International Journal of Medical Science and Public Health Research
7
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TYPE
Original Research
PAGE NO.
07-27
DOI
10.37547/ijmsphr/Volume06Issue06-02
OPEN ACCESS
SUBMITED
09 May 2025
ACCEPTED
26 May 2025
PUBLISHED
19 June 2025
VOLUME
Vol.06 Issue 06 2025
CITATION
Linda Armiana, Nasrul Zaman, M Yani, T Maulana, & Irwan Saputra.
(2025). Analysis of the Effectiveness of Below the Line Campaigns for
Prevention of Non-Communicable Disease in Banda Aceh City.
International Journal of Medical Science and Public Health Research,
6(06), 07
–
27. https://doi.org/10.37547/ijmsphr/Volume06Issue06-02
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Analysis of the
Effectiveness of Below the
Line Campaigns for
Prevention of Non-
Communicable Disease in
Banda Aceh City
Linda Armiana
Master of Public Health Study Program Faculty of Medicine, Syiah
Kuala University
Nasrul Zaman
Master of Public Health Study Program Faculty of Medicine, Syiah
Kuala University
M Yani
Master of Public Health Study Program Faculty of Medicine, Syiah
Kuala University
T Maulana
Master of Public Health Study Program Faculty of Medicine, Syiah
Kuala University
Irwan Saputra
Master of Public Health Study Program Faculty of Medicine, Syiah
Kuala University
Abstract
All community health centers (Puskesmas) within the
working area of the Banda Aceh City Health Office have
implemented
non-communicable
disease
(NCD)
prevention efforts, including bottom-line campaign
strategies such as banners, posters, brochures, and
leaflets. However, based on surveillance data, the
incidence of NCDs continues to rise. According to the
Banda Aceh City health profile, in the context of
minimum service standard indicators for NCD services
—
specifically hypertension and type 2 diabetes mellitus
—
there were 13,077 recorded cases of hypertension in
2021, increasing to 19,394 cases in 2022. Similarly, the
number of individuals with type 2 diabetes mellitus rose
from 9,573 in 2021 to 12,653 in 2022. This study aims to
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identify the factors influencing the effectiveness of
bottom-line campaigns for NCD prevention in Banda
Aceh City. This research employed a quantitative survey
method supported by qualitative data, analyzed using
Partial Least Squares
–
Structural Equation Modeling
(PLS-SEM). The study population comprised all residents
of Banda Aceh City, totaling 262,960 individuals. The
sample included individuals aged 15 years and older who
accessed general polyclinic services at three selected
Puskesmas in Banda Aceh and had seen or received
information on NCD prevention through bottom-line
campaign media. Data collection was conducted using a
questionnaire. The results indicate that accessibility,
target audience characteristics, and media content
significantly influence the effectiveness of bottom-line
NCD prevention campaigns in Banda Aceh City. The
study concludes that the effectiveness of bottom-line
NCD prevention campaigns in Banda Aceh City is
determined
by
media
accessibility,
audience
characteristics, and the content of the campaign
materials.
Keywords:
Campaign
effectiveness,
Grassroots
campaign,
non-communicable
diseases,
Media
accessibility, SmartPLS
Introduction:
Providing quality services to the
community is one of the government's responsibilities.
One of the healthcare service facilities is the Community
Health Center (Puskesmas), which implements both
public health and primary personal healthcare efforts,
with a greater emphasis on promotive and preventive
measures to achieve the highest possible health
standards for the population in its service area. One of
these efforts is health campaigns, which are organized
communication activities aimed at creating a specific
impact on a large portion of the target audience in a
sustained manner. The long-term success of such
programs does not depend solely on medical factors but
also on the participation and understanding of the
community regarding these efforts (Gustian et al.,
2024).
The campaign to prevent non-communicable diseases
(NCDs) is one of the health campaign types currently
being promoted in response to changes in public
lifestyles. The impact of NCDs on economic, social, and
community sustainability aspects is complex and
multidimensional. The high cost of healthcare, increased
work absenteeism, and reduced productivity due to
illness can significantly burden the economy.
Furthermore, the high rate of morbidity can drain
healthcare resources. This situation demands the
implementation of measurable preventive measures.
Educating the public on healthy lifestyle behaviors
becomes a fundamental proactive strategy.
Non-communicable
diseases
(NCDs)
cause
approximately 41 million deaths annually, accounting
for 74% of all deaths worldwide. Around 17 million
people die before the age of 70 due to NCDs, and 86% of
these premature deaths occur in low- and middle-
income countries. Cardiovascular diseases are the
leading cause of NCD-related deaths, with around 17.9
million deaths annually, followed by cancer (9.3 million),
chronic respiratory diseases (4.1 million), and diabetes
(2 million, including deaths from chronic kidney disease
due to diabetes). These four diseases account for
approximately 80% of premature NCD-related deaths
(Ministry of Health RI, 2023).
The mission of the Directorate for the Prevention and
Control of Non-Communicable Diseases (P2PTM) at the
Indonesian Ministry of Health is to protect the public
from NCD risks and to improve public health status,
survival rates, and quality of life. This is pursued through
enhanced prevention and control efforts, reduction of
shared risk factors, and the decrease of illness, disability,
and death rates from NCDs, along with lowering the
socio-economic burden resulting from these diseases
(Ministry of Health RI, 2023).
In the province of Aceh, the prevalence of NCDs among
individuals aged 15 years and above, based on diagnoses
by doctors from the 2023 Indonesian Health Survey
(SKI), was: hypertension (7.9%), diabetes mellitus
(2.2%), asthma (1.0%), cancer (0.7%), heart disease
(0.77%), stroke (8.8%), and chronic kidney disease
(0.2%).
According to the Aceh Province Health Profile, the
number of hypertension patients receiving minimum
service was 504,915 in 2022, which dropped to 343,260
in 2023. Meanwhile, diabetes mellitus patients receiving
minimum service totaled 109,466 in 2022 and 108,305
in 2023.
As stipulated in Minister of Health Regulation No. 71 of
2015 on the Control of Non-Communicable Diseases,
health promotion is the initial step in addressing NCDs.
Preliminary surveys indicate that all Puskesmas in the
Banda Aceh City Health Office's service area have
conducted various campaign efforts for NCD prevention
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as a form of health promotion. These campaigns were
also carried out at Posyandu (integrated service posts),
Posbindu PTM (Integrated Development Posts for
NCDs), and in public spaces.
In practice, NCD prevention campaigns in Banda Aceh
use a grassroots (below-the-line) strategy involving
media such as banners, posters, brochures, and leaflets.
These campaigns target the general population aged 15
years and above, especially those aged 40 and older as
the highest-risk group. However, based on surveillance
data from the Banda Aceh City Health Office, the
incidence of NCDs continues to rise.
According to Banda Aceh City’s health profile in 2021
and 2022, the top five NCDs are as follows: Hypertension
cases increased from 13,077 in 2021 to 19,394 in 2022;
type 2 diabetes mellitus rose from 9,573 to 12,653;
obesity surged from 9,441 to 26,005; coronary heart
disease increased from 2,252 to 2,516; and refractive
disorders remained at 2,836 in both years.
Below-the-line (BTL) campaigns are marketing strategies
that use more direct, specific, and personal
communication methods to reach targeted audiences.
Unlike above-the-line (ATL) campaigns, which are mass-
oriented and use large-scale media such as television,
radio, print ads, or social media, BTL campaigns focus on
direct interaction and activities targeting specific
segments using personal media such as posters,
brochures, leaflets, and banners.
Measuring the effectiveness of health campaigns is a
crucial process for evaluating whether the program has
achieved its intended goals. The long-term sustainability
of health programs depends not only on medical aspects
but also on public participation and understanding. The
study by Dwi Vilasari et al. (2024) on the role of health
promotion in increasing public awareness of NCDs
emphasizes the importance of maintaining momentum
in implementing health promotion programs. Practical
recommendations include improving access to health
campaign services, optimizing the use of information
technology in campaigns, and actively involving the
community in planning and implementing programs.
Based on the above explanation, the author considers it
necessary to conduct an analysis of the effectiveness of
grassroots campaigns for non-communicable disease
prevention programs in Banda Aceh City.
RESULTS
Table 1. Frequency Distribution of Respondents' Characteristics
Characteristics
Frequency (f)
Percentage (%)
Gender
Man
Woman
Age
15-39 years
40-59 years
>60 years
Education
Master’s Degree
Bachelor’s Degree
Diploma Three
66
134
91
85
24
10
78
29
33.0
67.0
45.5
42.5
12.0
5.0
31.5
14.5
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Senior High School
Junior High School
Monthly income
More than Rp. 3,685,000
Less than Rp. 3,685,000
83
15
63
137
41.5
7.5
31.5
68.5
Total
200
100
Table 1 shows that for the gender characteristic, there is a significant difference where the number of female
respondents was higher, totaling 134 people (67%), compared to male respondents, totaling 66 people (33%).
Based on age groups, respondents aged 15
–
39 years amounted to 91 people (45.5%), those aged 40
–
59 years
totaled 85 people (42.5%), and those over 60 years old were 24 people (12%).
In terms of education, respondents with a senior high school (SMA) education were the most dominant, totaling 83
people (41.5%), followed by those with a bachelor’s degree or equivalent (S1) with 63 people (31.5%), a diploma
(D3) with 29 people (14.5%), ju
nior high school (SMP) with 15 people (7.5%), and a master’s degree (S2) with 10
people (5.0%). Based on income, respondents with a monthly income of less than Rp. 3,685,000 dominated, totaling
137 people (68.5%), compared to respondents earning more than Rp. 3,685,000, totaling 63 people (31.5%)
Table 2. Frequency Distribution of the Measurement Results of Research Variables
Category
Frequency (f)
Percentage (%)
Accessibility
Very Good
Good
Fair
Poor
Very Poor
Target Characteristics
Very Relevant
Relevant
Less Relevant
61
115
20
4
0
66
118
16
30.5
57.5
10.0
2.0
0
33.0
59.0
8.0
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Not Relevant
Very Irrelevant
Media Content
Very Good
Good
Fair
Poor
Very Poor
Campaign Effectiveness
Very Effective
Effective
Less Effective
Ineffective
Very Ineffective
0
0
122
60
14
3
1
78
111
11
0
0
0.0
0.0
61.0
30.0
7.0
1.5
0.5
39.0
55.5
5.5
0.0
0.0
Total
200
100
Based on Table 2, the measurement results of the variable
accessibility of grassroots campaign media
, using
indicators such as media availability, ease of access, accommodation availability, affordability, and information
accessibility, show that the highest category is
good
, accounting for 57.5%, while the lowest is
poor
, at 2%.
For the variable
respondent characteristics
, which
includes indicators such as demographics, knowledge,
economic status, socio-cultural background, and
psychological factors, the highest category is
relevant
, at
59%, and the lowest is
less relevant
, at 8%.
For the
media content
variable, with indicators including
attention-grabbing,
interest-generating,
desire-
stimulating, decision-encouraging, and action-inducing,
the highest category is
very good
, at 61%, and the lowest
is
very poor
, at 0.5%.
Regarding the
effectiveness of grassroots campaign
media
, assessed through indicators such as media
productivity, campaign media efficiency, respondent
satisfaction with the media used, media adaptability,
and campaign program sustainability, the highest
category is
effective
, at 55.5%, and the lowest is
less
effective
, at 5.5%.
Figure 1
Outer Model of the Preliminary Test of the Relationship Between Indicator Variables and Latent Variables
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Based on Figure 1, in the outer model of the preliminary test, there are indicator loading factor values below 0.7,
which must be excluded from subsequent calculations. These indicators are the
psychological
indicator (X1.5) under
the
target characteristics
variable, with a loading factor of 0.679, and the
productivity
indicator (Y3.1) under the
effectiveness
variable, with a loading factor of 0.597.
Figure 2
Final Outer Model of the Relationship Between Indicator Variables and Latent Variables
Based on Figure 2, it can be observed that the outer loadings of all indicators in the final test exhibit values above
0.7. This indicates that all indicators have a sufficiently significant contribution to the measured construct.
Variable
Cronbach's Alpha
rho_A
Composite Reliability
Average
Variance
Extracted (AVE)
Accessibility
0.850
0.854
0.893
0.626
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Effectiveness
0.774
0.788
0.853
0.592
Target
Characteristics
o.763
0.772
0.850
0.587
Media Content
0.846
0.850
0.891
0.620
Based on Table 4.3, all research variables have Cronbach's Alpha values greater than 0.7, indicating that each
construct demonstrates good internal reliability. The Composite Reliability values are also all above 0.7, suggesting
that the constructs are consistently reliable.
Moreover, the validity test using the Average Variance
Extracted (AVE) shows that all variables have AVE values
exceeding 0.5. This indicates that each construct
possesses adequate convergent validity, meaning it can
explain more than 50% of the variance in its associated
indicators. Therefore, the measurement instruments
used in this study meet the required standards for both
validity and reliability.
Table 4 R Square Values
Variable
R Square
Adjusted R Square
Accessibility
0.480
0.478
Effectiveness
0.491
0.483
Media Content
0.553
0.550
Based on the data presented in Table 4, it can be
observed that the R Square value for the accessibility
variable is 0.480. This indicates that 48.0% of the
variance in accessibility can be explained by the
constructs within the model, while the remaining 52.0%
is explained by other variables outside the model.
The effectiveness variable has an R Square value of
0.491, suggesting that 49.1% of the variance in campaign
effectiveness is accounted for by the model constructs,
whereas 50.9% is influenced by external factors not
included in the model.
The media content variable shows an R Square value of
0.553, indicating that 55.3% of the variance in media
content is explained by the variables in the model. This
is the highest R Square value among the three variables,
signifying that the constructs in the model are most
effective in explaining media content compared to
accessibility and effectiveness.
Table 5 F Square Values
Variable
Accessibility
Effectiveness
Target Characteristics
Media Content
Accessibility
0.066
Effectiveness
Target
Characteristics
o.924
0.051
1.235
Media Content
0.059
The f-square (f²) value in the PLS-SEM model is used to
evaluate the effect size of an independent variable on a
dependent variable. Based on the results presented in
Table 5.
Accessibility to campaign effectiveness has an f-square
(f²) value of 0.066, indicating a small effect
size. This
suggests that easier access to campaign information
slightly improves its effectiveness. Although the effect is
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small, it remains relevant within the context of health
promotion.
Target characteristics on accessibility show an f² value of
0
.
924, which falls into the large effect category. This
means that differences in characteristics such as age,
education level, or social status play a significant role in
determining how respondents access campaign-related
information.
Target characteristics on campaign effectiveness have
an f² value of 0.051, indicating a small effect
size. This
shows that while differences in characteristics do
influence perceptions or evaluations of campaign
success, the impact is limited.
Target characteristics on media content show an f² value
of 1.235, which represents a very large effect. This
means that the media content used in the campaign is
heavily influenced by the characteristics of the audience.
Therefore, audience segmentation becomes crucial in
crafting effective campaign messages.
Media content on campaign effectiveness has an f² value
of 0.059, which also falls into the small effect category.
This indicates that although the content of the campaign
message is important, its direct influence on perceived
effectiveness is not dominant unless supported by other
factors such as accessibility and audience relevance.
Overall, the variable of target characteristics exerts a
large influence on both accessibility and media content,
indicating that differences in audience characteristics
play an important role in shaping perceptions of
information access and campaign content. The effects of
accessibility, target characteristics, and media content
on campaign effectiveness are small, yet statistically
meaningful within the PLS-SEM framework.
This analysis reveals that campaign effectiveness is
more
strongly influenced indirectly through variables
mediated by the characteristics of the respondents. The
target characteristics variable plays a very important
role in shaping perceptions of the campaign, particularly
in terms of information access and content reception.
Although variables such as accessibility and media
content have only a small direct impact on effectiveness,
they remain essential components in designing an
effective campaign communication strategy.
Figure 3 Inner Model Test Results
Figure 3 illustrates that the target characteristics variable influences both the accessibility and media content
variables, and is closely related to the effectiveness of
the grassroots campaign for non-communicable disease
(NCD) prevention in Banda Aceh. The research findings indicate that the variable with the most substantial influence
on the effectiveness of the grassroots NCD prevention campaign in Banda Aceh is media content, with a t-value of
3.278. All t-values of the variables in this model are greater than 1.96, indicating that the relationships between the
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latent variables are statistically significant.The estimated output for structural model testing can be observed
through the Path Coefficients values presented in Table 6.
Table 6 Path Coefficients of the Inner Model
Original
Sample (O)
Sample Mean
(M)
Standard
Deviation
(STDEV)
T Statistics
(|O/STDEV|)
P Values
Accessibility ->
Effectiveness
0.257
0.255
0.093
2.751
0.006
Target
Characteristics ->
Accessibility
0.693
0.696
0.049
14.259
0.000
Target
Characteristics ->
Effectiveness
0.274
0.282
0.107
2.555
0.011
Target
Characteristics ->
Media Content
0.743
0.742
0.038
19.680
0.000
Media Content ->
Effectiveness
0.261
0.255
0.080
3.278
0.001
Table 6 presents the results of hypothesis testing on the effects of campaign media accessibility, target
characteristics, and media content on the effectiveness of grassroots campaigns for non-communicable disease
(NCD) prevention in Banda Aceh. The significance of the relationships between latent variables is assessed based
on the criteria of t-values > 1.96 and p-values < 0.0
First, the effect of campaign media accessibility on
campaign effectiveness yields values of
(t = 2.751; p =
0.006)
, indicating a statistically significant relationship.
This means that the ease of access to campaign media is
significantly associated with the perceived effectiveness
of the grassroots campaign
Second, the relationship between target characteristics
and campaign media accessibility shows
(t = 14.259; p =
0.000)
, which also indicates a strong and significant
association. This suggests that differences in
respondents' characteristics (e.g., age, education, socio-
economic status) significantly influence their level of
access to campaign media.
Third, the effect of target characteristics on campaign
effectiveness results in
(t = 2.555; p = 0.011)
, reflecting
a significant but moderate association. This implies that
individual differences also play a role in how campaign
effectiveness is perceived.
Fourth, the influence of target characteristics on media
content has the highest values
(t = 19.680; p = 0.000)
,
indicating a very strong and significant relationship. This
highlights the importance of tailoring campaign content
to the audience's demographic and psychographic
characteristics.
Fifth, the relationship between media content and
campaign effectiveness yields
(t = 3.278; p = 0.001)
,
demonstrating a significant positive effect. This implies
that the quality and relevance of the media content used
in the campaign significantly contribute to its perceived
effectiveness.
Based on these results, it can be concluded that media
accessibility, target characteristics, and media content
all have statistically significant influences on the
effectiveness of grassroots campaigns for NCD
prevention in Banda Aceh.
Table 7. Model Fit Test Results
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Saturated Model
Estimated Model
SRMR
0.079
0.080
The table shows that the SRMR value for the saturated model is 0.079, and for the estimated model is 0.080. Both
values fall within the acceptable threshold range of 0.05 to 0.08, indicating a good level of model fit between the
estimated model and the fully specified model. The lower the SRMR value, the better the model fit. In this case, the
relatively low SRMR values suggest that the estimated model has a good fit with the observed data, supporting the
overall adequacy of the model structure
DISCUSSION
Univariate Analysis
Accessibility of Grassroots Campaign Media
The research findings indicate a positive assessment
from respondents regarding the accessibility of the
grassroots health campaign. This suggests that the
disseminated campaign media has largely met public
needs in terms of ease of access, as illustrated in Figure
4.
Figure 4. Frequency Distribution of Accessibility Assessment in the Grassroots Campaign
Nevertheless, 10.0% of respondents rated accessibility
as “less favorable”, and 2.0% as “unfavorable”,
indicating that a segment of the population still
experiences difficulties in accessing the printed
campaign materials. The study identified several
contributing factors, including uneven distribution of
media in strategic public locations and limited quantities
of materials distributed.
Some respondents expressed a preference for campaign
media that is easily obtainable and portable, such as
leaflets and brochures placed in public spaces
—
village
halls, markets, and other facilities
—
in large quantities
and accessible without having to ask staff members.
Additionally, respondents emphasized a desire for
practical, concise information that is directly applicable
to their daily lives, rather than theoretical explanations
or lengthy texts.
Target Audience Characteristics in Grassroots
Campaigns
The study results on the target audience characteristics
variable of the grassroots campaign received positive
responses, indicating that respondents perceived the
media used as relevant to their needs and profiles as
campaign targets, as illustrated in Figure 5.
Very
Good
30.5%
Good
57.5%
Fair
10.0%
Poor
2.0% Very poor 0.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Accessibility of the grassroots campaign
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Figure 5. Frequency Distribution Chart of the Target Audience Characteristics in the Grassroots
Campaign
However, 8.0% of respondents rated the media used as
less relevant to the characteristics of the target
audience. This suggests that a small portion of the
community still feels that the grassroots media does not
fully reflect their specific needs. According to the
researchers’ findings, contributing factors include the
media’s
limited reach to certain vulnerable groups such
as adolescents, as well as a general style of information
delivery that is insufficiently tailored to individual
circumstances.
Some adolescent respondents stated that they liked the
leaflets or posters because they were colorful and
image-rich, but when seeking information about
illnesses, they preferred to search the internet
—
particularly on platforms such as TikTok. This was
echoed by a working female respondent who mentioned
that information provided on available posters or
leaflets often did not match the disease prevention
topics she was interested in at that time. As a result, she
found it easier to look up health information online
through platforms like Facebook or TikTok, citing
reasons such as instant access to the desired topic
anytime and anywhere.
These findings indicate that, in order to improve the
effectiveness of future campaigns, it is essential to
enhance audience segmentation strategies in grassroots
media messaging. This includes taking into account the
public’s level of knowledge, age, and
local needs, as well
as expanding the use of upper-level media such as social
media platforms to better reach productive age groups.
Campaign Media Content
The research findings indicate that 91% of respondents
gave a positive assessment of the content of the
grassroots campaign media, as illustrated in Figure 6.
Figure 6. Frequency Distribution Chart of the Grassroots Campaign Media Content Assessment
Very Relevant
33.0%
Relevant
59.0%
Somewhat
Relevant
8.0%
Irrelevant
0.0%
Very Irrelevant;
0.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Target Audience Characteristics of Grassroots Campaigns
Very Good
61.0%
Good
30.0%
Fair
7.0%
Poor
1.5%
Very Poor
0.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Media Content of Grassroots Campaigns
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However, 7.0% of respondents rated the media content as less favorable, 1.5% rated it as poor, and 0.5% rated it
as very poor. This suggests that there is still a portion of the community that feels the printed media content does
not fully meet their needs
Several respondents expressed a preference for media
content that is practical and applicable, concise, and
easy to understand. They emphasized that messages
should avoid complex medical terminology and should
be directly relevant to everyday life. Other respondents
preferred content with more images, bright colors, and
large, bold fonts to enhance readability.
Effectiveness of Grassroots Campaigns for Non-
Communicable Disease Prevention
Based on Figure 7, the effectiveness of grassroots
campaign media in the prevention of non-
communicable diseases received positive evaluations.
This indicates that the message delivery strategies
through grassroots media used during the campaign
were effective.
Figure 7. Frequency Distribution Chart of Grassroots Campaign Effectiveness Assessmen
Nevertheless, 5.5% of respondents perceived the campaign media to be less effective. This serves as an indicator
that there is still room for improvement.
Several respondents felt that the campaign would be
more trustworthy if it involved community leaders or
local health cadres. Others suggested the need for
interactive components, such as opportunities for direct
dialogue or Q&A sessions, instead of relying solely on
one-way communication. According to the researchers'
findings, most respondents expressed a desire for the
campaign to be conducted not as a one-off event but as
a regular and continuous activity.
Multivariate Analysis
The Relationship Between Indicators and the
Accessibility Variable
Based on the results of the analysis, all indicator loading
factor values for the accessibility variable were greater
than 0.70. This indicates that all five indicators have a
statistically significant influence on the latent variable of
accessibility in grassroots media campaigns for the
prevention of non-communicable diseases (NCDs).
Among these indicators, accommodation demonstrated
the highest loading factor, with a value of 0.841,
indicating that this is the strongest indicator in reflecting
the ease with which the public can access grassroots
Very Effective
39.0%
Effective
55.5%
Somewhat
Effective
5.5%
Ineffective
0.0%
Very Ineffective;
0.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Effectiveness of Grassroots Campaigns
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campaign media. This finding is supported by the study
conducted by Rosidin, Nugroho, and Putri (2022) on the
effectiveness of banner media in the CERDIK program in
enhancing public knowledge of NCD prevention. In that
study, strategically placed banners in locations easily
accessible to the public were found to increase
respondents’ average knowledge scores by 23 points.
This suggests that printed media, when readily
accessible and located in strategic spots, significantly
contributes to improving public awareness and
knowledge of disease prevention.
Conversely, the cost affordability indicator showed the
lowest loading factor, at 0.732, suggesting a relatively
smaller contribution to the construct of accessibility
compared to other indicators. This may be attributed to
the fact that most of the campaigns are implemented by
government agencies through basic service channels at
no cost to the public. Grassroots campaigns are typically
conducted through public facilities such as
Posyandu
(integrated service posts),
Puskesmas
(community
health centers), or direct outreach programs, all of
which do not impose financial burdens on the
community. As a result, people do not consider cost a
major issue when accessing campaign information.
When the vast majority of respondents perceive that
there are no costs involved
—
or that any costs are
minimal
—
the response variability for this indicator
becomes low, thereby reducing its discriminatory power
in measuring the accessibility construct
.
The Relationship Between Indicators and the Target
Audience Characteristics Variable
In the measurement model (outer model), the
knowledge indicator exhibited the highest loading factor
on the target audience characteristics variable, with a
value of 0.850. This indicates that among all indicators,
knowledge is the strongest in reflecting the construct of
target audience characteristics in non-communicable
disease (NCD) prevention campaigns. This finding
suggests that an individual's level of knowledge is the
most decisive factor in defining an appropriate target
audience for health campaigns. A high loading factor
signifies that individuals with higher levels of knowledge
are more prepared to receive, comprehend, and act
upon the health messages conveyed in such campaigns.
Thus, knowledge emerges as the most powerful
indicator in shaping the ideal target segment.
This analytical result aligns with the study by Putri and
Rahmawati (2019), which demonstrated that the
success of health campaigns at the community level is
significantly determined by the knowledge level of the
target audience. Higher knowledge increases individual
receptivity to campaign messages and enhances active
participation in health promotion activities such as
posyandu
(integrated health services) and regular
medical check-ups.
Furthermore, these findings are consistent with the
research conducted by Sari et al. (2021), which focused
on hypertension prevention programs at community
health centers (
Puskesmas
). The study showed a
significant relationship between knowledge levels and
public participation in NCD control programs. This
further reinforces that knowledge is the most influential
indicator in defining the characteristics of the target
population.
On the other hand, the sociocultural indicator had the
lowest loading factor, at 0.706, indicating the weakest
reflection of the latent variable compared to other
indicators. This can be attributed to the abstract nature
of sociocultural constructs
—
such as norms, values,
traditions, and beliefs
—
which are often difficult to
quantify objectively. As a result, its contribution to the
target audience characteristics variable tends to be
weaker than that of more tangible indicators such as
knowledge or demographics.
In today’s information era, public mindsets are
increasingly shifting toward more rational and
knowledge-based perspectives. Consequently, the
influence of traditional cultural values is gradually being
overshadowed by the accessibility of modern health
information. Additionally, in urban areas such as Banda
Aceh, the high degree of sociocultural diversity may
diminish the strength of this indicator in uniformly
representing the entire respondent population.
Relationship Between Indicators and the Campaign
Media Content Variable
The media content variable plays a crucial role in
determining the success of message delivery. This
variable consists of several indicators following the
AIDDA approach, namely Attention, Interest, Desire,
Decision, and Action. In the measurement model (outer
model), the indicator of Desire showed the highest
loading factor on the media content variable with a
value of 0.827, meaning this indicator most strongly
reflects the media content in the campaign compared to
the other indicators.
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According to Kotler and Keller (2016), desire is the
emotional stage that serves as a turning point in the
persuasion process. When content successfully evokes
desire, the audience is not only interested but also
begins to imagine the personal benefits of the conveyed
message. In the context of health campaigns, this desire
may manifest as motivation to live healthily, avoid
diseases, or protect family members from the risk of
non-communicable diseases.
A study by Lestari and Wahyuni (2020) found that
campaign media featuring inspirational stories and
visualizations of health benefits can increase public
desire to take preventive actions, such as health check-
ups or participating in posyandu activities. This
reinforces that evoking desire is a critical point in the
communication flow of campaigns.
The Desire indicator is the most dominant aspect in
reflecting the effectiveness of media content because it
transforms passive interest into active intention,
touching the emotional and personal side of the
audience, increasing the likelihood of decision-making
and actual action, and acting as a bridge between
cognitive and affective aspects in the persuasion
process. One weakness of media content that only
attracts attention or interest is its short-lived effect.
However, when content succeeds in evoking desire, it
generates a deeper and more enduring intention. This is
supported by Fishbein and Ajzen (2010) in the Theory of
Planned Behavior, which states that strong intentions or
desires are the main predictors of behavior. Therefore,
health campaign media content must be designed not
only to convey information but also to evoke a strong
desire within the audience to encourage them to take
preventive action against non-communicable diseases.
The outer model results show that the Attention
indicator has the lowest loading factor at 0.712,
indicating that its reflection on the media content
variable is relatively the smallest compared to other
indicators. The factor of attracting attention heavily
depends on individual preferences and socio-cultural
contexts. What is considered attractive by one group
may not be relevant to another group. Therefore, this
indicator tends to be less consistent in representing the
general perception of media content quality.
The study by Susanti, R., & Mulyana, D. (2020) concluded
that the attention factor only provides a short-term
effect and often fails to change perceptions if it is not
followed by messages that touch emotional aspects or
are relevant to the personal needs of the audience.
In the context of non-communicable disease prevention
campaigns, media content aims to change behavior, not
merely to be viewed. Attracting attention is only the
initial step in the media communication process.
Although important, attention is often temporary and
does not always lead to deeper engagement. Therefore,
content that merely attracts attention without providing
educational value or evoking the desire to act is
perceived as less effective by respondents.
Relationship Between Indicators and the Campaign
Effectiveness Variable
Based on the outer model, for the variable of grassroots
campaign effectiveness, the adaptability indicator
showed the highest loading factor of 0.820 compared to
the indicators of efficiency, satisfaction, and program
sustainability. This indicates that t
he campaign’s ability
to be flexible and adjust is the key factor driving the
overall effectiveness of the program.
Grassroots campaigns operate at the community level,
where social, cultural, and geographical differences are
highly diverse. The adaptability indicator reflects the
campaign’s capacity to tailor messages, methods, and
strategies to local needs. In health program planning
models, Green and Kreuter (2005) emphasize that
health interventions must consider the social, cultural,
and environmental contexts of the target population.
This model underscores the importance of program fit
with community characteristics to ensure effective
acceptance and adoption.
Adaptive campaigns are better able to reach and
influence communities. Adaptability allows the program
to be adjusted to local languages, social norms,
residents’ schedules, and even modes of communication
(e.g., through community leaders). This contextual and
flexible approach strengthens community acceptance of
the campaign content and forms the foundation for
long-term program sustainability.
This finding aligns with research by Handayani and
Saputra (2021), which concluded that programs able to
adapt to local culture and field conditions are more
successful in reaching their targets compared to uniform
programs. Adaptability is regarded as a crucial element
in enhancing community participation.
The analysis also shows that the efficiency indicator has
the lowest loading factor for the grassroots campaign
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effectiveness variable. This suggests that efficiency is
less reflective of campaign effectiveness. According to
Green and Kreuter (2005), effectiveness in the context
of community campaigns cannot be measured solely by
input-output ratios but rather by the ability to reach,
mobilize, and be accepted by the community.
Efficiency is administrative and technical in nature,
which may not be directly perceived or valued by the
community as beneficiaries. Therefore, the community
cannot easily assess or experience the benefits of cost or
time efficiency, resulting in a low contribution score
towards effectiveness. This is consistent with the study
by Putra, B., and Lestari, D. (2019), which found that the
success of community-based health promotion
campaigns is highly determined by local involvement
and adaptation, whereas efficiency contributes the least
to program success.
Effect of Accessibility Variable on Campaign
Effectiveness Variable
Based on the analysis results, the relationship between
accessibility and campaign effectiveness yielded a T-
statistic value of 2.751, with a p-value of 0.006 and a
path coefficient (β) of 0.257. The T
-statistic value of
2.751 exceeds the critical value of 1.96 at a 5%
significance level, and the p-value is less than 0.05,
indicating that the relationship between accessibility
and grassroots campaign effectiveness is statistically
significant. Therefore, the null hypothesis (H₀) is
rejected, and the alternative hypothes
is (H₁) is accepted.
The path coefficient of 0.257 suggests that the strength
of the relationship between accessibility and campaign
effectiveness falls within the weak to moderate
category. This means that the higher an individual’s level
of accessibility to grassroots campaigns
—
considering
the availability of campaign media, ease of accessing
information, availability of accommodations, and
affordability
—
the greater the effectiveness of the
campaign in delivering non-communicable disease
prevention messages.
According to Nutbeam’s (2000) health literacy
framework, access to health information is only the
initial stage of a more complex process. Health literacy
encompasses the ability to understand, evaluate, and
apply the information. If the community has high access
to information but lacks sufficient understanding or
literacy capacity, the campaign’s effectiveness will still
not be optimally achieved.
This analysis is further supported by Rohmah and
Nursalam’s (2021) study, which highlighted that rural
communities remain unaffected by electronic media-
based health campaigns despite having access to such
media, due to the absence of emotional and social
engagement in the message delivery process.
Effect of Target Characteristics Variable on Accessibility
Based on the analysis results, the path coefficient
between the target characteristics variable and
accessibility to grassroots non-communicable disease
prevention campaigns is 0.693, with a T-statistic value of
14.259 and a p-value of 0.000. The T-statistic exceeds
the critical value at the 1% significance level (T > 2.58).
Since the T-statistic of 14.259 > 1.96, the null hypothesis
(H₀) is rejected, and the alternative hypothesis (H₁) is
accepted. The influence of target characteristics on the
accessibility of grassroots campaigns is statistically
significant at the 1% significance level (p < 0.01).
Moreover, the path coefficient of 0.693 indicates that
the relationship is strong, meaning that the better the
alignment or support of the target characteristics, the
higher their accessibility to information from grassroots
campaigns for non-communicable disease prevention.
Thus, it can be concluded that target characteristics
have a significant and strong influence on individuals’
accessibility to non-communicable disease prevention
campaigns implemented in Banda Aceh City.
Effect of Media Content Variable on Campaign
Effectiveness
The hypothesis testing regarding the relationship
between media content and grassroots campaign
effectiveness shows statistically significant results.
Based on the inner model analysis, the T-statistic value
is 3.278, with a p-value of 0.001 and a path coefficient of
0.261.
The T-statistic value, which is greater than the critical
value of 1.96 at a 5% significance level, indicates that the
relationship between media content and campaign
effectiveness is statistically significant. This is further
supported by a p-value of 0.001, which is below the
significance threshold of p < 0.05. Hence, the null
hypothesis (H₀) is rejected, and the alternative
hypothesis (H₁) is accepted.
The path coefficient of 0.261 suggests that the strength
of the relationship between media content and
campaign effectiveness falls within the weak to
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moderate category. This means that the more relevant,
engaging, and aligned the campaign media content is
with the needs and characteristics of the target
audience, the greater its ability to enhance the
effectiveness of grassroots non-communicable disease
prevention campaigns in the community. These findings
underscore the importance of the quality and suitability
of media content in supporting the success of non-
communicable disease prevention messages delivered
through grassroots campaigns.
Effect of Target Characteristics Variable on Media
Content
Based on the analysis results, there is a significant
influence of target characteristics on the media content
of grassroots non-communicable disease prevention
campaigns. The obtained t-statistic value is 19.680,
which far exceeds the t-critical value at the 1%
significance level (t-
stat ≥ 2.58), indicating that this
relationship is statistically significant. Furthermore, the
p-value of 0.000 (< 0.05) strengthens the conclusion that
target characteristics significantly affect the media
content of grassroots campaigns.
The path coefficient of 0.743 shows that the influence of
target characteristics on media content is positive and
strong. This means that the more aligned the target
characteristics are, the more relevant and effective the
grassroots campaign media content delivered will be.
This finding demonstrates that the success of a
campaign is highly influenced by a good understanding
of the target group’s characteristics.
This aligns with Purwanti’s (2021) study on the
effectiveness of anti-smoking campaigns among
adolescents, which found that campaigns not tailored to
adolescent characteristics tend to fail in achieving their
goals. Campaigns using visual approaches on social
media, colloquial language, and influencer figures are
more effective in influencing younger age groups
compared to formal approaches.
Similarly, Dewi and Mustofa’s (2019) research on
immunization campaigns in rural areas showed that
campaign success is strongly affected by the
community’s education level and understanding of
health information. Communities with low education
levels find it harder to comprehend health messages and
tend to reject immunization due to a lack of
understanding of its benefits.
Therefore, these analysis results reinforce the
importance
of
audience
segmentation
and
comprehensive mapping of target characteristics before
designing health campaigns. When campaign media are
tailored to the needs, preferences, and backgrounds of
the target audience, non-communicable disease
prevention messages are more easily accepted and
understood, thus increasing the potential for behavioral
change.
Effect of Target Characteristics Variable on Campaign
Effectiveness
The analysis results show a significant influence of target
characteristics on the effectiveness of grassroots non-
communicable disease prevention campaigns. The t-
statistic value of 2.555 indicates that it exceeds the
threshold t-table value at the 5% significance level
(≥1.96), so this influence is statistically significant. This is
also supported by a p-value of 0.011, which is below the
significance level p < 0.05, indicating the relationship is
unlikely due to chance.
The path coefficient of 0.274 indicates that target
characteristics have a positive effect on the
effectiveness of grassroots campaigns, although the
strength is moderate. In other words, the better the
alignment of target characteristics, the more effective
the grassroots campaign will be in delivering non-
communicable disease prevention messages.
According to McGuire (1985), audience or target
characteristics are a key component determining
message effectiveness. Factors such as age, education,
literacy level, and individual motivation significantly
influence the extent to which a person can receive,
understand, and respond to the conveyed information.
These findings underscore the importance of
segmentation and understanding target characteristics
in the planning and implementation of grassroots non-
communicable
disease
prevention
campaigns.
Campaigns that appropriately consider the target profile
tend to better capture attention and increase
effectiveness with the aim of encouraging the desired
behavioral change.
Model of Grassroots Campaign Effectiveness
Overall, the results of this study’s analysis indicate that
the effectiveness of grassroots campaigns for the
prevention of non-communicable diseases is the
outcome of a complex interaction between target
characteristics, accessibility, and the media content of
International Journal of Medical Science and Public Health Research
23
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the grassroots campaign. The interaction among these
three factors produces a significant influence. These
factors mutually reinforce each other in shaping
campaign effectiveness.
CONCLUSION
Based on the research findings, the following
conclusions can be drawn:
1.
Accessibility of campaign media has a significant
influence on the effectiveness of grassroots
campaigns for the prevention of non-communicable
diseases in Banda Aceh.
2.
Target
audience
characteristics
significantly
influence the accessibility of grassroots campaign
media for the prevention of non-communicable
diseases in Banda Aceh.
3.
Media content has a significant influence on the
effectiveness of campaigns for the prevention of
non-communicable diseases in Banda Aceh.
4.
Target
audience
characteristics
significantly
influence the content of media campaigns for the
prevention of non-communicable diseases in Banda
Aceh.
5.
Target
audience
characteristics
significantly
influence the effectiveness of grassroots campaigns
for the prevention of non-communicable diseases in
Banda Aceh.
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