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As the use of digital media for health promotion has become increasingly common, descriptive studies exploring current and innovative marketing strategies can enhance the understanding of effective strategies and best practices.
This study aims to describe the implementation of a provincial digital media campaign using complementary advertising platforms to promote healthy pregnancy weight gain messages and direct a Web audience to a credible website.
The digital media campaign occurred in 3 phases, each for 8 weeks, and consisted of search engine marketing using Google AdWords and social media advertising through Facebook. All advertising materials directed users to evidence-based pregnancy-related weight gain content on the Healthy Parents, Healthy Children website.
Google Ads received a total of 43,449 impressions, 2522 clicks, and an average click-through rate (CTR) of 5.80%. Of people who clicked on a Google ad, 78.9% (1989/2522) completed an action on the website. Across all Facebook advertisements, there were 772,263 impressions, 14,482 clicks, and an average CTR of 1.88%. The highest-performing advertisement was an image of a group of diverse pregnant women with the headline “Pregnancy weight is not the same for every woman.”
This study supports the use of digital marketing as an important avenue for delivering health messages and directing Web users to credible sources of information. The opportunity to reach large, yet targeted audiences, along with the ability to monitor and evaluate metrics to optimize activities throughout a campaign is a powerful advantage over traditional marketing tactics. Health organizations can use the results and insights of this study to help inform the design and implementation of similar Web-based activities.
Studies have consistently found that the majority of Canadian women do not meet the Health Canada [
While the prenatal visit offers an opportunity to provide pregnancy information and support, many women feel that discussions with health professionals are insufficient and use Web-based resources to compensate [
The internet, therefore, provides an opportunity to increase women’s awareness and knowledge about healthy GWG and connect women with credible resources, as other Web-based information may not be consistent and evidence-based. For health organizations, advantages of using digital platforms for these purposes include low cost, accessible information, interactivity with users, and the ability to deliver tailored messages with a wide reach to specific audiences [
Informed by recent Alberta-based maternal health research [
The GWG campaign was embedded within
The campaign objectives were to increase awareness about the importance of healthy GWG among women in Alberta and direct women to the HPHC website. Google AdWords and Facebook Ads were chosen to achieve these objectives as Google is the most popular search engine [
Google AdWords is a paid service that displays ad text and a website link above, beside, or below a list of Google search results when a user performs a search using keywords that match those selected by the advertiser. In the list of search results, these paid ads are labeled “Ad” to differentiate them from organic search results.
On Facebook, ads are paid messages from organizations or businesses displayed to members of a predefined audience. Paid ads look similar to unpaid Facebook content and can appear throughout the social network. Advertisers can set budget, articulate advertising objectives, and define a target audience, all of which determine where, how often, and to whom the ad is shown. For this campaign, the project team developed the ads using Facebook Ads Manager, Facebook’s advertising management platform.
The campaign occurred in 3 distinct phases of 8 weeks each between January 2 and December 3, 2017, with a total budget of Can $7034.44. This design was used to decrease the risk of message fatigue and overexposing the audience, which would have been more likely had this been carried out as a single 24-week campaign. To ensure equitable distribution across the entire province, the budget was allocated to 3 markets—65% (Can $4572.39/Can $7034.44) to 2 major cities in Alberta, 15% (Can $1055.17/Can $7034.44) to smaller cities throughout the province, and 20% (Can $1406.88/Can $7034.44) to rural Alberta. A local vendor was contracted to establish the advertising platforms and manage the first phase of the campaign. The remaining phases of the campaign were maintained by internal staff who attended local and Web-based digital marketing training sessions to gain knowledge and expertise. At the end of each campaign phase, staff reviewed the campaign results and adapted the strategy for the next phase.
Overall, 3 Google AdWords ads were developed to be used across all phases (
For Facebook ads, the audience was defined as female, aged 18-44 years, with interests in pregnancy. Ads were selected to show on all devices (mobile, tablet, and desktop) and in Facebook newsfeeds, instant papers, and in the right column of Facebook’s desktop platform. A flexible daily budget of Can $26 was set to have ads run continuously. Like Google AdWords, Facebook uses a bidding system to determine which ads to display. For the digital campaign, Facebook performed automatic bidding based on campaign objectives and audience to achieve the highest number of clicks on the ad at the lowest cost. Allowing for adjustments in daily spending through the automatic bidding process helped to take advantage of opportunities in the ad auction marketplace to optimize results.
Unlike Google AdWords, Facebook ads offer the opportunity for longer messaging, images, and branding. Two new HPHC-branded Facebook ads were developed by staff prior to each phase of the campaign using key messages about healthy pregnancy weight, stock photos, and a link to a relevant HPHC webpage (
During the first phase, ads incorporated color blocks using HPHC branding colors and text onto the image. For the second phase, women in the images were not visibly pregnant and the color blocks and text were removed. Ads for the third phase incorporated design and content elements of the top performing ads from the previous phases; these elements included an image of a woman talking with a health care provider, an image of diverse women to promote the individuality of weight gain, displaying the AHS logo, and the use of HPHC branding colors.
Facebook users can react and leave comments on paid ads; hence, throughout the campaign, staff monitored the ads for comments and provided timely responses, redirecting users to additional HPHC webpages as applicable. While privacy and profanity issues were not a challenge during the campaign, staff had prepared to hide comments that were inappropriate or revealed personal medical information, and connect with users through private messaging as needed.
Sample design of Google AdWords advertisements promoted during the campaign.
A screenshot of the Facebook advertisements for each campaign phase. (Source: photos purchased from iStock.com and Shutterstock.com).
Both Google and Facebook provide extensive data for paid ads delivered using their platforms. Ad performance data were collected from the HPHC Google AdWords account and Facebook Ads Manager. Definitions of key metrics can differ across digital platforms. For the results and discussion that follows, we will use the following terms and definitions:
Impressions: the number of times an ad was displayed to a user
Engagement: interaction with an ad, including Facebook user reactions, sharing, and comments, as well as ad clicks
CPC: price an advertiser pays for each click on the ad
Click-through rate (CTR): the number of clicks on the ad per the number of impressions
Conversions: actions that a user completes after clicking on an ad (completing the Web-based weight gain calculator, clicking to download the results of the Web-based weight calculator, clicking on a social media share button). These data could be collected because of the existing codes that had been added to the HPHC website by the website developer.
It was predicted that Facebook ad engagement would be low because weight can be a personal and sensitive topic, and many women in early pregnancy delay public announcement. Any reaction, comment, or share of the ads could be seen by the women’s Web-based social network, which may deter users from engaging in these ways. For this campaign, the CTR was a better indicator of overall success and user interest in the ad message.
Ads displayed on Google received a total of 43,449 impressions throughout the campaign. The average position of a campaign ad in the search results list was 1.3, meaning the ad was often displayed first or second when an associated keyword was searched. A total of Can $1913.72 was spent on ads with an average CPC of Can $0.76, which is the average amount charged for a click on an ad.
The Google ads were clicked 2522 times, with an average CTR of 5.80%. The most popular search term that led to an ad click was “calculate weight gain during pregnancy” with 137 clicks (
During the campaign, Facebook ads received 772,263 impressions, and the average number of times an ad was displayed to the same individual ranged from 2.53 to 3.28. A total of Can $5067 was spent on Facebook ads with an average CPC of Can $0.35. A greater amount was spent on Facebook ads because of the platform’s required minimum daily budget for an ad set.
Facebook ads were clicked a total of 14,482 times, for an overall CTR of 1.88%. Ads received 43 comments, 28 shares, and 247 reactions. While a rigorous content analysis was not performed, the majority of ad comments were neutral, with many users sharing about their personal weight gain experience. Several comments provided an opportunity to enhance knowledge. For example, when a woman commented on weight gain for carrying twins, our reply encouraged them to talk with her health care provider, and we shared a link to the HPHC webpage containing information about healthy weight gain for a twin pregnancy.
Top 5 performing keywords on Google AdWords by ad clicks.
Keyword | Clicks, n (%) | Click-through rate, % | Cost per click, Can $ | Cost, Can $ |
Calculate weight gain during pregnancy | 137 (5.43) | 10.65 | 0.65 | 88.91 |
Pregnancy weight gain chart calculator | 109 (4.32) | 17.90 | 0.54 | 58.39 |
Weight gain during pregnancy chart | 103 (4.08) | 12.06 | 0.58 | 59.96 |
Pregnant weight gain chart calculator | 90 (3.57) | 13.72 | 0.55 | 49.72 |
Calculate weight gain during pregnancy | 89 (3.53) | 8.52 | 0.64 | 56.65 |
Top 5 performing keywords on Google AdWords by click-through rate.
Keyword | Clicks, n (%) | Click-through rate, % | Cost per click, Can $ | Cost, Can $ |
Pregnancy weight gain | 13 (0.52) | 24.07 | 0.39 | 5.10 |
Healthy pregnancy weight gain chart | 4 (0.16) | 20.00 | 0.65 | 2.61 |
Weight gain during pregnancy month by month | 6 (0.24) | 20.00 | 0.75 | 4.50 |
Pregnancy weight gain chart calculator | 109 (4.32) | 17.90 | 0.54 | 58.39 |
Healthy pregnancy weight gain chart | 6 (0.24) | 17.65 | 0.50 | 03.01 |
Facebook Ads results during each phase.
Phase and ad headline | Impressions, n (%) | Clicks, n | Click-through rate, % | Cost per click, Can $ | Comments, n | Shares, n | Reactions, n | |
Find out where the weight goes and why it’s important | 27,747 (3.59) | 485 | 1.75 | 0.41 | 0 | 0 | 34 | |
Gaining a healthy amount of weight is important for you and your baby | 197,921 (25.63) | 4273 | 2.16 | 0.37 | 22 | 8 | 89 | |
Pregnancy weight is not the same for every woman | 295,762 (38.30) | 4741 | 1.60 | 0.34 | 11 | 6 | 47 | |
Pregnancy weight on target? | 60,522 (7.84) | 196 | 0.32 | 0.17 | 0 | 2 | 4 | |
Pregnancy weight is not the same for every woman | 176,288 (22.83) | 4521 | 2.56 | 0.33 | 10 | 12 | 62 | |
Gaining a healthy amount of weight is important for you and your baby | 14,023 (1.82) | 266 | 1.90 | 0.43 | 0 | 0 | 11 |
This observational study explored the use of a digital media campaign applying complementary tactics to increase awareness about healthy GWG among women in Alberta. Google AdWords targeted users who were actively searching for pregnancy-related information, while Facebook ads reached an audience who were not actively seeking this information. Both tactics directed users to an established website that had credible, evidence-based information, as well as helpful interactive tools to support women achieve a healthy GWG. Observational studies of digital campaigns and the sharing of lessons learned are important as health organizations continue to increase their presence on the Web and as Facebook increasingly limits the reach of unpaid messaging.
Although determining definitive benchmarks and comparing digital marketing tactics can be difficult because of the many variables involved (eg, budget, target audience, industry, competition, imagery, etc), the GWG digital campaign did exceed recently published standards. A digital marketing company in the United States investigated ad campaign metrics and determined that the average CTR across all industries in Google AdWords was 1.91% and average CPC was US $2.32 (Can $2.92) for paid search ads [
Previous health campaigns have used paid digital display ads (ads placed on various websites that are not affiliated with the advertiser) and search engine ads or have focused solely on social media platforms to reach target audiences. Cooper et al [
In this study, almost 80% of users who clicked on a Google ad completed a conversion on the website, which highlights the ability of these ads to attract highly interested users. Using Facebook ads instead of digital display ads as a complementary tactic also has several advantages, such as more effective targeting capabilities, higher-quality data on ad performance (which enabled us to refine the ad content between phases), ability to see user comments, the opportunity for 2-way communication, and extended organic reach when users interact with ads (because the engaged users’ social networks are seeing their engagement and thereby exposed to the ad message).
Online ads have been shown to impact users and increase awareness of the message even without a click [
A well-defined strategy including target audience research, aligning metrics with campaign goals, and a monitoring and evaluation plan was essential to the campaign. Lee et al [
The strategy allowed for each phase of the campaign to build upon the data collected and lessons learned throughout the project. The ability to measure, monitor, and adapt the strategy continuously allowed for gradual optimization of campaign elements toward target audience preferences, lower costs, and a wider reach. Using readily available metrics, campaign activities were adjusted on the basis of components that indicated effectiveness. The highest-performing social media ad, for example, occurred in the last phase of the campaign and represented a combination of the most successful elements (eg, text, branding, and imagery) from previous ads. Furthermore, ad fatigue is a common challenge with digital advertising, where ad performance tends to decline over time. Running 2 Facebook ads at a time—and testing the 2 against one another—helped to reduce ad fatigue by keeping the content new and engaging while providing a means to test the performance of various campaign elements among the target audience.
This study has a number of limitations. Conversions could only be reported for Google AdWords because of an oversight in placing a tracking code in the HPHC website. Future digital campaigns will include this coding consideration early in the planning stage to ensure that additional data can be collected. There are also limitations in comparing results between marketing tactics as they reach different audiences and have different aims. Determining which tactic is a better value or which had a larger impact on the target audience is dependent on the individual interpretation that considers audiences and objectives—it would not be accurate in this case to directly compare the CTR for Google AdWords with the CTR for Facebook ads, for example.
This study did not assess the impact of the campaign on women’s behaviors, knowledge, or attitude; however, 83% of women in a study by Lagan et al [
This study adds to the literature by employing search engine marketing and social media advertising as complementary tactics for GWG health promotion goals. While the quality of information on the Web is highly variable, Google AdWords can be used by health organizations to promote credible websites as women search for specific information to fill knowledge gaps and inform decisions about their pregnancy. An advantage of incorporating Facebook ads into an overall digital marketing campaign is the ability to deliver information to women without their intervention, reaching those who may not be aware of health information related to GWG and women who may not have information-seeking skills.
Harnessing the power of search engine marketing and social media advertising together is a promising strategy to reach women who may not receive adequate information about GWG from other sources. Advantages of digital marketing include the opportunity to target a large audience and the ability to monitor and apply user data to optimize digital marketing activities. While the impact of digital marketing on behavior change is unknown, it may play an important role in contributing to increased awareness and knowledge of health topics that inspire action.
Alberta Health Services
cost per click
click-through rate
gestational weight gain
Healthy Parents, Healthy Children
The authors thank Sheila Tyminski and Dr Kara Nerenberg for their contribution during the design of the Facebook ads. The authors also thank Dr Dolly Bondarianzadeh and Vincent Terstappen for their critical review of the manuscript. The campaign was funded by a Collaborative Research and Innovation Opportunities grant provided by Alberta Innovates.
None declared.