Content Analysis of American Network News Coverage of Prevention Strategies During the Initial Wave of the COVID-19 Pandemic

Abstract

Background

Broadcast media is a method to communicate health information to the general public and has previously been used in prior public health emergencies. Despite the current ubiquity of social media, traditional news programming retains relatively large audiences, which increased during the COVID-19 pandemic’s early days. Viewership of broadcast media networks’ evening news skews toward older groups (age 65 and up) which were vulnerable to health complications related to the COVID-19 pandemic.

Objectives

The current study explored the trends in American broadcast network news media coverage of prevention during the initial wave of the COVID-19 pandemic.

Design

Quantitative content analysis using the Public Health Framework for Prevention was used to analyze three major US media networks’ evening news content for thematic trends in COVID-19 coverage during the first US pandemic wave from March to May 2020.

Subjects

A total of 117 episodes of the evening news, 39 from each of the three major US media networks, evenly divided among the first 13 weeks of the pandemic in the US.

Main Measures

Outcome variables included average seconds of coverage per episode devoted to prevention strategies, COVID-19 coverage not related to prevention, and non-COVID-19 coverage.

Key Results

The proportion of coverage dedicated to COVID-19 sharply increased in the first 2 weeks of March and decreased in the last 2 weeks of May. Networks focused approximately half the COVID-19 coverage time on prevention issues (288 seconds/episode) compared to non-prevention issues (538 seconds/episode). Prevention coverage varied over time.

Conclusions

Although coverage included COVID-19 prevention content, more of the coverage was on other pandemic-related issues (e.g., economic impacts). Because public network news outlets have broad reach and accessibility, they could be an effective partner for public health agencies disseminating prevention messaging for current and future disease outbreaks and threats to public health.

INTRODUCTION

News networks in the United States (US) reported the first cases of SARS-CoV-2 virus (COVID-19) in January 2020. In March 2020, the number of cases sharply increased along with news reports on COVID-19. By May, COVID-19 had infected approximately 1.9 million US residents, of whom approximately 95,000 died.¹ During this initial pandemic wave, the only effective strategy to reduce or contain the spread of COVID-19 was prevention.

The Public Health Framework for Prevention consists of three distinct tiers: primary, secondary, and tertiary prevention.² Primary prevention focuses on intervening before the disease occurs (e.g., avoid infection).³ Primary prevention includes physical distancing, facial covering to reduce droplet spread, proper sanitation (e.g., hand hygiene), and vaccination. Secondary prevention aims to reduce the impact of the disease or infection that has already occurred; this consists of early detection through timely screening to identify subclinical or mild disease. Tertiary prevention focuses on management of the disease/infection management and involves treatment and mitigation of negative effects. Public health authorities emphasize primary prevention because it is cost-effective and can reduce the burden on healthcare systems, which were heavily strained during the initial surge.⁴ Primary prevention often requires individuals to adopt behaviors that promote health and prevent disease.³ Dissemination of prevention messages, especially those focused on primary prevention, is paramount for virus reduction and containment.

Past coverage of epidemics, such as H1N1, Zika, and Ebola, influenced the public’s perceptions and behaviors.^5–7 During these outbreaks, media provided information on routes of transmission, symptoms, and prevention strategies. Furthermore, studies on health communication and behavior show dose-response effects of exposure to health messaging leading to improved health behaviors.^8–13

During the start of the COVID-19 pandemic, broadcast networks’ ratings grew, indicating that the public was seeking trusted sources of information.^14–17 According to the Pew Research Center,¹⁸ in 2020 network evening news (ABC, CBS, and NBC) had a combined total average audience of 19.1 million people—substantially more viewership than for cable news. Pew also found that compared to other age groups, adults age 65 or older were consuming more news about the pandemic and their viewership of network news is historically higher than other age groups.^{19, 20} This viewership group was also at greater risk for severe COVID-19 disease and complications.²¹ Among media sources, broadcast news is readily available to those with a television and antenna and does not require subscriptions. Thus, these outlets are potential sources for equitable transmission of public health messaging.

To our knowledge, no studies have analyzed the extent to which broadcast network news reported on prevention strategies during the first major surge of COVID-19 in the US. Shifts in coverage to reflect prevention strategies during the initial first months of the pandemic are also unknown. Therefore, the purpose of our study was to explore how broadcast network news covered the COVID-19 pandemic during the initial wave, including reporting trends for primary, secondary, and tertiary prevention messaging, along with other COVID-19 coverage that does not fall within the Public Health Framework for Prevention. We also compared how these trends in coverage related to the spread of COVID-19 cases in the US.

METHODS

Study Design

We used quantitative content analysis²² to analyze three major media networks’ evening news content for thematic trends in COVID-19-related reports from March 1, 2020, through May 31, 2020. The Public Health Framework for Prevention was the theoretical framework for the content analysis.² The study period was selected by using a Google trends search (COVID-19 + Coronavirus) as a measure of public interest in the pandemic, and likely most attentive to media coverage of the subject.²³ Using a scale of 1 to 100, the Google trends data showed use of these pandemic search terms in the US. During the week of March 1, 2020, pandemic search terms started rapidly ascending from 3 to 9 before peaking at 100 the week of March 22. From there, searches steadily declined before hitting a local minimum of 24 the week of May 31, before beginning to ascend again with the spread of the country’s second wave. This 3-month time-period captured the initial arc of public attention to the pandemic, which provided the time frame in which to anchor our study.

Sample

Two trained coders viewed a systematic sample of evening news episodes from each of the three major US television networks aired during the 3-month period: ABC World News Tonight with David Muir, NBC Nightly News with Lester Holt, and CBS Evening News with Norah O’Donnell. Episodes were streamed from the network’s websites. We selected Monday, Wednesday, and Friday episodes from each week to capture evening coverage. Tuesday and Thursday episodes were periodically substituted for CBS Evening News due to unavailability of certain Monday, Wednesday, and Friday episodes (n=6). Coding three episodes a week for 3 months, the data set consisted of 39 episodes from each of the three networks, for a total sample size of 117 observations. Coders excluded the introductory segment (defined as the introduction music and the anchor’s preview of the newscast), transitions (transitions between stories and transitions to and from commercials), and any part of the closing segment where the anchor signed off.

Codebook Development

The team used a collaborative, iterative process to develop a codebook. Three researchers, two public health nurse researchers and a political scientist, determined the initial coding scheme based upon the Public Health Framework for Prevention.² The researchers independently viewed the same randomly selected episodes from each news network to define the coding categories. They used a spreadsheet with the initial coding categories to document the start time and end time of the content in the specific categories. Time was documented in the format of minute/second the news report began and ended. After viewing and coding each episode, the researchers met to review their independently coded times. Discrepancies and adjustments to coding categories were discussed and changes made through consensus. Codes included the three tiers of prevention and COVID-19-related reports that reflected content on political game schema, economy, reopening, and opposition to primary prevention strategies. If a story included information on an activity that fits in one of the three tiers of prevention, that section of the story was counted as prevention. Consensus on the coding scheme was determined at each meeting prior to individually coding an episode and then meeting together to refine the scheme. After coding 4 episodes, consensus on the coding scheme was determined (see Table 1 for the final codebook used for analysis).

Table 1.

Thematic Coverage Categories, Specific Topic Areas, and Examples

Broad thematic category	Specific topic area	Example
Primary prevention	Cleaning	Michigan doctor gave advice on disinfecting groceries to minimize exposure to COVID. Some pointers included sterilizing groceries, consuming hot liquids rather than cold, and using UV light box to sanitize products. NBC Nightly News (4/01/2020)
	Social distancing	Florida governor sanctioned mandatory14 days of self-isolation for passengers flying in from New York or New Jersey, the epicenter of the pandemic at the time. In another segment, Britain Prime Minister, Boris Johnson, took distancing measures early on during the pandemic limiting social gathering to no more than two people. He also addressed people to stay home. ABC World News Tonight (3/23/2020)
	Masking	Major airlines including Delta, United, and Southwest required crew and passengers to wear face masks starting at the time of check-in all the way to the final destination. More airlines to follow the same protocol. NBC Nightly News (5/04/2020)
	Vaccine development	NIH researchers in Montana administered vaccine, created by Oxford University, to rhesus macaque monkeys. Monkeys that got the vaccine showed no sign of pneumonia or virus in their lungs. Although rhesus monkeys share 93% DNA with humans, vaccine trials will not move forward until deemed safe for humans. CBS Evening News (5/15/2020)
Secondary prevention	Testing/screening	In a small Pennsylvania town, Dr. Ala Stanford traveled to impoverished neighborhoods screening residents for COVID-19 using PCR tests. Drive-thru booths were also set up to maximize testing in the town. ABC World News Tonight (4/29/2020)
Tertiary prevention	Disease management and treatment	President Trump invoked the Defense Production Act in order to combat the shortage of ventilators for hospitals. ABC World News Tonight (3/20/2020)
Non-prevention COVID-19	Cases and deaths	10,000 Americans died from coronavirus complications every 5 days over the month of April. Texas COVID cases surged 35% since the week before. NBC Nightly News (5/6/2020)
	Economy	The food chain became stressed due to the pandemic. Shortages were caused from hoarding and food supply workers contracting the virus. Additionally, farmers destroyed excess crops to avoid a food surplus. CBS Evening News (4/14/2020)
	Reopening	130,000 auto workers went back to work as the big-three car makers resumed production. Some employees believed they were back too soon while others believed it was a necessary risk. ABC World News Tonight (5/18/2020)
	Opposition to prevention	Spring breakers defy recommendations and flock to the beaches in Florida. CBS Evening News (3/18/2020
	Human-interest	A woman’s husband recovered from COVID-19 despite not receiving a plasma transplant. The wife stated that she feels blessed and lucky to still have him. NBC Nightly News (3/23/2020)
	Political “game” schema	Trump encouraged protestors against stay-at-home orders in states with democratic governors that he must win to gain re-election. Michigan’s governor said “it is better to be 6 feet apart right now than 6 feet under.” Hours later Trump sent a tweet that said “Liberate Michigan.” ABC World News Tonight (4/17/2020)
	Other COVID-19	Norah O’Donnell interviewed Dr. Vivek Murthy, who said we run the risk of becoming increasingly lonely with social distancing. He proposed we compensate with compassion and care for others. CBS Evening News (3/13/2020)
Non-COVID-19 coverage		The police officer charged with the murder of George Floyd was arrested. Floyd’s death ensued many protestors and a large police presence in the city of Minneapolis. NBC Nightly News (5/29/2020)

Data Collection

The principal investigator (Kamdar), who is trained in qualitative methods and is one of the researchers involved in the codebook development, trained two coders (Veldman and Budhwani) for data collection. The training consisted of the investigator reviewing the codebook with the coders. Then, the three co-coded three episodes from one network. The two coders and the investigator then independently coded one episode from each week of a network. They met weekly to review the coding for consistency. Discrepancies were discussed and recoded through consensus. Next, the two coders coded a random sample of 11 episodes across all networks (ABC = 4; CBS = 3; NBC = 4). Coding from these episodes was used to assess interrater reliability between the coders. The interrater reliability (intraclass correlation coefficient=0.986; 95% CI: 0.981–0.990) exceeded the a priori criteria of 0.80 for intraclass correlation.²⁴ The two coders then independently coded the remaining episodes. The coders continued to meet weekly to review their coding analyses with the principal investigator until coding was complete.

Data Analysis

We calculated the total time dedicated to each topic area in seconds per episode and normalized the coverage across episodes by dividing the time of coverage per topic area by the total number of seconds in an episode. These normalized measures allowed us to compare the proportions of coverage of the themes over time and across networks. We also reran each analysis on network-specific coverage as a sensitivity check for differences across networks. We also used the normalized average weekly reported new COVID-19 cases recorded by the COVID Tracking Project,²⁵ with the maximum average case count being scaled to 1, trended alongside the coverage of primary prevention, total prevention, and total COVID-19 coverage. All statistical analysis was done using Stata IC, Version 16.

RESULTS

Overall, from March to May 2020, most thematic content in the evening news was related to COVID-19; however, the content was not primarily focused on prevention. Table 2 shows the mean time per episode dedicated to coverage of the distinct thematic areas. Networks focused about 35% of COVID-19 coverage time on prevention issues (288 s) compared to 65% on non-prevention issues (538 s). The largest individual slice of categorical coverage consisted of human-interest stories (130 s). We found that the mean coverage time dedicated to non-COVID-19 coverage was dwarfed by a nearly 4:1 ratio by non-prevention COVID-19 coverage (538 to 146 s). As indicated in Table 2, non-COVID-19 coverage time roughly matched coverage time spent on primary and non-primary prevention issues.

Table 2.

Network Evening News Coverage (Mean Seconds of Coverage Time per Episode) by Thematic Categories

Broad thematic category	Specific topic area	Mean seconds coverage time per episode
Primary prevention	Cleaning	6.3
	Social distancing	89.1
	Masking	9.0
	Vaccine development	21.2
	Total:	125.6
Other prevention	Testing/screening	41.6
	Disease management and treatment	120.6
	Total:	162.4
Non-prevention COVID-19	Cases and deaths	76.8
	Economy	95.0
	Reopening	56.7
	Opposition to prevention	27.9
	Human-interest	129.8
	Political “game” schema	3.3
	Other COVID-19	148.9
	Total:	538.4
Non-COVID-19 coverage	Total:	146.3

Note: Totals may not add precisely due to rounding. Average times based on 117 weeknight episodes of the evening news split between the three major US networks between March 1 and May 30, 2020

The largest individual category in the areas of prevention was tertiary prevention (e.g., hospitalizations and treatments for COVID-19), specifically treatment (121 s/episode). Primary prevention coverage mostly focused on physical distancing (89 s). Reports on protests opposing prevention measures (e.g., protest in response to business closures) were approximately 28 s of coverage per episode, which is significantly less than time spent on prevention strategies.

Sensitivity analysis revealed no meaningful differences in coverage patterns across networks.

The stacked bar charts in Figures 1 and 2 highlight shifts in the overall percentage of coverage time across each week in our 3-month sample. Figure 1 shows the relative distribution of coverage of topics within the category of primary prevention. We found that prevention coverage emphasized social distancing across the entire period, and in mid-to-late April networks shifted their prevention coverage to a focus on vaccine trials. Figure 2 shows the percentage of coverage in a given week divided by the four broad categories: primary prevention, other prevention, other COVID-19 coverage, and non-COVID-19 coverage. The proportion of coverage dedicated to COVID-19 sharply increased in the first 2 weeks of March and decreased in the last 2 weeks of May. Figure 2 also demonstrates networks dedicated more time to non-prevention COVID-19 coverage than prevention coverage. This is consistent across nearly the entire timeframe, though total prevention coverage is elevated relative to non-prevention coverage for weeks 2–5 of our sample and somewhat declined in both relative and absolute percentage terms thereafter. Finally, primary prevention took on a larger relative percentage of prevention coverage for both the first 3 weeks and last 4 weeks of our study period, while secondary and tertiary prevention coverage dominated during the middle 6 weeks.

Fig. 1.

Percentage of weekly coverage time by topic, primary prevention coverage.

Fig. 2.

Percentage of weekly coverage by general categories.

Figure 3 plots the proportion of three measures of average weekly COVID-19 coverage (primary prevention, total prevention, and total COVID-19 coverage) against the normalized average weekly reported new COVID-19 cases. Results show the initial sharp surge of COVID-19 cases in the US in weeks 4–6 of our study period. This surge is preceded by a large increase in total proportion of the network evening newscasts dedicated to COVID-19 coverage in weeks 1–3 of our study. However, the proportion of coverage dedicated to any form of prevention only increased marginally in the weeks prior to and during the surge of infections, while the proportion of time dedicated to primary prevention remained relatively flat.

Fig. 3.

Weekly proportion of COVID-19 news coverage compared to weekly change in new COVID-19 cases. Normalized weekly total cases (with 1 being highest week) are plotted against proportion of weekly coverage dedicated to primary prevention, total prevention, and total COVID-19 coverage.

DISCUSSION

Although perhaps COVID-19 prevention messaging could have been more robust, network news consistently disseminated information on primary, secondary, and tertiary prevention. From March to May 2020, networks prioritized pandemic coverage and dedicated time to covering stories regarding prevention. As the US hit its peak in COVID-19 cases in the first surge between March and May 2020, entire news broadcasts were focused on the pandemic. Coverage proportions dedicated to COVID-19 ramped up quickly in the first 2 weeks of March as the virus infected large numbers of Americans and coverage slipped down in the last 2 weeks of May as the first US wave subsided. Although present, news coverage that focused on primary prevention, such as use of masks and physical distancing, was overshadowed by other types of COVID-19 coverage. It is unclear if more intentional messaging on primary prevention strategies would have impacted the pandemic’s course; however, behavioral science studies of health communication and behavior have shown that repeated exposure to health messaging is associated with improved outcomes.^9–13

Primary prevention had a larger percentage of prevention coverage for both the first 3 weeks and the last 4 weeks of our study period, while secondary and tertiary prevention dominated prevention coverage during the middle 6 weeks. Primary prevention coverage emphasized physical distancing across the entire period, especially at the beginning of the pandemic. As the initial surge leveled out during April, networks shifted their prevention coverage to vaccine research and clinical trials. Masking received minimal airtime related to other primary prevention topics, despite being an effective means in prevention of transmission.²⁶ This may be due in part to mixed messages from governmental sources on the effectiveness of masks, concerns about supply for frontline healthcare professionals,²⁷ or cultural barriers in which masking, for some, was interpreted as an invasion of personal rights.²⁸ Notably, coverage of prevention overshadowed time dedicated to those opposing prevention measures.

Despite consistent prevention coverage, networks focused nearly double the time on non-prevention issues, demonstrated by Figure 2’s patterns. Additionally, as noted in Figure 3, coverage of prevention messaging did not correspond to increases in cases. Of course, arguably other aspects of COVID-19 merited considerable coverage. For example, economic dislocation caused by the pandemic directly affected tens of millions of Americans in profound ways. Broadcast outlets also did not reduce pandemic coverage to the frame of who was benefitting or hurting politically as a result of the pandemic, despite happening in an election year. This finding matches previous research.²⁹

The largest individual slice of categorical coverage consisted of human-interest stories. Human-interest stories are a journalistic tool designed to captivate and engage the viewers.³⁰ While these stories, in addition to coverage of case counts, were not included in the categorization of prevention according to the prevention framework, this coverage may influence a viewer’s perception of the pandemic and in turn motivate them to take preventive action.^{10, 30} We found that coverage of the pandemic dominated the news during the study period, though the majority of coverage was not focused on primary prevention activities.

For prevention of future public health outbreaks, health professionals retain options to promote primary prevention in coordination with the news. State and federal agencies have a large apparatus devoted to working with media. Using this apparatus to pitch stories emphasizing primary prevention messages may shift coverage and accomplish an agency’s policy goals.³¹ Recognizing and adapting to media coverage patterns may maximize a media outreach strategy. Baum³⁴ has noted that making news stories more entertaining can educate individuals in foreign policy, which may provide a model to use the medias’ pattern of covering human-interest stories to promote public health. Another potential impactful strategy to reach news audiences, particularly the disproportionately vulnerable elderly audience, is to use governmental advertising campaigns during commercials. Scholars have documented effective campaigns advancing other health policy goals, like influencing consumers to purchase insurance under the Affordable Care Act.^{32, 33}

Maximizing the impact of these strategies requires a unified political and scientific front to magnify a shared message of prevention. Scientific unity reinforces simple messages that prevention measures work. Unity among policymakers may influence a more diverse audience to receive a given prevention message.³⁴ However, policymakers lacked unity during the early phases of the pandemic and scientists disagreed on the efficacy of masking for the general public, fearing both that the public would not be able to mask appropriately and that the public buying masks would endanger supplies for healthcare workers.²⁷ On the political side, political leaders polarized public opinion by casting doubt on the efficacy or necessity of prevention measures.³⁵ As a result, prevention messaging may have been undermined. Successful prevention interventions have shown that multilevel intervention aligning policy, communication, and dissemination components leads to optimal outcomes.³⁶ However, achieving this alignment is complex and requires combining evidence with participation and deliberation of stakeholders (e.g., health professionals, policymakers and leaders, network media, and feedback from the public) on the messaging.³⁷

Limitations/Strengths

This study has some limitations. The first limitation is it lacks generalizability to other media types and countries outside of US-based evening news programming. However, limiting the focus to three main broadcast news outlets allowed us to analyze historically non-partisan news that has broad reach, as compared to more partisan cable news outlets. Additionally, it was outside of the scope of this study to measure the impact of broadcast media messaging and dosing of the messages on preventive behavior adoption, and so we are unable to determine whether the coverage of prevention or non-prevention COVID-19 topics impacted the adoption of preventive actions. Future studies should include the analysis of the clarity and directiveness of media health messaging for behavior change. There is a need to examine the dosing of public health messaging and effective means of content delivery. As identified in the current study, the use of human-interest stories embedded with intentional public health messaging may be a viable possibility.

CONCLUSION

This is the first study to conduct content analysis and contextualize the data from network news outlets to understand trends in coverage on primary, secondary, and tertiary prevention strategies during the first wave of the COVID-19 pandemic. We found that despite including significant prevention coverage, most content was focused on other aspects of the pandemic. Given their broad reach and accessibility, broadcast networks could be an effective partner for healthcare and public health agencies to disseminate prevention strategies for current and future threats to public health.

Funding

This work was supported in part by the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX (#CIN 13-413).

Declarations

Disclaimer

The views expressed in this article are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs.