Strategic Framing in Public Health Campaigns: A Mumbai Municipal Health Department Case Study

Thesis Abstract

Strategic framing emerges as a critical determinant of the effectiveness of public health campaigns, particularly in dense urban settings where municipal health authorities must navigate diverse audiences, competing information environments, and complex policy landscapes. This study addresses the problem of inconsistent campaign impact within the Mumbai Municipal Health Department (MMHD) by examining how strategic framing shapes message reception, public attention, and behavioral intentions across heterogeneous populations. The aim is to elucidate how framing choices influence campaign outcomes and to provide actionable guidance for enhancing MMHD communications in multiethnic urban contexts. The specific objectives are (1) to identify prevalent framing strategies employed by MMHD public health campaigns over the last five years; (2) to assess the relationship between framing styles and audience engagement metrics, including recall, attitude change, and intended health behaviors; (3) to compare framing effectiveness across demographic subgroups (age, gender, education, and language region) and geographies within Mumbai; (4) to test the applicability of established framing theories to urban Indian health campaigns; and (5) to develop a context-specific framework for strategic framing that improves campaign effectiveness and equity. The study adopts a mixed-methods research design, integrating quantitative and qualitative approaches to capture both breadth and depth of framing effects. The population comprises residents of Mumbai exposed to MMHD health campaigns between 2019 and 2024. The quantitative strand samples 1,200 adults through stratified random sampling, ensuring representation across five municipal wards and linguistic groups (Marathi, Hindi, English, and Urdu). A parallel qualitative strand uses 30 in-depth interviews with campaign designers from the MMHD, 15 focus group discussions (each with 6–8 participants) focusing on campaign-affected communities, and 20 content analysis sessions of campaign materials (posters, social media posts, radio jingles, and press releases). Data collection instruments include a validated survey instrument measuring perceived framing, message recall, attitude change, trust in sources, and behavioral intentions; semi-structured interview guides for campaign staff; focus group guides for community members; and a coding scheme for content analysis aligned with framing dimensions (problem definition, causal attribution, moral evaluation, strategic appeals, and medium/channel choices). Validity and reliability procedures incorporate pretesting of the survey (pilot with 120 respondents), intercoder reliability checks for qualitative coding (Cohen’s kappa > 0.8), and triangulation across data sources. Analytical methods employ hierarchical linear modeling (HLM) to assess how framing variables predict recall and behavioral intent, controlling for demographic covariates and exposure frequency. The study uses regression-based path analysis to explore mediation effects of trust and perceived relevance on attitude change. Thematic analysis guided by Braun and Clarke is applied to interview and focus group data to extract nuanced framings, with a deductive-inductive approach to identify emergent categories. Content analysis adopts a structured coding frame to quantify framing elements and their prevalence across media (print, broadcast, and digital). The theoretical framework draws on the two prominent theories of strategic communication the Elaboration Likelihood Model (ELM) to distinguish central and peripheral processing based on issue involvement, and the Framing Theory (Entman’s framing dimensions problem definition, causal diagnosis, moral evaluation, and treatment recommendation) augmented by the cultural cognition approach to account for value-consensus dynamics in a plural Mumbai context. Expected findings indicate that campaigns employing explicit causal attributions, culturally resonant moral appeals, and multilingual delivery achieve higher recall and stronger intention-to-engage in preventive behaviors, particularly among low-literacy groups when paired with audio-visual media. Differential effects across language groups and wards are anticipated, with framed messages tailored to local health concerns and trusted messengers showing superior effectiveness. The study may reveal that trust in local health authorities moderates framing effects, while message saturation and exposure frequency interact with framing to influence outcomes. The research contributes to knowledge by integrating urban Indian public health communication into framing theory, providing a robust, context-specific model for strategic framing in megacities. It advances methodological rigor by combining HLM, path analysis, and thematic analysis within a unified mixed-methods framework, and by delivering practical guidelines for MMHD on message design, channel selection, and audience segmentation. The main conclusion is expected to emphasize that strategically framed health messages, which align problem definitions with local cultural values, employ credible local spokespeople, and leverage accessible channels, significantly enhance campaign effectiveness and equity in urban India. Recommendations include adopting a modular framing toolkit for MMHD campaigns, investing in continuous audience insight through community advisory panels, expanding multilingual content production, and institutionalizing framing audits at campaign planning stages to preempt misalignment with diverse urban audiences.