c/p\u003e \u003cp\u003e\u0026bull; No influence on media practices\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedia coverage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Planned Coverage (conclusion, what work, what didn\u0026rsquo;t work, the good example/reality)\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Just a little healthier\u0026rdquo; (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003cp\u003e\u0026bull; Debate \u0026ldquo;The panel\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Just a little healthier\u0026rdquo; tips\u003c/p\u003e \u003cp\u003e\u0026bull; News (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003cp\u003e\u0026bull; Web (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Coverage of news, conclusions, what worked, what did not work\u003c/p\u003e \u003cp\u003e\u0026bull; Project SoL themes\u003c/p\u003e \u003cp\u003e\u0026bull; \u0026ldquo;Sunday guest\u0026rsquo; and \u0026lsquo;What\u0026rsquo;s the point\u0026rsquo;\u003c/p\u003e \u003cp\u003e\u0026bull; Radio (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003cp\u003e\u0026bull; Web (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Project SoL themes\u003c/p\u003e \u003cp\u003e\u0026bull; News (events), interviews with local key stakeholders, recipes, and ideas on how to live \u0026ldquo;a little healthier\u0026rdquo;, took pictures of activities\u003c/p\u003e \u003cp\u003e\u0026bull; Articles (n\u0026thinsp;=\u0026thinsp;125)\u003c/p\u003e \u003cp\u003e\u0026bull; Web articles (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Coverage (fun parts, conclusions)\u003c/p\u003e \u003cp\u003e\u0026bull; News (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026bull; Coverage\u003c/p\u003e \u003cp\u003e\u0026bull; Radio (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003cp\u003e\u0026bull; Web (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026bull; Coverage like other news (interesting/fun news, Conclusion, what work, what didn\u0026rsquo;t work)\u003c/p\u003e \u003cp\u003e\u0026bull; Used press releases,\u003c/p\u003e \u003cp\u003e\u0026bull; Project SoL logo, took pictures of activities\u003c/p\u003e \u003cp\u003e\u0026bull; Articles (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* The information was obtained from interviews, e-mail correspondence, personal communication, and web-based searches.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e** The information was obtained from interviews and e-mail correspondence.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eThe mass media intervention of Project SoL\u003c/h3\u003e\n\u003cp\u003eThe mass media intervention aimed to raise public awareness about Project SoL's multicomponent initiative, promoting healthy living among children and families in Bornholm and Odsherred. Initially, efforts were made to gather all partners, including the local project coordinator, public sector practitioners, project researchers, and local media representatives, to jointly develop and implement the intervention. However, media stakeholders struggled to participate in joint meetings, so regular bilateral meetings between researchers and media stakeholders were organised to ensure their engagement. The local project coordinator managed action planning and implementation with TV2 Bornholm through monthly meetings, frequent phone calls, and email correspondence. Interaction with non-formal mass media collaborators occurred on an ad hoc basis during specific project activities, events, and campaigns.\u003c/p\u003e \u003cp\u003eThe intervention included various broadcasts on local TV, radio, and newspapers (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). TV2 Bornholm created two programmes on lifestyle, wellbeing, and health, resulting in around six hours of relevant content for Project SoL. The series \u0026ldquo;Just a Little Healthier\u0026rdquo; aired monthly from 2013 to 2016, discussing health promotion with project implementers and local stakeholders. The debate programme \u0026ldquo;The Panel\u0026rdquo; engaged the local project coordinator and other local health ambassadors e.g. from hospital or food schools discussing health topics e.g. the dietary guidelines. \u0026ldquo;Just a Little Healthier Tips\u0026rdquo; provided health promotion practices from residents over two months. DR Radio Bornholm included the local project coordinator in two debate programmes on health issues e.g. healthy breakfast and lunch and offered a media workshop for schools, which failed due to lack of resources and timing. An attempt to organise a similar massive mass media intervention in Odsherred failed due to insufficient time to build trust.\u003c/p\u003e \u003cp\u003eThe intervention also included items on the Project SoL website, Facebook, printed materials (e.g. bus banners, action guidelines, food recipes), and merchandise (e.g. posters, t-shirts, flags, magnets). Numerous press releases were disseminated through the project partnership\u0026rsquo;s media platforms.\u003c/p\u003e\n\u003ch3\u003eInterviews with representatives of local mass media stakeholders\u003c/h3\u003e\n\u003cp\u003eQualitative interviews were organised with representatives of all six (formal and non-formal) mass media collaborators in Bornholm (in month 16 of the intervention) and Odsherred (in month 10 of the intervention). This was done to capture their individual perceptions and experiences of engagement in community-based health promotion interventions, including Project SoL. The interviews were inspired by the concept of mediascape, which refers to both the platform for producing and providing information as well as the images of the world created by the media stakeholders (Appadurai, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1990\u003c/span\u003e). The images-centred mediascapes tend to be narrative-based accounts of reality. They provide elements like characters and plots, enabling people to create scripts of imagined lives for themselves and others (Appadurai, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1990\u003c/span\u003e). These scripts often evolve into complex metaphors that shape perceptions, aspirations, and desires for acquisition and movement (Appadurai, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1990\u003c/span\u003e). The interview guide addressed mediascape as organisational structures of mass media stakeholders, previous experiences in health promotion, and understanding of the health concept, and it was adjusted to the specific contexts and roles of mass media stakeholders in Project SoL (e.g. formal partner or non-formal collaborators). In addition, the interview guide included a combination of 20 semi-structured and open-ended questions addressing the following five themes: 1) the expectations and motivations of media stakeholders to engage in Project SoL, 2) their perceptions of the target group for the intervention, 3) their roles in the project, 4) their health promoting contributions in the project, and 5) their perceptions of mass media integration and sustainability of the project.\u003c/p\u003e \u003cp\u003eFace-to-face interviews were conducted with TV2 Bornholm, TV2 East, Newspaper Bornholm, and Newspaper Odsherred. One phone interview was conducted with DR Radio Bornholm while DR Radio Zealand answered questions through e-mails. The interviews had a duration of 22\u0026ndash;60 minutes. Oral informed consent to participate in the interviews was obtained from all interviewees and the recordings of the interviews were transcribed verbatim, stored anonymously, coded, and analysed by the main author using the qualitative data analysis software NVivo (Nvivo 10, QSR International Pty Ltd., 1999\u0026ndash;2013).\u003c/p\u003e \u003cp\u003eThematic analysis was conducted to find repeated patterns of meaning that were valid across interviewees within the specific aspects of interest (Braun and Clarke, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Brown et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), namely, to understand the barriers and potentials for engaging mass media stakeholders in community-based health promotion interventions. All quotes were translated from Danish to English and are presented anonymously. The interviews were supplemented with information on organizational structures of the mass media stakeholders gained through the interviews and internet searches.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eIn the following sections we analyse the mediascape, including the organisational structures, previous experiences, and perceptions of health among the six mass media stakeholders involved in Project SoL, which was found to influence the ability of mass media stakeholders to formalise their engagement in the project (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Furthermore, we point to both common barriers and drivers for engagement of mass media stakeholders in health promotion.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe influence of mediascape - barrier or facilitator for mass media stakeholder engagement.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eFirst, lack of time, financial resources and inflexible organisational structures were found to hinder the engagement of mass media stakeholders. The two newspapers found lack of time and resources as main barriers for their engagement in Project SoL, while DR Radio Bornholm mentioned limited resources and organizational obligations to the bigger DR consortium, as main obstacles for making long-term and formalised commitments to Project SoL. The Editorial Secretary of DR Radio Bornholm explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We don\u0026rsquo;t feel that we can commit to a two or three-year project with obligations to do this in October and then do that, because there are so many other things we have to take into account, not just holiday periods with staff shortages, but also elections and things like that, as well as internal issues like, for example, DR as a corporation has campaigns in various areas.\u0026rdquo;\u003c/em\u003e [Editorial Secretary, DR Radio Bornholm]\u003c/p\u003e \u003cp\u003eThe Editorial Secretary of DR Radio Bornholm further noted that TV2 Bornholm was a relatively independent regional TV station under the TV2 corporation:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;One of the major differences between TV2\u0026rsquo;s regions and DR\u0026rsquo;s regions is that we are an integrated part of a national corporation, whereas TV2 is organised around independent companies connected to a parent channel.\u0026rdquo;\u003c/em\u003e [Editorial Secretary, DR Radio Bornholm]\u003c/p\u003e \u003cp\u003eThe Editorial Secretary of DR Radio Bornholm assumed that organisational independency of the regional TV2 channels gave TV2 Bornholm more flexibility to formally engage in projects like Project SoL.\u003c/p\u003e \u003cp\u003eSecondly, previous experiences with health promotion limited engagement among some mass media stakeholders, while the potential for exercising corporate social responsibility incentivised other media stakeholders to engage.\u003c/p\u003e \u003cp\u003eTV2 East had previously developed and broadcasted a TV programme series on health promotion. With financial support from Trygfonden, a Danish philanthropic funding agency, \u0026ldquo;Live life\u0026rdquo; targeted adults in the region of Zealand via TV and radio (DR Radio Zealand\u003cb\u003e)\u003c/b\u003e and this made TV2 East reluctant to also engage in Project SoL. The Editor in Chief of TV2 East explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;So that means, well, we have kind of taken a big step there \u0026hellip;in the health area \u0026hellip;and therefore you could say\u0026hellip;when we hear about this initiative, we do not think we should join and do that again.\"\u003c/em\u003e [Editor in Chief, TV2 East].\u003c/p\u003e \u003cp\u003eThe Editor in Chief of TV2 East elaborated that they had invested substantial amounts of resources in \u0026ldquo;Live life\u0026rdquo; and successfully broadcasted the programme for two seasons. On that basis, TV2 East felt they had fulfilled their corporate social responsibility in relation to health promotion engagement.\u003c/p\u003e \u003cp\u003eContrary to TV2 East, TV2 Bornholm had no previous experience with health promotion programmes and were eager to get started. Prior to launching of Project SoL, TV2 Bornholm therefore developed a TV program series on health promotion.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Well, before the project started, we had developed [the TV programme] \u0026lsquo;Just a bit healthier\u0026rsquo; and we had already started [broadcasting] but found that we lacked fuel in the programme ...but then slowly it [the material] emerged.\u0026rdquo;\u003c/em\u003e [Editorial Director, TV2 Bornholm]\u003c/p\u003e \u003cp\u003eAccording to the Editorial Director of TV2 Bornholm, the launching of Project SoL came at the right time to ensure alignment with the efforts of TV2 Bornholm to engage in health promotion in Bornholm.\u003c/p\u003e \u003cp\u003ePrevious successes with the development and broadcasting of a health promotion programme were not a driving factor for TV2 East to establish a formalised engagement with Project SoL. However, the right timing and alignment with existing agendas appeared to be a driving factor for TV2 Bornholm to formalise the engagement with Project SoL.\u003c/p\u003e \u003cp\u003eThirdly, alignment with a broad and positive understanding of health facilitated the engagement of mass media stakeholders in Project SoL. It was important for the mass media stakeholders not to be paternalistic when communicating health to the public. The Editorial Secretary of DR Radio Bornholm said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We sometimes have discussions in the editorial office about whether it is our job to tell people what to do, and if so, how we should go about doing it, so that it is not just us saying, \u0026lsquo;Eat more broccoli.\u0026rdquo;\u003c/em\u003e [Editorial Secretary, DR Radio Bornholm].\u003c/p\u003e \u003cp\u003eMost interviewees expressed a positive and broad understanding of the concept of health. The Editorial Director of TV2 Bornholm explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026rdquo;Our philosophy has been that this [health promotion] is about making small adjustments to many\u0026hellip;\u0026rsquo;Just a bit healthier\u0026rsquo; is a good name, right? If it is going to change the bigger statistics, it is important to get a lot [of people] to do a little bit rather than a few to do a lot.\u003c/em\u003e [Editorial Director, TV2 Bornholm]\u003c/p\u003e \u003cp\u003eTV2 East emphasised the importance of being positive and solution-oriented in health promotion:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;You could say that we focus on where there are problems and where there are discussions\u0026hellip;on being solution-oriented\u0026hellip;Some people call it constructive news\u0026hellip;like, when people see us, they do not feel they are being told off \u0026hellip;they feel that, yes, there is hope for life tomorrow, right?\u0026rdquo;\u003c/em\u003e [Editor in Chief, TV2 East]\u003c/p\u003e \u003cp\u003eHealth topics were also met with scepticism. The Editorial Secretary of DR Radio Bornholm questioned if health information is beneficial to people or whether it makes them more confused and the Editor of Newspaper Odsherred expressed scepticism about the commercial focus in health:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;and in 99.99% of all cases there is some manufacturer that has produced something that you are supposed to drink or eat or put in your hair or on your nose or whatever, and which is really, really healthy (ha-ha). So, when we see the word \u0026lsquo;healthy\u0026rsquo;, it is always with a very high degree of scepticism\u0026rdquo;\u003c/em\u003e. [Editor, Newspaper Odsherred].\u003c/p\u003e \u003cp\u003eAlthough interviewees did not deliver a specific definition of health, most of them expressed a positive and broad understanding of the concept, but also a certain scepticism and critical view on it. These somewhat contrasting perceptions could both favour and disfavour the engagement of mass media stakeholders in health promotion interventions.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eChild focus and a broad reach to engage mass media stakeholders in Project SoL\u003c/h2\u003e \u003cp\u003eHealth promotion was a hot topic in the public and among the media stakeholders, especially when involving children, and the project was expected to bring inspiration for healthy living into the everyday lives of families in the targeted municipalities. The mass media stakeholders in Bornholm and Odsherred of Project SoL had high expectations towards Project SoL and thematic focus was regarded as a motivational factor for the engagement of mass media stakeholders. A journalist at Newspaper Bornholm said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For my part, it [Project SoL] is something that I have welcomed. As I said before, it is good material.\u003c/em\u003e\u0026ldquo; [Journalist, Newspaper Bornholm]\u003c/p\u003e \u003cp\u003eContrary to these motivations, TV2 Bornholm was disappointed about the narrow scope of the project. In accordance with the stipulations of the public service agreement for Danish mass media, TV2 Bornholm anticipated that Project SoL would be targeting all citizens living in the targeted municipalities. The narrow focus on families with young children living in selected communities came as an unpleasant surprise to them.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026rdquo;You could say that the narrow geographical and age-related focus affected our expectations\u0026hellip;and the potential to make good TV out of it. It (the intervention) was not as broad as we thought.\u0026rdquo;\u003c/em\u003e [Editorial Director, TV2 Bornholm]\u003c/p\u003e \u003cp\u003eThe Editor in Chief of TV2 East also found Project SoL to be too local and selective, and decided not to give the project full media coverage:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eHere [in Project SoL] you have really tried to do something very local and therefore, of course, it is not the same. But in that case, that just means that maybe we were not completely ready to say \u0026lsquo;let us join in and give it the whole programme\u0026rsquo;, you know\u003c/em\u003e?\u0026rdquo; [Editor in Chief, TV2 East].\u003c/p\u003e \u003cp\u003eContrary to this, the two newspaper stakeholders were pleased to note that the project reached out to a broad target group, including parents, families, grandparents, those who know the children, people involved in schools and day-care institutions as well as shop owners. The Editor of Newspaper Odsherred explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It is one of those [health projects] where we would say \u0026lsquo;that really sounds good\u0026rsquo;. It reaches out to the families, and it reaches out to those who are also our customers, namely, the business owners\u0026hellip;\u0026rdquo;\u003c/em\u003e [Editor, Newspaper Odsherred]\u003c/p\u003e \u003cp\u003eNewspaper Odsherred had their expectations fulfilled on being contacted upfront by phone or e-mail with information and press releases about project activities as this would ease their prioritization and selection of news material. The child focus, the non-commercial focus and the positive health messages motivated the stakeholders to cover the news from Project SoL.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;So, when this [project] showed up, I thought [with a clap], oh, finally, ha-ha. Here is something with a bit of flesh and blood on it, something interesting, you know? That is also why we have used your press releases, I would almost say in their entirety\u0026rdquo;.\u003c/em\u003e [Editor, Newspaper Odsherred]\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePartnership between mass media stakeholders and researchers – the importance of communication and relevance\u003c/h3\u003e\n\u003cp\u003eTV2 Bornholm was the only formal mass media partner in Project SoL and its engagement in the project therefore differed from the engagement of the other mass media stakeholders. Initially, TV2 Bornholm found the communication with project researchers to be too academic and this negatively affected the collaboration.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We cannot make TV based on research studies\u0026hellip;and talking. It needs to be real, because otherwise it serves no purpose\u0026hellip;so we have been really focused on the reality part and the collaboration part, you know\u0026rdquo;?\u003c/em\u003e [Editorial Director, TV2 Bornholm]\u003c/p\u003e \u003cp\u003eThe academic design of Project SoL challenged the initial communication and collaboration with TV2 Bornholm. The project was found to be heavy, slow, academic, and detached from reality. To improve the situation, problem-solving meetings between the mass media stakeholders and senior project researchers were organised. The decisive turning point came with the recruitment of a local (native) project coordinator. The Editorial Director of TV2 Bornholm expressed it this way:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Well, after hiring the local project coordinator with lots of local knowledge and competence to do everything, then it [the project] became really, really good.\u0026rdquo;\u003c/em\u003e [Editorial Director, TV2 Bornholm].\u003c/p\u003e \u003cp\u003eThe local project coordinator allegedly improved the communication between Project SoL and TV2 Bornholm by organising monthly planning meetings and inviting TV2 Bornholm to review planned project activities and propose improvements if they were suboptimal for TV production. TV2 Bornholm had a genuine interest in contributing to the promotion of public health and characterised themselves as a real project partner with co-ownership of the intervention. The commitment of the TV station manifested itself through massive engagement in developing and broadcasting health promotion activities of the project (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eOne thing is what the pastor preaches. It is what he actually does that is important\u0026hellip;and that is what we want to show in the TV programmes, you know?\u0026rdquo;\u003c/em\u003e [Editorial Director, TV2 Bornholm]\u003c/p\u003e \u003cp\u003eThe Editorial Director of TV2 Bornholm elucidated that they constantly sought a practical angle in their TV programmes in efforts to document the reality of healthy living in the settings of people\u0026rsquo;s everyday life, while communicating healthy tips of real people and panel discussions among local health professionals. This was all broadcasted from different geographical locations and settings in Bornholm to make health promotion omnipresent and meaningful for everyone. Project activities carried out in day-care centres and primary schools were favoured by TV2 Bornholm because they very concrete (e.g. cooking, gardening, sensing, playing, caring) and easy to communicate and visualize on TV. Also, project activities carried out in partnering supermarkets were strongly supported by TV2 Bornholm because this was (to TV2 Bornholm) a new and interesting stakeholder with much more to offer than profit-thinking. TV2 Bornholm found the supermarkets to be surprisingly collaborative and willing to experiment, contribute, and break the news on TV. The Editorial Director of TV2 Bornholm elaborated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;They [partnering supermarkets] think it is fun to join in. We can sense it, too, when we visit the supermarkets, there is a lot of goodwill out there, you know? So, for sure, some of the things that have been done out there as part of the project have certainly given us ideas and inspiration.\u003c/em\u003e\u0026rdquo; [Editorial Director, TV2 Bornholm].\u003c/p\u003e \u003cp\u003eAs stated above the collaboration with local stakeholders in supermarkets and day-care institutions created win-win situations and promoted the engagement of TV2 Bornholm in health promotion.\u003c/p\u003e\n\u003ch3\u003eThe traditional media role of non-formal mass media stakeholders\u003c/h3\u003e\n\u003cp\u003eThe non-formal mass media collaborators of Project SoL never made any attempts to formalise their engagement in Project SoL and felt no ownership of the project at any point in time (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). They covered Project SoL activities in a traditional way and could not see that the project had contributed to their media practices. DR Radio Zealand perceived its role in society to be descriptive:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eOur approach is mainly journalistic, not activistic. So, to the extent that there is interesting news to talk about, we would of course be happy to do it.\u003c/em\u003e\u0026rdquo; [Producer, DR Radio Zealand]\u003c/p\u003e \u003cp\u003eNewspaper Bornholm expressed the same position in the following way:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;So, I see us only to be placed on the side line in the sense that we tell people what it [the project] is about, but we are not a part of it.\u0026rdquo;\u003c/em\u003e [Editor, Newspaper Bornholm].\u003c/p\u003e \u003cp\u003eNewspaper Bornholm found the project activities easy to communicate due to the positive messages and meaningful content e.g. on children\u0026rsquo;s involvement in health promotion. The newspaper therefore published numerous press releases and created public awareness about the project and its activities in a very positive and constructive manner.\u003c/p\u003e \u003cp\u003eTV2 East acknowledged and appreciated the existence of Project SoL but would not fully commit to the project\u0026rsquo;s health promotion agenda, mainly because the scope and focus was perceived to be narrow in terms of selected target groups and geographical coverage. The Editor in Chief said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It is like we have not been \u0026hellip;you could say, we have not committed ourselves to embrace the whole message, but just to subscribe to something when there was something that was a bit fun in itself\u0026rdquo;.\u003c/em\u003e [Editor in Chief, TV2 East].\u003c/p\u003e \u003cp\u003eTV2 East\u0026rsquo;s limited commitment to Project SoL negatively affected the collaboration and caused frustration on both sides in relation to the planning for press coverage of project activities. The Editor in Chief explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;She [the local project coordinator] was a bit frustrated, too, because she felt a bit that\u0026hellip;, then she wrote to us and then it was, like, a new editor she met, and some people didn\u0026rsquo;t know about it [the project] and things like that. And then I just said to her but, of course, it\u0026rsquo;s a bit the \u0026lsquo;rule of the game\u0026rsquo; when we are not part of it, because that\u0026rsquo;s how we work. We work a bit from day to day and we look at, well, what is on the agenda today\u003c/em\u003e?\u0026rdquo; [Editor in Chief, TV2 East].\u003c/p\u003e \u003cp\u003eWhereas mass media coverage of project activities was rather limited by TV2 East, it was very intense by Newspaper Odsherred and Newspaper Bornholm. They eagerly announced upcoming project events in their newspapers and reported from all of them to strengthen the publicity and recognisability of the project in the local community. A journalist at Newspaper Bornholm elaborated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yes, so basically, we cover it [project activities] to the extent that we can. Sometimes it is only a photographer going out and taking some pictures \u0026hellip;and then I have talked with [name of the local project coordinator] on the phone. At other times, I have gone out there myself, if, for example, it has taken place at a school, and spoken with a teacher and a couple of students, maybe.\u0026rdquo;\u003c/em\u003e [Journalist, Newspaper Bornholm].\u003c/p\u003e \u003cp\u003eThe journalist further explained that public interest in the topic, time constraints, and the volume of other news stories influenced the coverage of project activities in the newspaper. The Editor of Newspaper Odsherred mentioned the struggle for public attention, tough prioritization of news stories, and timing of announcements and press releases as critical factors influencing the level of collaboration with Project SoL. The editor elaborated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It sounds a bit like we are saying: \u0026lsquo;we want it all handed to us on a silver platter\u0026rsquo;. Hmm, actually we would really like that (smile). Also, because we\u0026rsquo;re pretty busy making these newspapers, so we cannot just set aside an afternoon, three hours or so, and go to the mall and create the story\u0026rdquo;.\u003c/em\u003e [Editor, Newspaper Odsherred]\u003c/p\u003e \u003cp\u003eDR Radio Bornholm also found the timing of receiving information about project activities to be a critical factor in the communication and collaboration with Project SoL. They had observed that they received press releases from the project after TV2 Bornholm, as the formal media partner, received them and this decreased the newsworthiness, motivation, and willingness to cover project activities. The Editorial Secretary of DR Radio Bornholm explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We have actually been invited to some meetings and could maybe also have engaged more actively with it [the project], but we felt excluded from the beginning and also during the project, and that is the way it is, it is common human behaviour, when we feel excluded, we may choose to opt out\u0026rdquo;.\u003c/em\u003e [Editorial Secretary, DR Radio Bornholm]\u003c/p\u003e \u003cp\u003eThe Editor in Chief of TV2 East touched upon the difference in expected levels of commitments between formal project partners and non-formal collaborators:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We are also just people and obviously, the moment you have crossed a line and said, we are part of this [project] now, we are going to try now, then you go in and take ownership of it and\u0026hellip;engage more actively in it. Rather than if you are just receiving press releases, and then at some point in time, \u0026lsquo;Argh, no, \u0026hellip;it is them writing again, I cannot be bloody bothered now\u0026rdquo;.\u003c/em\u003e [Editor in Chief, TV2 East]\u003c/p\u003e \u003cp\u003eThe influence of local mass media on shaping public opinion and practice was believed to be very high in the targeted municipalities, especially in Bornholm, as elucidated by the journalist of Newspaper Bornholm:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Well, I think that the media are hugely important here on the island, I mean, there is massive media coverage relative to the size of the island and the size of the population. So, I think it has a really big impact and there are lots of people who follow [the local mass media]\u0026rdquo;.\u003c/em\u003e [Journalist, Newspaper Bornholm]\u003c/p\u003e \u003cp\u003eAll interviewees expressed a readiness to cover and perhaps even engage actively in future health promotion activities and projects. Even TV2 East, as perhaps the most sceptical mass media stakeholder in Project SoL, acknowledged the potentials of engaging more actively and formally in a research-based project like Project SoL because of its action-oriented nature. The Editor-in-Chief of TV2-East explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We wanted to pass on some experiences that everyone would be interested in, you see? Participate in discussions that everyone might debate with themselves at home in the living room. So yes, yes, yes, you could say that this is applied science, right\u0026rdquo;?\u003c/em\u003e [Editor in Chief, TV2 East].\u003c/p\u003e \u003cp\u003eA summary of the barriers and drivers for creating a conducive environment for the engagement of mass media in health promotion are given in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFacilitators and barriers for the engagement of mass media stakeholders in health promotion. Data was obtained from interviews (n\u0026thinsp;=\u0026thinsp;5) and e-mail correspondence (n\u0026thinsp;=\u0026thinsp;1) with mass media staff involved in Project SoL.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eEngagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFacilitators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBarriers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMediascapes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrganisation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Flexible organizational structure\u003c/p\u003e \u003cp\u003e\u0026bull; Editorial independence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Inflexible organizational structures\u003c/p\u003e \u003cp\u003e\u0026bull; Dependence and obligations as part of National consortium\u003c/p\u003e \u003cp\u003e\u0026bull; Poor staffing and resources\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFraming of health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Broad and positive concept of health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Commercial focus\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTarget group and reach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Broad reach to the target group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Narrow reach (age and geographical)\u003c/p\u003e \u003cp\u003e\u0026bull; Lack of possibility to fulfil public service agreements\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerceived role in society\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Problem solving\u003c/p\u003e \u003cp\u003e\u0026bull; Active role\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Descriptive role of mass media\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eContent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; News value\u003c/p\u003e \u003cp\u003e\u0026bull; Attractive topics (practical activities, children, health)\u003c/p\u003e \u003cp\u003e\u0026bull; The non-commercial focus\u003c/p\u003e \u003cp\u003e\u0026bull; Corporate social responsibility\u003c/p\u003e \u003cp\u003e\u0026bull; Output conclusions, what worked; what did not work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Skepticism towards the abundance of health information\u003c/p\u003e \u003cp\u003e\u0026bull; Academic approach\u003c/p\u003e \u003cp\u003e\u0026bull; Abstract and repetitive nature of health activities\u003c/p\u003e \u003cp\u003e\u0026bull; Lack of news value\u003c/p\u003e \u003cp\u003e\u0026bull; Lack of project resources (lack of intensity)\u003c/p\u003e \u003cp\u003e\u0026bull; Lack of content for mass media\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCommunication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Matching expectations\u003c/p\u003e \u003cp\u003e\u0026bull; Clear roles\u003c/p\u003e \u003cp\u003e\u0026bull; Plan ahead\u003c/p\u003e \u003cp\u003e\u0026bull; Use a local coordinator to bridge academia and mass media Communication plan (e-mails, phone, press releases, meetings)\u003c/p\u003e \u003cp\u003e\u0026bull; Choose the right communication and media channel\u003c/p\u003e \u003cp\u003e\u0026bull; Access to relevant local stakeholders\u003c/p\u003e \u003cp\u003e\u0026bull; Accept input from media stakeholders\u003c/p\u003e \u003cp\u003e\u0026bull; Create ownership\u003c/p\u003e \u003cp\u003e\u0026bull; Create win-win for media and local stakeholders\u003c/p\u003e \u003cp\u003e\u0026bull; Human factors (interest, relationship)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026bull; Diverse expectations and interests\u003c/p\u003e \u003cp\u003e\u0026bull; Unclear roles\u003c/p\u003e \u003cp\u003e\u0026bull; Lack of resources (struggle for attention, the tough prioritizing)\u003c/p\u003e \u003cp\u003e\u0026bull; Changing staff\u003c/p\u003e \u003cp\u003e\u0026bull; Bad timing of sharing news\u003c/p\u003e \u003cp\u003e\u0026bull; Choose the wrong media channel (e.g. repetitive activities in radio)\u003c/p\u003e \u003cp\u003e\u0026bull; Previous experiences\u003c/p\u003e \u003cp\u003e\u0026bull; No ownership, lack of involvement and commitment\u003c/p\u003e \u003cp\u003e\u0026bull; Human factors (interest, relationship)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study shows how mass media stakeholders successfully can be engaged in health promotion by creating potentials for exercising corporate social responsibility, adopting a broad and positive understanding of the concept of health and focusing on relevant themes e.g. children and health to attract the attention of a large audience. Barriers for engagement in health promotion within the mediascape were found to be inflexible organizational structures of mass media, lack of financial and human resources and a demand to maintain a disseminating, descriptive and neutral role in the mediascape. Furthermore, a narrowly selected target population and geographical outreach of project activities limited the engagement of mass media stakeholders. Other studies have identified lack of time and resources alongside difficulties in mobilising other stakeholders as major barriers for communicating health (Wilkinson et al., 2022) The successful engagement of mass media stakeholders may be attributed to the close collaboration, the focus on planning the communication, the use of role models and creating win-win situations among mass media, supermarkets, day-care centres, primary schools, and other local stakeholders. This novel partnership approach provided mass media with good news material, access to key persons, and new target groups like young people and their parents. Supermarkets and day-care centres benefited from media exposure, presenting their organisations as responsible and dynamic. Researchers effectively communicated their messages, enhancing awareness and advancing the local health agenda. It has been documented that collaboration between health organisations and mass media may increase professionalism of the mass media and strengthen the reporting of health issues to the public as well as influence public perceptions of the involved health organisations (Berridge, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Successful collaboration can thus support and strengthen the engagement of the mass media in promoting a health agenda, informing and steering public opinion, and influencing expectations and beliefs of the public (Benelli \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFactors within the mediascape identified as drivers for the engagement of mass media stakeholders in health promotion include embracing a broad and positive understanding of the concept of health, taking a problem-solving responsibility in society, and actively exercising corporate social responsibility. Local mass media may more easily than national mass media base their operations on social responsibility principles and advocacy (Atton, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Kolandai-Matchett, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). In Project SoL, mass media stakeholders generally endorsed the broad and positive understanding of health and strived to communicate health issues in a constructive and inspiring way. This is consistent with the findings of a survey carried out in seven European countries, which identified enthusiasm about the topic in question, and a desire to educate and counter misinformation as key drivers for mass media to engage in communication of health (Wilkinson et al., 2022). Other drivers of local mass media engagement have been defined, including having a broad public appeal with news that is locally relevant, informative, and satisfying to the local community (Fogarty, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Pauly and Eckert, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Local mass media stakeholders in Project SoL enthusiastically covered many of the health promotion activities of the project because they fulfilled the main criteria of having high news value and good potential to influence the behaviours of citizens. These activities were relevant to the local context of everyday life, practice-oriented, amusing, inspirational, and easy to communicate through pictures and words. Practice-oriented issues related to active living and healthy eating have previously been recognized as salient topics for mass media (Andsager et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), which signifies that it is both possible and realistic to communicate health promotion interventions through mass media.\u003c/p\u003e \u003cp\u003eIn Project SoL, TV2-Bornholm developed health promotion programs using local role models to demonstrate and discuss health behaviours. The use of local health ambassadors rather than experts signifying the importance of differential prestige of news source (Scheufele \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). Other mass media studies used role models to which the target group could identify to overcome barriers related to healthy eating (Dale and Hanbury, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Finlay and Faulkner, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Watching fellow community members participating in health promotion activities may motivate others to comply with the media \u0026lsquo;messages\u0026rsquo; (Renger et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Moreover, the ability to identify oneself with a role model may further enhance the ability to remember the advice that has been communicated (Dale and Hanbury, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Using role models is also a way for mass media to target social networks, which have proven successful in stimulating interpersonal communication to positively influence awareness, attitudes, and behaviours (Dunlop et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Abroms and Maibach, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Viswanath et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe engagement of mass media stakeholders in health promotion was however hampered by the application of an academic project approach, which entails numerous meetings and workshops, long and intellectual processes of developing and agreeing on activities, bad timing and lack of news value due to a repetitive nature of activities. Similarly, the involvement of supermarket staff in health promotion was challenged by the academic approach of researchers (Winkler et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Project SoL, the news value of project activities received substantial attention by mass media stakeholders. This is consistent with the observation that news value in terms of proximity, significance, novelty, relevance, and applicability is important in the constant struggle of mass media to attract public attention (Zhang et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The collaboration between mass media and research institutions may be further challenged by differences in objectives and perspectives, including expectations and interests, roles and functions, and working and communication practices. In Project SoL, TV2 Bornholm merely wanted to relate to everyday life of citizens by momentarily satisfying their needs and demands for news. There was no need for lengthy academic processes to satisfy this purpose. This signifies the importance of norms of generalisation and simplification for the mass media stakeholders (De Brun \u003cem\u003eet al\u003c/em\u003e., 2013) and confirms the existence of a gap between the practical perspective of the mass media world and the intellectual perspective of the academic world; a gap which has been referred to as a division of \u0026ldquo;arenas\u0026rdquo; of internal scientific and public communication of everyday knowledge (Peters, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, mass media stakeholders may not commit themselves to the health promotion agenda simply because they consider active engagement to be beyond their mandate and responsibility. The reluctance to commit to health promotion was also observed among the supermarket store managers(Winkler et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) indicating a general trend among commercial stakeholders. In Project SoL, this argument was mainly noted among stakeholders from radio stations and newspapers, and it is consistent with previous observations that the function of mass media is not to lead or drive public opinion, but to communicate it (De Brun \u003cem\u003eet al\u003c/em\u003e., 2013). Limited commitment may also reflect personal rather than organisational considerations among mass media stakeholders, including experiencing unfulfilled expectations, being overlooked or lacking interest in public health. Previous studies have suggested that the production of news may not only be influenced by the structural and organisational pressures and economic constraints of the mediascape, but also by pressure from interest groups as well as individual attitudes, social norms and values, media and working routines, ethics, prejudice, and ideology (Shoemaker and Reese, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Tuchman, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1978\u003c/span\u003e; Scheufele, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Andsager et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). This signifies the importance of securing good communication and strong relationships with media partners in health interventions (Bell et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). In Project SoL the engagement of mass media was thereby strengthening by carefully matching expectations and clarifying roles of partners and by having local representation, communications plans, and different channels for communication.\u003c/p\u003e \u003cp\u003eA growing production of, and public demand for, knowledge and information on health and medical issues may force mass media stakeholders to take hasty and perhaps irrational or emotional decisions on news to be communicated by mass media (Benelli, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Large mass media organisations may be in a better position than small organisations to allocate resources to recruit health science journalists who can cover complex health issues more deeply and objectively (Bradshaw et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; McCaw et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Lee, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Small mass media organisations rarely have such opportunities as they struggle with inflexible work schedules and limited resources that may result in inadequately researched and sketchy news stories (Fogarty, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Arnold, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Freedman and Fico, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Lee, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Pribble et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Such organisations would benefit from engaging in professional and trusting partnerships with health promotion stakeholders (Zhang et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This is what occurred in Project SoL.\u003c/p\u003e \u003cp\u003eInterestingly, regional differences in the engagement of mass media stakeholders were observed. Mass media stakeholders in Bornholm were much more engaged in Project SoL than mass media stakeholders in Odsherred. Mass media stakeholders in Bornholm engaged in activities that were quite unusual for such kind of organisations and included allocation of programs and arial time to the project, active participation in project meetings, setting up and organising workshops and interviews, and publishing guidelines and recipes on their websites and social media platforms. The likely explanation for this excessive engagement is that the media landscape in Bornholm had a very good contact with citizens, allegedly due to the rather limited geographical size of the island and strong social cohesive forces.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study identified factors supporting a conducive environment for engaging mass media stakeholders in health promotion interventions. Drivers and barriers of engagement were related to the mediascape, the content of activities, human factors, the communication and the collaboration between mass media stakeholders and health promotion professionals. The findings suggest that it is both possible and realistic to communicate health promotion interventions through mass media, and that engagement of mass media stakeholders as formal partners may strengthen health promotion interventions and aid the development of new health promotion strategies in local community settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study adhered to all aspects of the Helsinki Declaration. Informed consent to participate in the study was obtained from all study participants. Study participants were briefed about the study, the use of data and their rights to withdraw from the study and retract their data. Oral informed consent was obtained from the mass media stakeholders as written consent was not required according to the Danish Data Protection Agency or other national legislation at the time. In Denmark, approval from the Research Ethical Committee was not required according to Danish law, as the research project was based on interview data and therefore did not contain human biological material (cf. Section 14 no. (2) in Act on Research Ethics Review of Health Research Project https://www.nvk.dk/forsker/naar-du-anmelder/hvilkeprojekter-skal-jeg-anmelde). The study was approved by the Danish Data Protection Agency according to the Danish Act on Processing of Personal Data (2007-58-0015).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe corresponding\u0026nbsp;author has full access to the data reported in the manuscript.\u0026nbsp;Data will be made available on request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Project was supported by the Nordea-Fonden, which had no involvement in preparation of the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHCR, UT, BEM and PB drafted the initial Project SoL research protocol. HCR conducted the data collection in collaboration with students. HCR conducted the data analyses in close collaboration with all co-authors. HCR and PB drafted the manuscript. All authors critically reviewed and approved the final manuscript for publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge and thank the local partners within schools and day-care centres, the municipality of Bornholm, the mass media stakeholders, especially Peter Funch, Editorial director of TV2 Bornholm and supermarkets for fruitful collaboration as well as study participants, other community members, colleagues and students (especially Mia Pedersen and Luise Hyllekilde Andersen) for their contribution. Further special thoughts to deceased Elizabeth Jill Archer for translating the citations from Danish to English.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbroms, L. C. and Maibach, E. W. 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Characterizing the (perceived) newsworthiness of health science articles: A data-driven approach. \u003cem\u003eJMIR Medical Informatics\u003c/em\u003e, \u003cstrong\u003e4\u003c/strong\u003e(3), e27. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5454860/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5454860/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The potential positive effects of mass media stakeholders in health promotion have long been recognized. Health promotion interventions may benefit from exposure in mass media by attracting public attention and political support. More formal and partnership-based engagement of mass media may have even larger impact potentials. Nevertheless, few projects have included mass media as formal partners in health promotion interventions. The aim of the present study is to identify potentials and barriers for the engagement of mass media stakeholders in health promotion\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Project SoL, a community-based health promotion intervention carried out in two municipalities in Denmark, applied the supersetting approach to establish a formal partnership with local mass media, supermarkets, childcare centres, and primary schools in efforts to promote healthier eating and physical activity among families with young children.\u003c/p\u003e\n\u003cp\u003eSix semi-structured in-depth interviews with mass media stakeholders involved in Project SoL were carried out to identify barriers and drivers for engagement of local mass media in health promotion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Thematic data analysis revealed that engagement of mass media stakeholders was promoted by potentials for 1) exercising corporate social responsibility, 2) adopting a broad and positive understanding of the concept of health and 3) attracting the attention of a large audience. In contrast, barriers for their engagement included 1) inflexible organizational structures of mass media, 2) lack of financial and human resources and 3) a demand to maintain a disseminating and neutral role in the mediascape.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003eThe findings suggest that engagement of mass media stakeholders as formal partners may strengthen health promotion interventions and aid the development of new health promotion strategies in local community settings\u003c/p\u003e","manuscriptTitle":"Strengthening the engagement of mass media stakeholders in community-based health promotion interventions - The Danish Project SoL","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-02 05:31:16","doi":"10.21203/rs.3.rs-5454860/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-18T08:44:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-15T12:04:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-15T12:00:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-11-14T14:51:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"65b99986-c10c-49cb-95ff-670d81efa074","owner":[],"postedDate":"December 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-03T00:53:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-02 05:31:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5454860","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5454860","identity":"rs-5454860","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}