On Social Marketing and Social Change

Getting Social Marketing Wrong in Health Behavior and Health Education

2009-11-04T08:00:05-05:00

I often find myself asking “Where do people get these odd ideas about social marketing from?” You probably know some of them, such as –

Social marketing programs take a lot of time to plan.
Social marketing is expensive to do.
You have to do focus groups to do social marketing.
Social marketing segments audiences to deliver tailored messages to them.
Social marketing is consumer-driven.
Social marketing is about reducing the barriers and costs to engaging in healthier behaviors.
Social marketing is the application of commercial marketing principles and techniques for social change.
Social marketing is all about delivering benefits to a target audience.
Social marketing is a framework to identify what factors might drive and maintain behavior change.
Social marketing is a way to develop strategic communication campaigns.

And I imagine after reading some of these you might wonder “What’s so odd about this one?”

Well, to the first question first…

The key reason that people misunderstand social marketing is that most public health academicians do not understand it – though they write books and articles about it, teach it in classrooms and other settings, develop research proposals that are funded to evaluate it and consult to unsuspecting agencies about how to do it. As the acknowledged achievers of the summit of educational and intellectual prowess (they are, after all, ‘professors’ at universities and colleges), they have the credibility, recognition and prestige to be listened to, read and believed by many people. Unfortunately, as I saw again this week, when it comes to the topic of social marketing it is ‘consumer beware!’

I just finished reading the chapter on social marketing in the 4th edition of Health Behavior and Health Education edited by Karen Glanz, Barbara Rimer and K. Viswanath. This book is said to be, by C. Tracey Orleans of the Robert Wood Johnson Foundation, …the preeminent text and indispensable reference for our field…the first book we reach for to help us think about the foundations on which to design an intervention or research plan, inform a systematic evidence review, write or review an article or grant application, plan a course or presentation, and consult with other practitioners or researchers… (Foreword, p. XV). Quite an endorsement and I have no reason to suspect its validity. Indeed, all the more so to expect high quality and accurate work – something on the order of Wikipedia perhaps?

The chapter on social marketing is written by people I know. They are acknowledged health communication experts at the Center for Communication Programs at the Johns Hopkins University Bloomberg School of Public Health. And they approach the subject as health communication people, not as social marketers, to the point of labeling a key section as The Role of Social Marketing Within A Strategic Communication Framework. I have said before how editors and peer reviewers need to gently, or not so gently, correct authors of papers who use the term ‘social marketing’ to refer to an intervention that is clearly focused on only 1P – promotion or communication. In a textbook for the field, I wish the editors of this book had thought about that responsibility a little longer rather than summarize the chapter as ‘a fresh look at social marketing…[that] emphasize[s] how social marketing can be applied within a strategic communication framework' (p.513). Maybe then other editors and peer reviewers would have a clue as to what social marketing is when they reached for this ‘indispensable reference book.’

The shirking of responsibility is what irks me. The authors are certainly entitled to their view of social marketing as a tool that improves their strategic communication programs, but including it in a book as described by Tracey Orleans makes it obvious how and why social marketing becomes misunderstood among students, researchers and practitioners. It is the diffusion of a slanted perspective (OK, a different one) to an unsuspecting reader in the absence of anything resembling a true north – an approach similar to asking (and accepting) a Jungian to author a chapter on Freud’s theory for a book on personality theories for psychiatrists, an AIDS denialist to write a chapter about HIV prevention in southern Africa for health care professionals or an advertising person to write a marketing chapter for a graduate business text (or how about if Julia Child had written an Italian cookbook then?).

Let’s go to the quotes (and compare them to the list I started off with):

Not only is commercial marketing…a highly sophisticated and complex undertaking…it is also highly expensive (albeit not always successful; p.435). I call that classical conditioning – or guilt by association. Every time we link social marketing to commercial marketing principles and techniques – INSTEAD OF marketing principles – we do the same thing and undermine our credibility, perpetuate myths about planning and expense (despite what Reynolds Wrap is able to achieve on relatively small marketing budgets) and end-up in a conversation about lousy and deceptive marketing practices rather than creating more effective and efficient social change programs that deliver relevant and useful value to people’s lives. And do not think that ‘commercial’ marketers are not watching and learning from their nonprofit and public sector colleagues.

Careful reading of that last sentence shows the frame I prefer to use to talk about marketing practice: in the context of commercial (or private), public and nonprofit sectors [Note to the 5th P (politics) believers – it is the public sector context of many social marketing programs that drives the political aspects of them, not the people the programs are intended for]. This perspective then naturally leads to a larger discussion of whether the private sector can ‘do social marketing.’ My position is ‘of course’ – why not have a triple-win of social, personal and corporate (though I believe that the public sector and nonprofit/NGO sector agencies get some wins from success too)? See my post on Creative Capitalism to get a more in-depth look at some of the new thinking in this area.

After noting that debate over the definitions of social marketing will continue (p.437), the authors describe the five principles of social marketing as including (1) focusing on behavioral outcomes, (2) putting consumer’s benefits ahead of the ones of marketers, (3) maintaining an ecological perspective, (4) developing a strategic ‘marketing mix’ of communication elements according to the 4Ps and (5) using segmentation to identify how differences among consumers may affect their responses to the product or service being offered. While each of these deserve longer commentary, for here I will note:

1. Behavioral outcomes are important steps to achieving the population or social objectives, but social marketers do have larger and longer lasting goals in mind as well for which a social marketing framework is very useful.

2. Marketers’ benefits are no different than any other group of employees or professional service consultants who are hired to perform tasks and services for an organization; what they may have meant is that organizational goals are subservient to the ones of the audience – though I tend to disagree with this. I have not run across many funded projects where the donor has said “Whoops, we picked the wrong outcomes to focus on, clearly ones that are not priorities of the community. We need to go back and change them.” And fewer yet that fund an organization to do social marketing, or any type of intervention, with the mandate ‘discover what people are really passionate about changing and then work with them to do it!’ [If you have examples of these, I would really like to learn about them. Positive deviants are usually quite helpful in shifting the conversation.]

3. An ecological perspective is a theory-driven one. One principle that distinguishes the best social marketers, I believe, is an unrelenting understanding, empathy and advocacy of the perspective of our priority population or community that is not slanted by what the theory or research evidence does or does not tell us. Social marketers should get into debates with theorists and researchers – it is the latters’ reality versus the ones of people that will drive program design, delivery and evaluation (how do ‘we’ know it worked?).

4. A marketing mix has FOUR elements to create value for people. Not THREE (for the Easy, Fun and Popular crowd, which is also a theory) and certainly not ONE communication element. Period.

5. Segmentation is a bigger idea than determining a response to a product, service or behavioral offering. Market segmentation has become narrowly focused on the needs of advertising, which it serves mainly by populating commercials with characters that viewers can identify with – the marketing equivalent of central casting…The idea was to broaden the use of segmentation so that it could inform not just advertising but also product innovation, pricing, choice of distribution channels, and the like.

Again, I think the 4th point in particular continues to perpetuate the misunderstanding of the differences between marketing and communication. I understand that communication academicians want the whole world to see life as one long communication process and understandably then want to subsume marketing and everything else under its benign umbrella. However, that is only a POV. Others might suggest that life is just a series of exchanges, some of which are communications and others that involve products and services under different sets of circumstances (see the other 3Ps). And of course, biologists, mathematicians, economists and political theorists (to just name a few) have their own POV – as do Jungians, denialists, advertising executives and chefs.

As you can imagine, I have notes on every page of the chapter where I agree to disagree. But the final straw was when they introduced their cases for international and domestic (US) social marketing experiences by saying: In this section, we profile two health communication programs from a social marketing perspective. They might as well as used Freud.

And as for the second question, you could have seen it coming. Try going through the list of oddities now.

Reference

Storey JD, Saffitz GB and Rimon JG. Social marketing. In K Glanz, BK Rimer & K Viswanath (Eds). Health behavior and health education: Theory, practice and research. San Francisco:Jossey-Bass, 2008.

Social Models for Marketing: Building Communities

2009-10-20T10:09:00-04:00

For many years communities were inextricably linked with social marketing. Lefebvre & Flora (1988) laid out the defining features of the social marketing approach based on experiences they shared directing community interventions for cardiovascular disease reduction. Yet, even by the early 1990s, we can recall where social marketing and community development components of Health Canada could not find common ground for collaboration. As more practitioners appropriated social marketing as the basis for the development of ‘new’ health communication campaigns, the term became associated (and in some quarters still is) with mass media campaigns that segmented their audience, pretested materials and considered the 4Ps only in the context of communication planning, not marketing.

The differences in the social marketing approach became even more pronounced in the international community where social marketing became synonymous with the marketing of products for family planning, HIV prevention and malaria control while various other groups organized themselves around concepts such as behavior change communication, health communication, development communication and community mobilization to name a few. Responding to this fracturing of resources and talent, McKee (1991) wrote a book that he hoped would enhance the understanding of social mobilization, social marketing and community participation amongst communicators who sometimes set up unnecessary barriers between their various fields. Few seem to have heeded his call.

A hybrid approach developed independently in North America to reunite community with social marketing was coined as community-based social marketing (CBSM; McKenzie-Mohr, 2000). McKenzie-Mohr & Smith (1999) described CBSM as a process of identifying the barriers and benefits to engaging in behaviors and then organizing the public into groups with shared characteristic in order to more efficiently deliver program (p.3). Carol Bryant and colleagues at the Florida Prevention Research Center (2000) use the term ‘community-based prevention marketing’ to refer to programs with similar strategies that combine community participation with social marketing approaches.

The community-based approach as a context for implementing social marketing programs has much to commend it. Drawing from my experience and those of McKee (1992) these advantages include:

• Gaining community insight into problems and their support for proposed solution.

• Ensuring the use of indigenous knowledge and expertise.

• Mobilizing and employing local communication channels including local mass media and local social and interpersonal communication networks.

• Localizing distribution of products and services and improving access and opportunities to engage in new behaviors.

• Helping build sustainable solutions.

Engaging the community is not without its drawbacks too. McKee (1992) notes that community participation can also mean cursory consultation with the community rather than full engagement in a dialogue about problems AND solutions. Participation from the community may develop into a ‘participating elite’ who may, or may not, represent broader community viewpoints. Program planners can fail to recognize the opportunity costs for people who are approached to participate in the development and oversight of the program. Open participation also can lead to manipulation and conflict by and among different parties or stakeholders. And local agendas may not match those of the donor or lead agency. Finally, he also notes that to truly move from a social marketing ‘shell’ of a program to a community-driven one, there is a need for partnership development and to gain strong public advocacy and political commitment to create a culture in which to embed and support social goals. These are skills many social marketers are in need of learning.

The characteristics of effective community networks for social action have been found to include the following: common attributes, goals or governance; a diversity of connections; several paths exist between people and/or organizations within the network to work around possible disruptions or removal of them (e.g., being absent from meetings, moving away from the area); some nodes of the network are more prominent than others by being brokers, hubs or boundary spanners; and the majority of the linkages within the network tend to be short (or go through few other people and organizations) to minimize delays and distortions in communication or information flow (Krebs & Holley, 2006 pdf).

These authors highlight that to achieve this high level of functioning, networks must be actively managed, otherwise they tend to drift towards high levels of homogeneity (less diversity) and form closer and denser ties that are resistant to newcomers and new information. Network weaving is an essential step in identifying small fragments of networks that may be organized around similar issues or interests, but that do not relate with each other, and bringing them together into a larger network by facilitating their interactions with each other. These weavers often become the ‘hub’ for these disparate networks to move information from and to them in a more organized manner. In their experience, these ‘hub and spoke’ networks are quickly transitory with the aim of weaving the existing networks together so that they begin to directly interact with each other through boundary spanners and shared information and communication vehicles. As this occurs, the original network weaver moves on to bringing more networks into the new system and coordinating with and mentoring other network weavers or boundary spanners that emerge to encourage and support their ability to collaborate on meeting shared goals and objectives. As the network continues to mature and expand, the network weaver becomes more of a facilitator for network interactions and expansion and to focus on larger policy goals. Marketers who think of themselves as 'social' need to work on and hone their weaving skills.

I also believe that future social marketing efforts need to work from asset-based models of community development rather than ones solely based on mapping and addressing deficits or needs. Kretzmann & McKnight (1993) list several arguments against relying on needs assessments and mapping in community projects including:

•    It provides a nearly endless list of problems and needs that leads to a fragmentation of efforts to provide solutions.
•    Targeting resources based on a needs assessment directs funding not to residents but to service providers, a consequence not always either planned for or effective.
•    Making resources available on the basis of the needs map can have negative effects on the nature of local community leadership by forcing them to highlight their problems and deficiencies, and ignoring their capacities and strengths.
•    Providing resources on the basis of the needs map underlines the perception that only outside experts can provide real help.

These authors argue that a needs based strategy will inevitably focus on community survival rather than shift to serious change or community development. As an alternative approach, they propose an ‘asset-based community development’ approach that involves three interrelated characteristics:

•    The strategy starts with what is present in the community, the capacities of its residents and workers, the associational and institutional base of the area - not with what is absent, or with what is problematic, or with what the community needs.
•    The development strategy concentrates on the agenda building and problem-solving capacities of local residents, local associations and local institutions to stress the primacy of local definition, investment, creativity, hope and control.
•    Implementation of the resulting strategy will be relationship driven. Thus, one of the central challenges for asset-based community developers is to constantly build and rebuild the relationships between and among local residents, local associations and local institutions.

This look at the asset-based model is intended to reinforce for social marketers, particularly those who work in resource constrained contexts and with disadvantaged populations, the need to view their work in communities as needing to expand to working with communities. Through these programs, community strengths and competencies should receive at least equal attention in marketing plans as do needs and barriers. Indeed, one of the potential unintended effects of well-done community-based programs could be that they result in lowered social capital, self- and collective efficacy and increasing dependency among citizens. An asset-based approach also reinforces two core values of the social marketing approach: the audience orientation and the engagement of people in the process rather than only treating them as passive consumers of messages and programs.

Social marketers who venture into the real-life world of community-building should also be attentive to what is being learned by people involved with online community-building (and vice versa). How to encourage and guide people into moving from spectators to actors to leaders (see Preece and Shneiderman, 2009 for examples), and increasing their level of engagement with problems and solutions, is common ground on which to build conversations with our social media marketing colleagues.

References

Bryant, C.A., Forthofer, M.S., McCormack Brown, K.R., Landis, D.C. and McDermott, R.J. (2000) Community-based prevention marketing: The next steps In disseminating behavior change. American Journal of Health Behavior, 24: 61-68.

Kretzmann, J.P. and McKnight, J.L. (1993) Building Communities from the Inside Out: A Path Toward Finding and Mobilizing a Community's Assets. Evanston, IL: Institute for Policy Research.

Lefebvre, R.C. and Flora, J.A. (1988) Social marketing and public health intervention. Health Education Quarterly, 15: 299–315

McKee, N. (1992) Social Mobilization & Social Marketing in Developing Communities: Lessons for Communicators. Panang, Malaysia: Southbound.

McKenzie-Mohr, D. (2000) Fostering sustainable behavior through community-based social marketing. American Psychologist, 55: 531-537.

McKenzie-Mohr, D. and Smith, W. (1999) Fostering Sustainable Behavior: An Introduction to Community-Based Social Marketing. Washington, DC: Academy for Educational Development & Gabriola Island, BC, Canada: New Society Publishers.

Preece J. and Shneiderman B. (2009). The reader-to-leader framework: Motivating technology-mediated social participation. AIS Transactions on Human-Computer Interaction;1:13-32

Social Models for Marketing: Social Networks

2009-10-15T08:29:24-04:00

Over the past decade there has been a dramatic shift in the emphasis of determinants of health and social behaviors from individuals to networks and communities. For example, in three major areas of interest for public health officials and social marketers – the prevention of HIV infection, obesity and tobacco use – the role of social networks in disease transmission and the prevalence of risk behaviors is creating new opportunities for both concepts and practices that focus on social units of analysis, change and outcome.

Concurrent sexual partnerships, that is, having two or more stable sexual partners over time is being seen as one of the previously hidden drivers of the HIV epidemic. Concurrency, especially when the partners are sexually active with others in a small world network (see below), heightens the risk of HIV transmission because these relationships are not casual or one-off sexual encounters, but are maintained over time where a level of trust develops that diminishes their perceived riskiness. Thus, when one partner becomes infected, they are highly likely to have sex with one or more other partners during the window of greatest HIV infectivity. Developing interventions to address the network effects of sexual activity are only just beginning.

Similarly, the work of Christakis & Fowler (2007, 2008) provides descriptive evidence that the likelihood of becoming obese rises as close members of one’s social network become overweight and obese and that stopping smoking is also highly susceptible to the smoking status of others. Again, the implications for interventions are only now being explored. However, it is clear that simply focusing on individual and/or environmental determinants of these conditions can no longer be a singular pursuit for social marketing or any other type of risk reduction programs.

The world of social network theory introduces us to an entirely new set of concepts and ways of thinking about human behavior and the social forces that directly influence it. Goyal, for example, posits that individual choices related to the gathering of information for making behavioral choices are shaped by the pattern of connections between people in a society. Three core network properties he discusses are (1) degrees or how many links each member in a network has with others; (2) clustering – how dense the connections between members of a network are; and (3) average distances or how far away from one another each person in a network is from another in terms of the number of links necessary to reach them (popularized as “6 degrees of separation” or “the Kevin Bacon game”). A network that is characterized with small average degrees (everyone has at least a few connections with others), high clustering (they mostly connect with others in the network), and small average distances (there are few degrees of separation between them so that most people know or are at least acquainted with most of the others) are referred to as small world networks (Watts and Strogatz, 1998). Recall that these closed networks are less likely to adopt innovations or new evidence-based recommendations (a new take on ‘the old boys network’).

One of the implications of this work with social networks is that people learn about and choose among behavioral options not only based on directly observing others in their social circle engage in behaviors and the consequences they experience, but also by whom their friends and associates connect with outside that proximal network and then bring that information or those practices back to the immediate network. Goyal (20070 concludes from his review of empirical work in economics and social networks that variations in behaviors among individuals are related to not only the connections people have within the same social group, but also from their being members of different groups as well. The implications for social marketers seem clear; who people associate with, or are connected to, must be considered and addressed by intervention efforts. These network variables, in turn, might also serve as intervention points by, for instance:

1. focusing on people with large numbers of connections within a network (connectors, influentials, or opinion leaders);

2. reducing the density of a network in which risk behaviors are concentrated by introducing more boundary spanners or increasing social connections of members of the group outside of their immediate network;

3. understanding the members of a network who are most attentive and responsive to the behaviors of others (or more easily influenced or persuadable) and providing them with protective or alternative behaviors to prevent adoption;

4. and enhancing the salience and attractiveness of the ‘out group’ [positive deviants] by positioning these practitioners of desired behaviors in a way that attracts imitation or modeling.

Social network analysis must also be sensitive to information asymmetries that will exist among individuals within a group as well as between groups. Viswanath and Kreuter point to the existence of communication inequalities as possibly underlying many of the social inequalities we see in health risks and conditions. These communication inequalities are manifested as differences among social classes in the generation, manipulation, and distribution of information at the group level and differences in access to and ability to take advantage of information at the individual level. As a consequence, communication inequalities may act as a significant deterrent to obtaining and processing information; in using the information to make prevention, treatment and survivorship-related decisions; and in establishing relationships with providers.

Social networks have also played a major role in the development of the so-called Web 2.0 in which collaborative and dynamic models of communication underlie the philosophy, software development and user behaviors. The ubiquity and popularity of blogs and microblogs, social network sites, social sharing sites, wikis and virtual worlds have made the network connections among people more obvious. And, more importantly, these social media have unleashed a set of tools and resources that allow the people formerly known as the audience to create content for themselves and to tap into pools of collective wisdom. Social marketing programs must adapt to be both relevant to people’s (new) lives and to harness this collective wisdom and power for social change.

Similarly, the explosion in the adoption of wireless communication technologies, notably mobile telephones and smart phones, are enabling communications that transcend place-based methods (‘we call to individuals, not places’; Ling, 2008) and are further driving home the idea that people are communities, not individuals (Ahonen & Moore, 2005). As I have said elsewhere, while we have always been aware that there are social influences for many of the individual behaviors we seek to influence for environmental protection and the improvement of public health and social conditions, social technologies are changing the weights we use in our models of determinants of behavior and the ways in which we approach changing them. Given all of this, in the future let’s consider the consequences and implications of adopting a social networking perspective into our work as social marketers:

• How can we enhance linkages that already exist among people, organizations, and communities to allow them to access, exchange, utilize, and leverage the knowledge and resources of the others?

• How do we help develop, nurture, and sustain new types of linkages that bring together like-minded people, mission-focused organizations, and communities that share interests to address common problems and achieve positive health and social change?

• How do we identify, encourage and enable the many different types of indigenous helpers that are found in social networks so that they can be more effective in promoting positive health, environmental and social behaviors and policies?

• What do we do to better engage communities in monitoring, problem analysis, and problem solving; striving to health and social equity; and increasing social capital?

• How do we go about weaving together existing social networks of individuals, organizations and communities to create new sources of power and inspiration to address health and social issues?

• How does a networked view of the world disrupt our usual ways of thinking about and engaging the people, organizations, and communities with which we usually work? What are the insights we can gain from this perspective?

Clearly we need to dig much deeper into social netwrok theory to understand the dynamics of diffusion and change of various types of health behaviors. More importantly, we need to develop and test programs for which change among social networks and connections are a primary focus of our efforts. Where information and communication technologies may evolve to in the next few years is an open question. But blending social media tools and mobile technologies with social marketing to capitalize on and impact social networks is also an area for further exploration in achieving scalable results for networks of healthy people.

References

Adimora, A.A., Schoenbach, V.J. and Doherty I.A. (2007). Concurrent sexual partnerships among men in the United States. American Journal of Public Health, 97: 2230-2237.

Ahonen, T.T. and Moore, A. (2005). Communities Dominate Brands. London, UK: futuretext.

Christakis, N.A. and Fowler, J.H. (2007). The spread of obesity in a large social network over 32 years. The New England Journal of Medicine, 357: 370-379.

Christakis, N.A. and Fowler, J.H. (2008). The collective dynamics of smoking in a large social network. The New England Journal of Medicine, 358: 2249-2258.

Goyal, S. (2007) Connections: An Introduction to the Economics of Networks. Princeton, NJ: Princeton University Press.

Helleringer, S., Kohler, H-P. (2007). Sexual network structure and the spread of HIV in
Africa: evidence from Likoma Island, Malawi,. AIDS, 21: 2323–2332.

Lefebvre, R.C. (2007). The new technology: The consumer as participant rather than target audience. Social Marketing Quarterly, 13: 31-42.

Ling, R. (2008). New Tech, New Ties: How Mobile Communication is Reshaping Social Cohesion. Cambridge, MA: The MIT Press.

Mah, T.L. and Halperin, D.T. (2008). Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward. AIDS and Behavior. Published online: 22 July 2008. [Cited 5 March 2009].

Viswanath, K. and Kreuter, M.W. (2007). Health disparities, communication inequalities, and e-Health: A commentary. American Journal of Preventive Medicine, 32(5 Suppl): S131–S133.

Watts, D.J. and Strogatz, S.H. (1998). Collective dynamics of ‘small-world’ networks,. Nature, 393 (June): 440-442.

Watts, D.J. (2003). Six Degrees: The Science of a Connected Age. New York: W.W. Norton & Company.

Social Models for Marketing: Diffusion

2009-10-12T18:13:43-04:00

Among the most data-driven models for behavior change, particularly at scale or on a population-basis, is Rogers' diffusion of innovations. When I reviewed the most popular theories and models then being used in social marketing programs, I added that Diffusion of innovations research and concepts offer a tremendous amount of insight for social marketers to use in designing their programs, yet we see very little active discussion of it in social marketing circles. Social diffusion offers one of the most robust theories for taking innovations in ideas, behaviors and practice to scale. Yet, though the calls for scaling up successful behavioral interventions for such things as HIV prevention are reverberating around the globe, we see little discussion or application of the model by social marketers or, for that matter, few others in public health.

Social marketing needs to focus on ‘pushing the curve’ of adoption of health practices among individuals, the adoption of effective interventions among practitioners, and the adoption of health-promoting and supportive policies among policy-makers. Adopting diffusion of innovations means that we understand how and why people adopt (or fail to adopt) healthier, environmentally conscious or socially beneficial behaviors. These characteristics include (a) the contextual factors that surround the adoption of new practices and policies, (b) people’s perceptions of the innovation as a normative behavior among their reference group or peers (which studies suggest account for anywhere from 50-86% of the variance in the rate of diffusion of new behaviors), and (c) a risk-benefit analysis that substitutes certainty of outcomes and familiarity with the new behavior over costs and benefits of changing current ones.

Social marketers need to design their behavior, product and service offerings to answer the questions people have that are associated with adoption or termination:

How is this better than what I currently do? ·

How is it relevant to the way I go about my everyday life? ·

Is it simple enough for me to do?·

Can I try it first?

Can I watch others and see what happens to them when they do it?

Social marketing for behavior change at scale also needs to explore more extensively the use of audience segments such as:

Innovators: who have a high tolerance of risk; are fascinated with novelty; usually viewed by others in their community as mavericks, not opinion leaders; and whose social networks transcend geographic boundaries.

Early Adopters: who are the community opinion leaders and well-connected socially and locally; have the resources and risk tolerance to try new things; and are the people who are watched by others – and they know it.

Early Majority: the people who are very engaged in local peer networks; rely on personal familiarity before adoption and continually ask the question ‘How does this new behavior, product or service help me?’

Late Majority: the group of people who are most sensitive to peer pressure and norms, yet very cautious about change of any kind; they seek to minimize uncertainty of outcomes and want to see the proof of relative advantage locally – not read about it on web sites or see it on television.

Laggards: these are the traditionalists who believe in the tried and true; they are near isolates in their social networks which explains why they can be so difficult to reach and influence (versus having individual deficits); they are often suspicious of innovation and change agents; and they are seeking assurances that adoption of new behaviors (such as stopping smoking, driving a low carbon emission vehicle) will not fail.

The diffusion of innovations literature should also wake-up policy-makers and social marketers that there are immediate needs to apply marketing principles to such social goals such as improving evidence-based practices in public health and medicine. Maibach, Van Duyn & Bloodgood (2006) suggest three marketing-based solutions: (1) conduct consumer research with prospective adopters to identify their perspectives on how evidence-based prevention programs can advance their organization’s mission, (2) build sustainable distribution channels to promote and deliver evidence-based programs to prospective adopters, and (3) improve access to easily implemented programs that are consistent with evidence-based guidelines.

There are lessons we have learned over the years that can be used to re-conceptualize social marketing strategy to promote diffusion of product and service use as well as adoption of new behaviors.

1. Find sound innovations/solutions. Ones that meet the criteria noted earlier and are relevant to people’s everyday lives.

2. Provide opportunities for Innovators to discover them.

3. Engage the curiosity of the Early Adopters.

4. Target the weak ties between Innovators and Early Adopters through identifying the ‘boundary spanners’ who interact with multiple networks.

5. Promote the work of Early Adopters.

6. Create spanable social distances between groups through various means including using social media such as social network sites and blogs and convening meetings of the ‘unlike’ rather than the usual host of agents.

7. Enhance the salience and attractiveness of the ‘positive deviants’ – the people who are already practicing the target behavior or using the product and service; put the practitioners of ‘new’ behaviors in contexts and situations that attracts imitation or modeling.

8. ‘If you can’t imitate them, don’t copy them.’ Expect and encourage reinvention.

9. Support time and energy for discovery, testing, networking, adapting, monitoring and preserving the past. Do not write off the traditionalists, especially when encouraging organizational change.

10. It starts with yourselves and your partners.

With respect to this last point, remember that highly linked and centralized coalitions are less likely to adopt new evidence-based public health programs than ones that are less dense and have more decentralized structures. What is important for adopting new practices and programs are 'boundary spanners' or individuals from organizations who are not tightly bound exclusively to the clique (or usual cast of characters). These are the people more likely to be open to innovation; the traditionalists have their own, seemingly immutable, point-of-view.

Our challenge in the years ahead, whether it is in HIV prevention or the prevention of childhood obesity, is to apply in a deliberate and systematic way what we have learned from the evidence-base of diffusion research to achieve broad and sustainable change. It seems that very few policy-makers, behavioral change experts and public health officials know how to transform programs focused on individual behavior change to ones scaled for population impact. And few program directors and donors seem willing to take the risk that is inherent in moving from ‘the zoo’ of controlled experiments to ‘the jungle’ of people’s real lives. Social marketing provides us with a framework to fill this gap between knowledge and practice.

References

Global HIV Prevention Working Group. (2007) Bringing HIV prevention to Scale: An urgent global priority.

Lefebvre, R.C. (2001). Theories and models in social marketing. In P.N. Bloom and G.T. Gundlach (eds), Handbook of Marketing and Society. Newbury Park, CA: Sage Publications, pp. 506-518.

Maibach, E.W., Van Duyn, M.A. and Bloodgood, B. (2006). A marketing perspective on disseminating evidence-based approaches to disease prevention and health promotion. Preventing Chronic Disease [serial online] July.

Rogers, E. (1995). Diffusion of Innovations (4^th Ed). New York: The Free Press.

Valente, T.W., Chou, C.P. and Pentz, M.A. (2007). Community coalition networks as systems: Effects of network change on adoption of evidence-based prevention. American Journal of Public Health, 97: 880-886.

Phillip Kotler on Marketing 3.0

2009-10-11T15:19:54-04:00

Late last week, Guy Kawasaki was all-atwitter (and otherwise) with Phil Kotler's description of Marketing 3.0. He even included a picture of the slide Phil used. If you are like me and found Guy's shot a little hard to read, here's the original and a brief comment about it from the marketing guru himself.

My colleagues and I believe that Mktg 1.0 represented an effort to establish the superior performance of a product ("Tide cleans better," "Volvo is safety,") In Mktg 2.0, marketing added an emotional dimension to strengthen its appeal to prospective customers. We are entering Mktg 3.0 where marketers are adding a human spirit dimension. Mktg 1.0 and 2.0 is how about a product or offering will serve you. Mktg 3.0 is how a product and its company are sensitive to social and economic issues that are a concern to everyone. Companies that conduct themselves ecologically and create real value that aligns with the social good will be competitively favored. The new media will increasingly carry more favorable statements about "caring" companies" and this will influence the buying choices of more consumers.

My thanks to Phil for the slide and the comment. There will be more to come in Philip Kotler, Hermawan Kartajaya and Iwan Setiawan, Mktg 3.0: From Products to Customers to the Human Spirit to be published by John Wiley in April 2010.

Social Models for Marketing: An Overview

2009-10-07T12:58:32-04:00

At a Social Marketing in Public Health conference 10 years ago, I did a session on Putting the ‘Social’ Back Into Social Marketing. I was concerned that social marketing theory and practice were being turned into another approach to individual behavior change. Indeed, despite early calls for social marketing to be concerned with social and population-based change by Kotler & Zaltman (1971-pdf), Lefebvre & Flora (1988-pdf) and Walsh, Rudd, Moeykens & Moloney (1993-pdf), many definitions of social marketing that emerged over the next two decades promoted a variation of the theme ‘individual behavior change for the common good’ (cf, Andreasen, 1995; Kotler & Lee, 2008; Siegel & Lotenberg, 2007). My session looked at how models of community asset development, political economics and social and anthropological theories provided us with a richer understanding of the social dynamics underlying health and how these approaches could improve the development of social marketing programs. That many so-called social marketing programs then (and now) were little more than persuasive messages delivered as ‘health communication’ is a testimony to the power of theory, and the lack of it, to constrain and limit our effectiveness.

More recently, Gerard Hastings (2007) has embraced the notion of social marketing as a way to enhance social goals and also to analyze the social consequences of marketing policies, decisions and activities. Similarly, Donovan & Henley (2003) take issue with the prevailing individually-focused definitions and call for a focus on social determinants seeing ‘the primary future goal of social marketing as achieving changes in these social determinants of health and well-being’ (p. 6). For the next few days, I am going to explore how to incorporate more social perspectives into social marketing. The social models I believe are important to the vibrancy and success of social marketing include social diffusion, social networks, social determinants, social capital, building communities and social franchising. In the end will look to how social marketing can become an important lever in the arena of social policy development and implementation – although if you can’t wait, you can always go to this earlier post I did on the subject.

Feel free to jump in at any time.

References

Andreasen, A.R. (1995) Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the Environment. San Francisco: Jossey-Bass.

Donovan, R. and Henley, N. (2003) Social Marketing: Principles & Practice. Melbourne, Australia: IP Communications.

Hastings, G. (2007) Social Marketing: Why Should the Devil Have All the Best Tunes? Oxford, England: Elsevier.

Kotler, P. and Lee, N.R. (2008) Social Marketing: Influencing Behaviors for Good (3rd Ed). Thousand Oaks, CA: Sage.

Kotler, P. and Zaltman, G. (1971) Social marketing: An approach to planned social change. Journal of Marketing, 35:3-12.

Lefebvre,R.C. and Flora, J.A. (1988) Social marketing and public health intervention. Health Education Quarterly, 15:299–315.

Siegel, M. and Lotenberg, L.D. (2007) Marketing Public Health: Strategies to Promote Social Change (2nd Ed.). Sudbury, MA: Jones and Bartlett Publishers.

Walsh, D.C., Rudd, R.E., Moeykens, B.A. and Moloney, T.W. (1993). Social marketing for public health. Health Affairs, 12:104-119.

The Seven Rules of Projects

2009-10-02T09:02:09-04:00

Most social markers and change agents work on projects – perhaps the least useful way to generate passion, commitment and results. Matthew May writes about The Seven Laws of Projects, and How to Break Them. Worth a close look.

1. A major project is never completed on time, within budget, or with the original team, and it never does exactly what it was supposed to.

2. Projects progress quickly until they become 85% complete. Then they remain 85% complete forever. Think of this as the Home Improvement Law.

3. When things appear to be going well, you’ve overlooked something. When things can’t get worse, they will. (Murphy’s Law says, “If something can go wrong, it will”—this is a corollary).

4. Project teams hate weekly progress reports because they so vividly manifest the lack of progress.

5. A carelessly planned project will take three times longer to complete than expected. A carefully planned project will only take twice as long as expected. Also, ten estimators will estimate the same work in ten different ways. And one estimator will estimate ten different ways at ten different times.

6. The greater the project’s technical complexity, the less you need a technician to manage it.

7. If you have too few people on a project, they can’t solve the problems. If you have too many, they create more problems than they can solve.

OK, now that you know them – breaking them is the courageous next step. When has this worked for you?

The 4Ps of Demarketing Tobacco Use

2009-09-28T13:53:05-04:00

Demarketing as a strategy for social marketers is a popular, but unknown or poorly understood part of social marketing practice. Those are my initial conclusions from the feedback and hits from the recent post, Demarketing Sugar Consumption in Drinks. Popular in that many people are obviously interested in the topic; unknown or misunderstood either because people tell me they have never heard the term before, or thought 'it had something to do with counter-advertising.'

I have talked about how such strategies were employed to frame tobacco control in the NCI ASSIST study [Social Marketing and Tobacco Control Policy], and I noted in the Demarketing Sugar post that demarketing tobacco was studied recently by Edward Shiu and his colleagues. Because of the curiosity in demarketing approaches, here is a synopsis from their article to broaden your perspective on this social marketing strategy and how it intersects with many public policy approaches to the topic.

In a social marketing context, they define demarketing as having the objective to decrease demand by discouraging consumption or use of products such as alcohol and cigarettes that pose health risks. They note that while governments use various demarketing strategies and instruments independently to curb smoking (increasing taxes, clean indoor regulations, banning advertising), little research is available on how the 4Ps work in conjunction with each toward reducing tobacco use and how they influence consumer behavior over time.

This chart by the authors shows how traditional marketing and demarketing approaches to tobacco can be thought about. Working through the 4Ps, product is framed as product replacement and displacement – most often by offering free or low-cost replacement products (e.g., nicotine replacement therapies) as well as support services (e.g., telephone quit-line and other information services). Increasing taxes and therefore the sales price primarily realigns the price variable. They view place interventions as restricting tobacco consumption opportunities through such instruments as bans on smoking on public transportation and clean-air policies in public places. Promotion interventions are most familiar to readers who lean towards communication approaches to the issue: implementing counter-advertising campaigns, mandatory package warning labels and restrictions on tobacco advertising.

To summarize their overall approach, the authors write:

Conceptualizing the 4Ps from a consumer perspective and linking them to consumer intention via attitudinal mediators is novel and contributes to the literature. Modeling governmental demarketing from a consumer perspective allows one to determine the impact of this government approach not only on consumers' intention to cease consumption, but also on consumer attitudes both toward consuming the product and toward companies that promote and sell these products.

They then go on to develop and test a model of demarketing using data from the International Tobacco Control Four Country Survey (http://www.itcproject.org) – a nationally representative, longitudinal panel survey of adult smokers that was designed to evaluate whether and how a number of key government policy initiatives led to reductions in tobacco consumption. The authors used structural equation modeling to test the hypothesized relationships among policy initiatives aimed at each of the 4Ps, attitudes towards smoking, attitudes towards the tobacco industry, and intentions to quit smoking at two points in time.

The results show that the two attitudinal variables only partially mediated the effects of each of the 4Ps on intention to quit. In each case, the direct effect of each demarketing element on intention is significant over and above the effects of the mediators in the hierarchical regression. The only exceptions to a number of hypotheses about the effects of demarketing strategies on attitudes and intentions were:

1. The demarketing element of product does not affect their attitude toward smoking nor their intention to quit (they suggest that many smokers are already familiar with many of these quit smoking products and services and have already been unsuccessful in using them to quit themselves).

2. Price does negatively affect their attitude toward the tobacco industry (respondents attribute price increases to the industry, not government taxation policies, is their assumption to explain this).

3. The demarketing element place does not affect their attitude toward smoking.

Their results demonstrated that governmental demarketing activities during 2002 and 2003 in the U.S. have resulted in significant beneficial changes in smokers' attitude toward smoking and their intention to quit. They conclude:

This study demonstrates the differential effect of the 4Ps of demarketing and the central significance of promotion and price, which are the only demarketing mix elements that influence all three outcome variables, attitude toward the tobacco industry, attitude toward smoking, and intention to quit smoking. At the same time, the empirical evidence from this study shows that the demarketing mix element product, in terms of product replacement and displacement through the promotion of NRT [nicotine replacement therapies] and behavioral support programs, is less effective in terms of changing smokers' attitude toward smoking and intention to quit smoking. Lastly, smoking restrictions at work and in public places do not influence attitude but have a small direct effect on intention to quit.

Two lessons the researchers draw for social marketers are:

1. Social marketers and consumer-policy makers cannot assume individual demarketing measures will be effective in changing the attitudes and behavior of the priority audience. Rather, a comprehensive demarketing mix aimed at decreasing the attractiveness of tobacco and impeding the availability and consumability of cigarettes is needed to result in measurable changes.

2. Ad hoc and one-off demarketing measures are unlikely to have the desired effect. The results show an effect over time of the 4Ps of demarketing, suggesting that governments should equip anti-smoking campaigns with sufficient and sustained demarketing resources.

SO when you consider 'upstream social marketing,' think demarketing and all 4Ps.

Reference: Shiu E, Hassan LM & Walsh G. (2009) Demarketing tobacco through governmental policies – The 4Ps revisited. Journal of Business Research; 62:269–278

Free Copy of 'Obama's Wired Campaign'

2009-09-24T18:55:14-04:00

I am delighted to note that the article, Obama’s Wired Campaign: Lessons for Public Health Communication, I co-authored with my colleague Lorien Abroms at the GWU-SPHHS Program in Public Health Communication & Marketing, is a FREE selection in the current issue of Journal of Health Communication.

ABSTRACT: The Obama campaign has relevance for how we conduct and build communities around our public health campaigns. As such, an understanding of how new media was used in energizing the public in the Obama campaign is worthy of reflection. The Obama campaign’s use of new media can be grouped into those applications related to: 1) the campaign website, 2) the campaign TV channel, 3) social networking sites, and 4) mobile phones. The authors also briefly describe 5) the campaign materials created by supporters which made use of new media, as these also contributed the campaign. The authors briefly describe each of these and, where available, provide indicators of use by the public. Then, through the lens of public health communication principles, the authors discuss what seems to have been effective about their efforts, and how public health campaigns can make use of similar strategies in the future. [Journal of Health Communication, 14:415–423, 2009]

Download the pdf here. And thank you Scott and Routledge!

Frieden: Behavior Change Follows Policy Change

2009-09-23T23:06:09-04:00

What changes and priorities can we expect at the Centers for Disease Control and Prevention? The new Director of CDC, Dr. Thomas Frieden, spoke to these and other questions raised by the audience at a forum convened by the CDC Foundation Wednesday afternoon in Washington, DC.

His prepared remarks were rooted in ‘partnerships’ – the necessity for them and the need to strengthen them at the local, state, national and global levels. The bookends were the theme of ‘public health achieves its greatest triumphs when we remember the faces behind the numbers.’ More on that later.

Dr. Frieden identified 5 ‘areas for improvement’ at CDC; these included (1) enhancing surveillance and epidemiology, (2) strengthening local and state support functions at CDC, (3) strengthening public health institutions across the globe, (4) increasing the impact of health policies (noting that there was more prevention that could be done through policy), and (5) addressing the leading causes of disabilities, diseases and death. He did field a number of questions from the audience including H1N1 preparedness, and – this being DC - health reform and what he saw as the opportunities to incorporate public health into it (and various elaborations on that theme).

What I found curious in his responses was his constant reference to tobacco control initiatives (not that surprising as he was one of the forces behind the Bloomberg Family Foundation's Global Tobacco Control Project), and to the number of people with uncontrolled high blood pressure and high blood cholesterol levels where better medical treatment could reduce unnecessary deaths. Someone finally asked him what he thought the 3 major initiatives for improving public health were and, after the caveat of how leaving something out will wind up making 500 new enemies, he suggested two: global tobacco control and nutrition policy. The third he (wisely) left open for future developments.

I then had to comment that up to that point in time (about 40 minutes) the word ‘behavior’ had yet to be uttered by him. I also reflected that all the preventive strategies to incorporate into health reform he presented were medical ones (including EHRs) - the word medicalize even came out of my mouth. Yet, I suggested, what lies between data and faces are many different behaviors by people on the street, patients, health care providers, legislators and public health professionals. What are his views on the importance of behavior research and behavioral interventions at CDC, including communication and marketing programs? After a few minutes of talking about something else (and I learned after years In DC to tune that out), he finally came back to the question and said: My view is that behavior change follows policy change. Period. Nothing about behavioral research, forget about risk behavior change, no other determinants… elegantly – simple?

It will be interesting to see what now happens at CDC as it reorganizes and staff begin to shift their focus (some views compiled by Kaiser Health News). I have written before about how one’s theory shapes everything from how you frame a problem to how you research and address it, the outcomes you desire and what you consider success. How this theoretical (ideological?) perspective is translated into $373 million of cooperative agreements for putting prevention to work will begin to give us a sense of where this may be heading.

Hispanic Population Groups and Wireless Boradband Access

2009-09-23T11:42:18-04:00

A new report by The Hispanic Institute and Mobile Future, "Hispanic Broadband Access: Making the Most of the Mobile, Connected Future," [pdf] demonstrates the pervasiveness of wireless broadband services in their daily lives.

Highlights of the report include:

1. While Hispanics trail other U.S. populations in overall Internet access, they are among the most avid users of mobile broadband. In fact, Hispanics and African Americans lead mobile broadband use (53% and 58% respectively), with both communities far ahead of Whites (33%).

2. Hispanics are more mobile than the general U.S. population and, thus, rely more on cell phones. In fact, compared to Americans generally, Hispanics account for more minutes used and for a higher percentage of cell-phone ownership despite their relatively low incomes.

3. Given that roughly 40% of U.S. Hispanics are born abroad, in countries where wireless service often is more common than landline phones, the American Hispanic community is more open to mobile broadband than many other population groups. This familiarity makes the leap to smartphones and other connected mobile devices a more intuitive step for many than turning to wired, home broadband adoption and computer usage.

4. In 2008, Hispanics outpaced the general population in accessing and downloading digital media (music, video, audio, movies, television programs, video games and podcasts), 42% to 35%.

At the talks I do about social and mobile media, most public health people are stunned to learn that Hispanics are such avid mobile users. Indeed, the first objection to using mobile and SNS is that 'they will not reach my population.' As I say then, and here again, get your preconceptions behind you. Hard-to-reach is a source-driven construct, not an audience-driven one.

International Social Marketing Developments

2009-09-21T10:28:18-04:00

Our latest milestone of raising money to support the development of a global social marketing association was a success. A VERY SPECIAL THANK-YOU to each of you who made a pledge, and the organizations that did so as well – including Academy for Educational Development, American Social Marketing Association, Center of Excellence for Public Sector Marketing, Envision Solutions, George Washington University, Kirby Marketing Solutions, McKenzie-Mohr & Associates, Ogilvy Public Relations Worldwide, Population Services International, Salter Mitchell, Worldways Social Marketing! And in case you did not hear about the fund-raising effort and would like to make one now, please continue reading.

In response to a number of requests, we now have a PayPal account established so you can send in your pledges and new contributions more easily. Please do this as soon as possible so we can proceed with our planning and budgeting for organizing activities between now and next June. You can directly access our PayPal account here.

We are also in the midst of establishing an overall Organizing (or Guidance) Committee. Nominees from developing countries are especially welcome at this point to assure that the global presence and activities of social marketing are represented on the board. Some countries have taken the step of convening groups to make nominations; you might consider that as well to avoid too many individuals applying separately - space is limited on this committee, though there will be plenty of positions available on the work groups once they are established by the Organizing Committee.

I have also prepared a brief survey to assess the level of interest in having a World Congress of Social Marketing on 13-14 June 2010 as part of the launch of the association. Please take the 2-3 minutes to complete it so we can make an informed decision if this is something the community would like to see happen and participate in.

Several groups are leveraging this global organizing effort to foster local organizing activities as well, including the Australians and Europeans. Convergence of energies is something to behold!

I'm in an Audience State-of-Mind

2009-09-16T07:44:13-04:00

When I look at how many of us use the term 'audience,' I conjure an image of a passive, shiftless, group who are waiting to be persuaded (about something), entertained (by something), engaged (with something) or encouraged (to do something). This image has a direct effect on how I think about my social marketing and health communication efforts: do I inform? Amuse? Create interesting products and services? Get emotional? Or some combination of them?

When I think about people, I construct a sense of groups that are striving to accomplish things (if just to survive the day), aspiring to better lives, seeking solutions to their problems and constructively interacting with others. My social marketing program might them revolve around: How can I be relevant in their lives? Help them reach their goals? Solve their problems (not mine, the organization's or society's)? Interact more effectively with others? [Some might refer to these as 'adding value' - I agree. I just like to move beyond the vague].

The details of the answers to these questions lie in our ability to communicate and empathize (NOT sympathize) with people formerly known as the audience. But those are the wrong questions for today.

Rather, seeing people as active and creative actors in their own lives, and not passive recipients of their fate - or what 'we' do, sets the tone for how we each respectively approach our social role. When I am 'an audience,' I DO want to be entertained, satisfied immediately and left alone in my experience of the moment (try interrupting THAT!). When I am 'the change agent,' I want to disrupt this perceived passivity, challenge the 'satisfied now,' and stimulate experiences of social solidarity and action.

I choose to create relevance and immediacy in their lives with meaningful ideas and experiences.

I desire to create thoughtfulness and passion to bring people fully in touch with their beliefs and motives and act on them responsibly (yes, that's opening a debate).

I aspire to create hope that their lives can be better (however each of us defines it), our institutions can improve and the world can be a better place too - and that we can find ways to do just that.

I want to shift to shift the dominant social forces that preach ideas and behaviors such as 'consume and die,' "be still, be quiet, be docile,' and be 'easy, fun and popular.'

Most of all, I want to do it as 'us' - not to them, at them or for them. We talk about the changing role of the audience and the emerging role of the change agent; should we talk more about the 'us' of change?

What Public Health and Social Marketers Can Learn From P&G

2009-09-14T15:24:03-04:00

I was tuned into Proctor & Gamble's new values-based strategy to touch and improve more consumer's lives in more parts of the world... more completely via @GrahamHill on Twitter (my social source of news) and his RT of the link to Rosabeth Moss Kanter's blog post.

We will provide branded products of superior quality and value that improve the lives of the world's consumers, now and generations to come. As a result, consumers will reward us with leadership sales, profit and value creations, allowing our people, our shareholders, and the communities in which we live and work to prosper.

While many people in social marketing and public health often look to companies such as Apple, Coca-Cola, McDonald's and Nike as models for successful consumer marketing to aspire to, P&G stands out among the best and most innovative. What is most attractive to me about P&G is that they have 10 different business areas, ranging from baby care to home care, with 43 brands of over a half billion USD each. If you are in the public health business - not just the obesity, physical activity, breast cancer, HIV prevention or tobacco control business - then the way P&G creates and manages a portfolio of brands, not a unitary one, is where you should go to school.

Here are a few nuggets quoted from their annual report - the core strengths to win:

1. No company in the world has invested more in consumer and market research than P&G. We interact with more than five million consumers each year in nearly 60 countries around the world. We conduct over 15,000 research studies every year. We invest more than $350 million a year in consumer understanding. This results in insights that tell us where the innovation opportunities are and how to serve and communicate with consumers.

2. P&G is the innovation leader in our industry. Virtually all the organic sales growth we’ve delivered in the past nine years has come from new brands and new or improved product innovation. We continually strengthen our innovation capability and pipeline by investing two times more, on average, than our major competitors. In addition, we multiply our internal innovation capability with a global network of innovation partners outside P&G. More than half of all product innovation coming from P&G today includes at least one major component from an external partner.

3. P&G is the brand-building leader of our industry. We’ve built the strongest portfolio of brands in the industry with 23 billion-dollar brands and 20 half-billion-dollar brands. These 43 brands account for 85% of sales and more than 90% of profit. Twelve of the billion-dollar brands are the #1 global market share leaders of their categories. The majority of the balance are #2.

4. We’ve established industry-leading go-to-market capabilities. P&G is consistently ranked by leading retailers in industry surveys as a preferred supplier and as the industry leader in a wide range of capabilities including clearest company strategy, brands most important to retailers, strong business fundamentals and innovative marketing programs.

5. Over the decades, we have also established significant scale advantages as a total company and in individual categories, countries and retail channels. P&G’s scale advantage is driven as much by knowledge sharing, common systems and processes, and best practices as it is by size and scope.

6. P&G has earned a reputation as one of the world’s best companies for leaders. We work hard at leadership development because, as a build-from-within company, our future success is entirely dependent on the ongoing strength of our talent pipeline.

Put another way:

Public health agencies should invest significant proportions of their resources in (1) talking with and understanding their audiences (rather than a few focus groups here and there), (2) innovating in public health programs (rather than recreating wheels or sitting still waiting for evidence bases to develop), (3) creating and sustaining strong public health program brands (not their corporate image), (4) being the go-to partner for public health retailers or intermediaries (not someone to avoid because of bureaucracy and painful ‘processes’), (5) having in place common systems for getting things done across disease and behavioral risk areas (think about CDCynergy for example), and (6) developing leaders rather than rewarding the status quo.

To sum it all up, as the new CEO Bob McDonald phrases it:

I believe it comes down to one simple and remarkably constant factor: the clarity and constancy of P&G’s Purpose. Since the Company was founded, we’ve been in the business of providing daily essentials that improve the quality of people’s lives. We help people care for their babies, pets and homes. We make everyday chores easier to do. We help people look and feel better. We’ve stayed true to the inspiring Purpose of touching and improving people’s lives in meaningful ways.

Perhaps McDonald's quote should be on the walls of the offices of more public health leaders - along with a strategy to win.

Hazards of Using SNS

2009-09-08T14:20:26-04:00

Social media users from public, private and NGO sectors are increasingly using social network sites (SNS) as part of their efforts. Usability maven Jakob Nielsen looks at the problems with outsourcing social media functions to platforms like YouTube, especially when linked from enterprise websites. The key risks involve lowering the usability of the primary site while also risking losing potential viewers (having less loyalty and losing value to search engines).

...there's no doubt about the everyday design implications of hosting any material on other sites. Don't just use the default template, and definitely don't assume that simply dumping stuff onto a popular SNS will automatically make you popular.

Demarketing Sugar Consumption in Drinks

2009-09-03T10:29:56-04:00

Demarketing: Efforts aimed at discouraging (not destroying) the demand for a product which (1) a firm cannot supply in large-enough quantities, or (2) does not want to supply in a certain region where the high costs of distribution or promotion allow only a too little profit margin. Common demarketing strategies include higher prices, scaled-down advertising, and product redesign.

The term came to me as I was reviewing the New York City Health Department campaign 'Are You Pouring on the Pounds.' The health communication campaign is using outdoor signage and other elements of the communication Ps (PSAs, pamphlets, posters and publicity - oh, and a blog that I am delighted to see has comments turned 'on'!) to raise awareness of sugars in popular beverages and urge New Yorkers to cut back on sugary beverages and quench their thirst with water, seltzer or low-fat milk instead.

I have talked about obesity prevention many times here and have outlined how social marketing approaches can be used to address the obesity epidemic beyond the 5% solutions offered by communications programs such as this one.

The NYC project is a start, but if pubic health practice wants to move from simple communication campaigns to more complex and effective marketing ones, they might learn from the tobacco experiences and target the marketing mix, not the people. I am looking forward to reading a new article, Demarketing tobacco through governmental policies - The 4Ps revisited in the Journal of Business Research. As the authors note in their abstract (unfortunately all the information that is available online)

....governments use anti-smoking advertising to highlight the health risks of smoking and regulatory measures to dissuade consumers from consuming tobacco. In the past, governments tended to take these steps in isolation, now they are more likely to combine these strategies as part of a demarketing mix.

Sounds shockingly (?) familiar to ideas I have talked about with respect to needing new ways to think about and solve wicked problems. Perhaps the obesity community could start learning how to develop comprehensive demarketing programs rather than focus on recycling evidence based practices which more often than not stifle innovation and demonstrate how truly behind the times in strategy AND action they really are.

And the Institute of Medicine released a report today with a list of actions that hold the greatest potential to curb obesity rates among children. From the press release:

Many of these steps focus on increasing access to healthy foods and opportunities for active play and exercise. They include providing incentives to lure grocery stores to underserved neighborhoods; eliminating outdoor ads for high-calorie, low-nutrient foods and drinks near schools; requiring calorie and other nutritional information on restaurant menus; implementing local "Safe Routes to School" programs; regulating minimum play space and time in child care programs; rerouting buses or developing other transportation strategies that ensure people can get to grocery stores; and using building codes to ensure facilities have working water fountains.

Gosh that sounds so...marketing (I added the underlines in case you missed them). Better products and services, accessibility and opportunities, incentives, promotion efforts (or reducing the industry's) - that about covers it.

Does the Internet Increase Civic Engagement?

2009-09-02T11:27:11-04:00

The glow of the Obama campaign and its ability to mobilize people has certainly dimmed in the past few months. When it comes to whether the internet is stimulating an increase in social action and making it more accessible to all, however, a new report by the Pew Internet and American Life Project on The Internet and Civic Engagement concludes:

Contrary to the hopes of some advocates, the internet is not changing the socioeconomic character of civic engagement in America. Just as in offline civic life, the well to-do and well-educated are more likely than those less well off to participate in online political activities such as emailing a government official, signing an online petition or making a political contribution (p.3).

Though the survey does find a smaller gap between younger and older adults with respect to measures of civic engagement, the overall findings still suggest that within any age group socio-economic status (SES) remains the highest correlated variable. They also find that about 1 in 5 adult internet users have posted content about a political or social issue or in some other way used a social network site [pdf] for other forms of civic engagement. In what may signal changes to come in online civic engagement, these latter internet users are less likely to be characterized by higher SES levels. These online adults are also more likely than people not engaging in political and social actions to be active offline as well. And over half (56%) of these active online adults use digital tools such as email and group websites to communicate with each other.

And despite this sobering news, a new set of free tools for grassroots movements is being launched. It's still early on...

Marketing a Total Response to H1N1

2009-08-25T12:41:43-04:00

‘What does social marketing offer us to improve the nation’s preparedness activities for H1N1?’ was the question posed to a group of social marketers at the CDC National Conference on Health Communication, Marketing & Media. Nancy Lee picked it up first and talked about the need to establish a new brand for H1N1…starting with perhaps a new name. I could not jump onto that more quickly: ‘H1N1 already has a brand, and it sucks’ I said. I went on to talk about how most brands happen while we’re busy doing something else, and that a new brand (or name) was not going to change things in the next few months (certainly not before October-November). ‘As a marketing problem, I would focus on logistics and distribution. No matter what the communication strategy is, if the vaccine isn’t where it’s needed when it’s needed, if the health professionals don’t trust its safety and that it will be there when they need it, NO communication effort is going to ultimately be successful. Word-of-mouth will rule the day.’

Mike Rothschild jumped in and agreed that marketing distribution and logistics were the crux of the issue facing H1N1 preparedness. Bill Smith managed to agree with everyone.

It is remarkable to me that ‘marketers’ jump to the communication solution so easily and quickly – despite all the evidence to the contrary. Having personally been through or debriefed on innumerable planning scenarios for infectious biologic agent outbreaks, and planning national and statewide responses to them, communication programs become important when every thing else is going wrong: there are not enough stockpiles of vaccine or drugs to treat the problem, surge capacity of the health care system is quickly overwhelmed, people can't afford to NOT go to work, health care workers and first responders stay at home (often times because their spouse insists on it), and local news stations see the opportunity to dramatize and drive up viewership. These things quickly escalate not because ‘we had a communication problem,’ but because we had a significant disregard of the marketing mix and the problems we unearth when we talk with people who are important for success, not the planners in conference rooms and offices.

I was in Connecticut last week for some social media workshops and started asking health care professionals who were there about their perspective on H1N1 readiness. After listening to the cracks about changing the name from swine flu to H1N1 to satisfy the pork producers and politicians (and the irony was palpable when they said it), ‘brand sucks’ fits rather well. Then when I asked them what they are most concerned about – supply and distribution were uniformly the number one answer. It was also interesting to hear that colleges and universities had to demand guidelines for how to be prepared – they had somehow been overlooked.

Now I realize that a lot of commercial businesses don’t get that coordinated and integrated product, distribution, pricing and communications are marketing. They, like most public health agencies, see marketing as the messages, sales brochures, television and radio ads, publicity events and, oh yes, a Twitter account. But when facing the task of trying to mobilize a complacent nation – as HHS Secretary Sibelius put it yesterday – re-making ‘brands’ and refining talking points and risk communication messages is not going to do it. Show us you mean business!

Over a month ago when talking with some colleagues late one night, they asked me about the H1N1 vaccine being ready for the announced date of early October. Though I don’t have the inside track on what is happening with this current vaccine testing and production effort, knowing enough about it led me to state unequivocally that there was no way that would happen in any meaningful way. It was a pipe dream. The CDC is now publicly revising their shipment dates.

July 30, 2009 - The CDC expects about 120 million doses of the vaccine to be available by the end of October, obviously not enough to cover all of the recommended groups. Los Angeles Times

August 17, 2009 - Health officials had predicted having 120 million doses of vaccine ready by mid October. Now they say it will be more like 45 million. And with two doses needed to be effective, the nation's protection blanket will start out much smaller than the experts hoped. CBS News

August 24, 2009 – [HHS Secretary] Sebelius said it will take until Thanksgiving to fully immunize people against H1N1 because most will need to undergo two vaccinations. The first would be given in mid-October; the second would be administered three weeks later and it takes about two weeks after the second shot to build up full immunity to the virus. FOX News

August 24, 2009 - CDC officials say they expect between 45 million and 52 million doses of vaccine by mid-October, followed by roughly 195 million doses by the end of the year. FOX News

Confused? Poor ‘branding’? Is what we have here is a problem to communicate?

Now we could assume that once availability of the vaccine is solved, we can rest easy. But look again. Consider this story from The Globe and Mail yesterday: Canada does not have the manpower to deliver the H1N1 influenza vaccine as quickly as it becomes available, despite ordering enough doses to inject all of its citizens.

At least they are starting to focus on the rest of the marketing issues, and not the horse race as to when the vaccines will be in the starting gate. That’s when you’ll see the real problems start. (Then again, Canada has done their planning after a real-life response with SARS).

What I suggest is that the entire marketing complex (whether you think that includes you or not) for the H1N1 response to get into the room and integrate logistics with in-the-arm delivery points (not hospital and clinic refrigerators), distribution systems mapped onto the locations of high priority groups, and communication messages that enhance and compliment local capacities and plans. And stop trying to control the message from top down if they are being used to manage expectations rather than to be honest and transparent. Every time 'the message’ changes from government sources, another measure of trust is tapped from the well. Judging from what I hear, that well is already running dry. Setting and changing expectations for whatever reasons is setting the stage for more complacency and failure to adopt appropriate precautions.

It all comes down to a matter of trust. If health care providers and the informed public cannot trust what is being said one week to another, they are certainly conveying that sense in ways large and small to their patients, colleagues, friends and neighbors. They are where brand building needs to begin. They are the critical element for the success of the vaccination effort – not the perceived risk and susceptibility of the person-in-the-street. They need to feel confident and able to receive and deliver vaccines to as many people as are in need of it without the begging, waiting, cajoling and fielding questions from frightened parents, worried well and local reporters who ‘thought everything was under control.’

And as for renaming H1N1, maybe CDC should adopt the NOAA policy and name each new flu variant with a person’s name (I suggested ‘Bob’ for this one in a conversation later). Then maybe the rest of us can look forward each year to having a relationship with our ‘flu brand.' [And I love this from the NOAA site: Experience shows that the use of short, distinctive given names in written as well as spoken communications is quicker and less subject to error… The use of easily remembered names greatly reduces confusion when two or more tropical storms (read ‘flu strains’) occur at the same time.]

Today’s updates on ‘swine flu’ from Kaiser Health News is filed with more sobering news - 50% may be affected, a call to get vaccines into the field by mid-September, intensive care units' limited surge capacity, and packaging problems. So many people in public health keep saying that 'we don't DO marketing' like it is beneath them. Perhaps it really is beyond them?

Photo from Getty Images with permission.

Mad Men Meets Health Care

2009-08-17T16:50:57-04:00

The great paradox for communicators and marketers is that while we give rhetorical priority to concepts of interactivity and audience-focused programs, we continue to hammer away at “breaking through the clutter,” “capturing people’s attention” and “getting people to do things.” Yet, even before the emergence of social media the music was already echoing off the walls: It’s no longer about getting attention, it’s about earning it.

That was written in January 2007 as an introduction to a post Moving Towards Engagement in which I began describing the results of a research initiative that looks beyond behavioral targeting, or simply counting the clicks (the 21st century version of 'beans'). Our team just presented the results from developing the eHealth Engagement Scale at the National Conference on Health Communication, Marketing and Media last week. The title (with a link to the presentation) and abstract as printed in the program follow.

The Assessment of User Engagement with eHealth Content: The eHealth Engagement Scale.

This presentation describes a scale for measuring the engagement properties of eHealth content that was adapted from commercial advertising research. Accompanying research suggests that a 9-item revised eHealth Engagement Scale is a robust tool to operationalize this concept across a variety of health topic areas. The eHealth Engagement Scale may prove to be an important mediator of user retention of information, intentions to change, and ultimately efforts to undertake and achieve behavior change.

There are many different ways to think about engagement. This scale begins to get at the consumer/user experience of engagement that we define as the process of involving users in health content in ways that motivate and lead to health behavior change.

'Increasing the engagement of people' with advertisements, brands, communities, issues and media gets thrown around by many, however, rarely do I see someone operationalize it beyond eyeballs and clicks.

From our scale:

Engagement = Involving + Credible + [not dull + hip, cool]

See the presentation for more details, including the path model, and I look forward to your comments!

Post title from Susannah Fox on Twitter.

How Do We Address the Wicked Problems: The Australian POV

2009-08-07T14:06:00-04:00

Wicked problems are all around us. They are defined in Wikipedia as ones that are difficult or impossible to solve because of incomplete, contradictory, and changing requirements that are often difficult to recognize. Moreover, because of complex interdependencies, the effort to solve one aspect of a wicked problem may reveal or create other problems. Examples include what to do about climate change, health care, the HIV pandemic, flu preparedness, drug use, mental health and care and obesity prevention.

I have written about how social marketing provides a complimentary approach to the more traditional public policy tools that are used to tackle these and many other types of social problems (see the previous links for more examples). For another, independent point of view (POV), I have selected some of the summary comments from the Australian Public Service [APS] Commission's report on Changing Behavior: A Public Policy Perspective (pdf). For those of you who work in and around policy-shapers and makers (for more about these people as market agents), it makes several relevant points about the need to move away from outmoded and largely discredited 'rational choice' models to more comprehensive approaches in which social marketing can serve as a useful heuristic and integrating framework. Be sure to share this with them.

Governments regularly use a range of traditional policy tools to influence citizens’ behaviour, including legislation, sanctions, regulations, taxes and subsidies, the provision of public services and information and guidance material. In many areas this range of traditional tools works well. For some social policy problems such as so-called wicked problems, however, influencing human behaviour is very complex and the effectiveness of traditional approaches may be limited without some additional tools and understanding of how to engage citizens in cooperative behavioural change. It has become increasingly clear that government cannot simply deliver key policy outcomes to a disengaged and passive public. In the areas of welfare, health, crime, employment, education and the environment, achieving significant progress requires changing behaviour.

Detailed cost-benefit analyses in a number of key areas of public policy such as health and crime have shown that more sophisticated behaviour-based interventions can be very much more cost-effective than traditional approaches to policy and service delivery. This is particularly the case if a longer-term time frame is taken to evaluate the constraints, costs and benefits. Agencies may have more impact on key policy outcomes by using their limited resources to more effectively engage, involve and change the behaviour of users and other parties, than by concentrating only on traditional policy tools and service delivery.

Accordingly, policy makers in the APS need to have a better understanding of how the rational choice model of behavioural change can be supplemented by insights from behavioural change theory and evidence at the individual, interpersonal and community levels. A social marketing approach is one practical tool that tries to integrate these three levels of theories.

…The need to formulate a comprehensive approach to behavioural change, to understand how components interact, to work cooperatively across jurisdictions and organisations and to engage stakeholders, highlights the need for a range of core skills in addition to the more traditional analytical, conceptual and project management skills. These include communication and influencing skills, the ability to work cooperatively, and big-picture thinking skills. There is also a need for policy makers to be aware of and apply behavioural change theory, and to understand the importance of investing in evaluation and research.