On Social Marketing and Social Change

Digital Social Networks and Health: Reviewing the Research and Evidence

2013-05-05T14:58:43-04:00

A review of the research and evidence for the use of social network sites (SNS) to improve cardiovascular health, “Digital social networks and health," was published in the 30 April 2013 issue of Circulation, a journal of the American Heart Association. In this article, Alex Bornkessel (aka Social Butterfly) and I document the emergence of social media, and specifically SNS, and their impact on health information-seeking and health-related behaviors. We survey user behavior on SNS to document how health information is being transformed from an individual or clinical endeavor into a social health experience, and the implications this has for patient privacy and confidentiality in digital social networks. The research evidence for how SNS may influence health behaviors is also reviewed. We conclude by offering recommendations for practice to optimize the use of social media and its contribution to improved health outcomes, and pose a series of questions to guide the development of a research agenda in this area. The article is available for free download.

"Social media, and especially SNS, are moving us away from an individual view of health to one that encompasses social connections among patients, their families and caregivers, and their healthcare provider team. New media technologies are going to increase and sustain this trend. We have shown that the research evidence is quite limited for how SNS can be effectively and efficiently used to improve health in an equitable way across the population. We have demonstrated where and how SNS can be put into practice now, and identified some of the important concerns and questions that research in this area might address" (Lefebvre & Bornkessel, 2013, p. 1835).

Reference

Lefebvre, R.C. & Bornkessel, A.S. Digital social networks and health. Circulation, 2013; 127:1829-1836.

New Books on Social Marketing

2013-03-26T16:34:32-04:00

“This is it -- the comprehensive, brainy road map for tackling wicked social problems. It’s all right here: how to create and innovate, build and implement, manage and measure, scale up and sustain programs that go well beyond influencing individual behaviors, all the way to broad social change in a world that needs the help.” - Bill Novelli, Professor, McDonough School of Business, Georgetown University, former CEO, AARP and founder, Porter Novelli and Campaign for Tobacco-Free Kids

“I’m unaware of a more substantive treatise on social marketing and social change. Theoretically based; pedagogically focused; transdisciplinary; innovative; and action oriented: this book is right for our time, our purpose, and our future thinking and action.”- Robert Gold, MS, PhD, Professor of Public Health and Former Dean of the School of Public Health at the University of Maryland, College Park

"This collection is a superb reference source for anyone involved in promoting better health, education, environments, and communities to start their search for great ideas and guidance." - Philip Kotler, PhD, Kellogg School of Management, Northwestern University

"I'm pleased to see this very useful collection assembled and especially pleased that two volumes of it are devoted exclusively to social marketing in developing countries. Family planning social marketing is especially important in developing areas and this collection will help spread the word about that important development." - Phil Harvey, DKT International

[click on image for more information about each one]

Designing Community Campaigns For Weight Loss

2013-03-25T16:04:05-04:00

Developing community and statewide initiatives to combat obesity has been described “as American as second helpings of apple pie” (Levitz & McKay, 2013). Checking in on this trend, the writers noted that while there have been a few successes, more often local and state leaders are trying to figure out how their projects did so poorly. They note 10% participation rates, weight loss of 3 pounds per person over 8 weeks, achieving only 6% of a collective weight loss goal, and the “fizzling out” of a 1-year citywide challenge.

Thre are the usual suspects behind these disappointing results: everyday hassles that preclude making more healthy eating choices or increasing physical activity levels, the temptations of fast and convenient food outlets, and the lack of money to adequately promote the program. In response to these failures to initiate and sustain behavior change, several cities have turned to local ordinances to post calorie counts in certain restaurants or are building more hiking and bike trails. One could conclude that broad-based weight loss initiatives are not worth the effort and that time and effort is better spent issuing regulations and changing the environment. I believe that these community and state efforts need better marketing of weight management.

Developing programs to reduce obesity at scale means thinking about the problem as a wicked one. As I've talked about before, wicked problems have at their core the need for large scale behavior change. Wicked problems also require multi-faceted solutions, and not one-shot wonders - whether these are weight loss challenges or state-of-the-art walking trails and exercise facilities. Rather than thinking about an either-or approach to improving the public health in a city or state, I encourage leaders to consider a strategy that balances behavior change with regulatory and environmental prompts and supports for these changes. Another way of thinking about this is that we need to generate both demand for weight loss and stimulate supply of ways to achieve it. Unfortunately, most states and cities choose one or the other.

Increasing demand and supply for losing weight is the marketing challenge for public health programs at the local, state and national level. My experience and related research suggests the following roadmap for creating a second-generation of public engagement and participation efforts around weight management.

1. Set realistic expectations. Especially if this is your first effort, unrealistic metrics (anything that includes the word “all” or “everybody”) will undermine program planning, staff morale and participant engagement. Think of your initial efforts as a prototype, not a full-fledged program. Take your initial results to set benchmarks for the next one. Similarly, set a 5 to 8 week period for your campaign to focus everyone's attention, avoid the “fizzle” or fatigue factor, and to set achievable weight loss goals of 1-2 pounds (0.5-1kg) a week for participants.

2. Understand your priority group. Weight-loss campaigns will appeal to certain types of people including, obviously, people who perceive themselves as needing to lose weight. However, every program feature you plan will affect its appeal to certain groups. For example, linking to many group support programs will be more appealing to women; individual and team-based competitions may engage more men; the nature of incentives and grand prizes will attract people with those types of interests; recruitment primarily through worksites leaves out other segments of the community; etc. Best practice would be to involve people who are your core priority group in the planning of the program so you can get inputs and immediate feedback in designing the key program elements.

3. Use incentives to promote participation and success. Incentives for weight loss do not need to be viewed as undermining intrinsic motivation for making healthier choices. Rather, what is more often found is that incentives are a great aid in attracting attention from media and intermediaries to promote the program. Grand prizes, chosen through a lottery of successful campaign completers (we used a 1-2 pound weight loss multiplied by the number of weeks of the campaign as the criteria for success), are also helpful in gaining and focusing the attention of specific segments of the community – think of the different types of people who would be attracted to a weight loss campaign that had grand prizes of $1,000 cash, or weekend retreats for two at local spas, or lifetime memberships to fitness clubs.

4. Build supply and demand. The default strategy for most of these campaigns is to focus on individual responsibility and behavior change. I suggest you consider all of your local assets and focus on the marketplace for healthier behaviors. Design the campaign to increase demand for healthier food choices and access to physical activity facilities. But also build in from the beginning the participation of local restaurants, physical activity businesses and nonprofit organizations, and other groups who can support people in their efforts to lose weight (i.e., meet the demand the campaign is generating). Having supportive businesses offer reduced-cost or limited-time free access to their offerings on a trial basis generates prospective customers for them and opens up alternative behaviors for people wanting to manage their weight.

5. Localize, localize, localize. Even in smaller communities, holding events in specific geographic areas can help the campaign reach and touch people more effectively. In our Lighten Up campaigns, many aspects from recruitment to weekly walking events to final “weigh outs” were planned to minimize cost of participation. Worksites, religious organizations, fire stations, government offices can all be used to ensure there is a hyper-local presence of the campaign in people’s lives.

6. Pay attention to time. Campaigns that have finite start and finish points are easier on everyone. We found that 5-6 weeks is about what many community organizations, businesses, participants and our own staff could manage to keep up the energy and maintain focus. Some professionals get concerned that such limited time will not be enough for many people who want to lose significant amounts of weight. We agree and build into these campaigns options for people who want to continue in more structured exercise and weight loss situations.

7. Monitoring and evaluation. It is also essential to have at least an initial and final campaign weight measurement that makes the participant’s commitment to the campaign public (though they don't have to disclose their actual weight to anyone). Making a decision to lose weight during the campaign while standing on one's bathroom scale is very different from showing up and weighing-in where you work, worship, learn or play. Similarly, the weigh-out is another public affirmation of one's desire to manage their weight. These book-end events provide program planners with the opportunity to collect pre- and post-campaign data. There are also many ways to use websites, social media and mobile technologies for participants who wish to self-monitor and report eating and physical activity behaviors on a daily or weekly basis. However, I would be against making this response burden a requirement for campaign participation.

8. Leadership. People who are involved and visible in the campaign need to be from the peer groups and constituencies that form the core of the priority group. Elected officials often want to be seen as the leaders of these efforts. Yet, not everyone in the state or community will appreciate or be drawn to particpate by his or her presence. It is important to have the visible and on-going involvement of local campaign organizers, personalities from the media, religious and business leaders, and other people who are attractive and appealing to your priority group.

9. Get the healthy involved. Fortunately, not everyone in your community needs to lose weight. But that should not preclude them from being involved in the campaign. One of the more successful strategies we developed was to have a “buddy program” in which these people could formally adopt or sponsor a family member, friend or co-worker who was engaged in the campaign. We would provide these buddies with materials to increase their understanding and use of various social support techniques that help facilitate behavior change for weight loss. In some campaigns buddies were also eligible for grand prizes if their sponsored participant lost weight. There are people who are quick to point out that buddies could game the system by sponsoring more than one weight loss participant and thus increase their chances of winning. Such are the ways of changing social norms in a positive direction! As far as we were concerned, the more participants they recruited and personally supported to lose weight, the better for all of us.

Now it’s up to you.

Further Reading:

Del Prete, L., English, C., Caldwell, M., Banspach, S.W. & Lefebvre, R.C. (1993). Three-year follow-up of Pawtucket Heart Health's community-based weight loss programs. American Journal of Health Promotion; 7:182-187.

Levitz, J. & McKay, B. (2013). Can a whole city stick to a diet? Fat chance. The Wall Street Journal (January 23): pp. A1, A12.

Litchfield, R.E., Muldoon, J., Welk, G., Hallihan, J. & Lane, T. (2005). Lighten Up Iowa: An interdisciplinary, collaborative health promotion program. Journal of Extension; 43:

Nelson, D.J., Sennett, L., Lefebvre, R.C., Loiselle, L., McClements, L. & Carleton, R.A. (1987). A campaign strategy for weight loss at worksites. Health Education Research; 2:27-31.

More on marketing approaches to preventing obesity.

Demographics of Social Network Site Users - 2013

2013-02-14T15:00:56-05:00

The rise in the use of social network sites (SNS) among internet users over the past 7 years has been dramatic. In 2005 less than 10% of any age group on the internet reported using a SNS, and by 2012 two-thirds of all internet users said that they use at least one SNS. Note that I use SNS here as suggested by boyd and Ellison (2007) who make the important distinction between social networking sites in which initiating relationships between strangers is a major activity (such as on dating sites) and social network sites that allow people to make their networks visible to others. It may seem a small point unless you are the user.

Today Duggan and Brenner (2013) report the demographic characteristics of the users of SNS from the latest Pew Internet and American Life survey. They note statistically significant differences for gender with women more likely to be users than men (71% to 62%); age differences predictably favored younger age groups being more involved with SNS; and people living in urban areas were more likely than people living in suburban or rural areas to be using SNS. No differences in SNS use were noted for race/ethnicity, education attainment or household income.

Digging deeper into SNS use, 67% of all SNS users were on Facebook and it is especially popular with women and adults ages 18-29 (though 57% of 50-64 year-olds, and 35% of people age 65+ are using it as well). Twitter is used by 16% of internet users; the 18-29 year olds, African-Americans and urban residents were significantly more likely to use it than other groups. Women, adults under 50 years of age, whites and people with some college education or an annual household income greater than $50,000 are more likely to use Pinterest (overall it was used by 15% of all internet users). Using Instagram is reported by 13% of internet users, and was especially appealing to the 18-29 age group, African-Americans, Latinos, women and urban residents.

The popularity of SNS sites seems to be plateauing, and even declining slightly, among all age groups. There is also selection and concentration of SNS users occurring as striking differences do emerge among users of specific SNS. You might also want to compare these figures with the SNS demos we were talking about four years ago.

References

boyd dm, Ellison NB. Social network sites: Definition, history and scholarship. Journal of Computer Mediated Communication, 13(1).

Duggan M, Brenner J. (2013). The demographics of social media users – 2012. Washington, DC: Pew Internet & American Life Project.

Making Plans for the World Social Marketing Conference

2013-01-03T12:54:46-05:00

Join the largest gathering of social marketing experts from across the world.

The third World Social Marketing Conference will take place 21-23 April 2013 in Toronto, Canada.

At a time of fundamental reappraisal of many public service programs and restricted budgets the world over, the conference takes on major significance as we search for better ways to address the many different types of wicked problems that challenge us.

In 2013 the Conference has an impressive line up of speakers from across the world, covering issues as diverse as obesity, substance abuse, transportation, the role of social media, environmental issues, and the developing world. All the speakers will explore how social marketing can and is being used to make social programs more effective and efficient.

Keynote session presenters include Professor Robert Lusch and Dr Phillip Kotler; Dr. Brian Wansink, Andrea Dolan, Jim Diorio and Jeff Jordan; Francoise Lagarde and Shiraz Latiff; and Carol Abade and Dr. Doug McKenzie-Mohr. PLUS there will be over 30 breakout sessions to choose from. Pre- and post-conference workshops are also being offered. See the entire program here.

Book now to save 20%

Now is a great time to make sure you're part of the largest ever gathering of social marketing thought and practice leaders. If you act quickly, you can still take advantage of the early-bird discount by registering before 6 January 2013 to save 20% on delegate fees.

The 10 Best mHealth Papers of 2012

2012-12-27T16:42:09-05:00

The mobile health (mHealth) space, especially as it relates to health behavior change and chronic and infectious disease management, has been a long running theme of mine for increasing reach, effectiveness, efficiency and equity of interventions. (See Integrating cellphones and mobile technologies into public health practice -pdf). The allure of mHealth, often promoted via stories, case studies and visions of the mobile future, has raced ahead of most objective analyses. For the best mHealth papers of 2012, I selected ones that address many important - but skimmed over - issues. The first paper examines how to assess health systems, their readiness and capacity to scale up mHealth interventions. This paper focuses on South Africa, but the framework and conclusions could fit most developed and LMIC contexts. The article by Whittaker and colleagues reflects on their experiences and discusses the important steps for developing quality mHealth apps and evaluating their effectiveness. It is a paper that most app developers and mHealth designers should put at the top of their reading list for 2013.

The next four articles are systematic reviews and meta-analyses of mHealth interventions for, respectively, behavior change programs in developing countries, increasing levels of physical activity, the management of diabetes, and self-management of chronic illnesses. Each of these areas generates a lot of excitement and buzz at mobile health conferences, but as every one of these authors note, the evidence-base is both structurally weak (poor research designs and data reporting) and inconsistent with respect to outcomes.

The two papers that follow describe intervention trials. The first utilizes an RCT to demonstrate the value of integrating mobile technologies into standard care approaches to weight loss management. The second study, a diabetes management program for low-income urban women, is significant not so much for its findings but for its penetrating review of its failures – the nearly 50% drop-out rate. All program designers should give this one a careful read for the lessons it offers.

Finally, the last two articles look at the current and future state of mHealth. Whittaker reports her findings from interviews with key US mHealth stakeholders and Dolan wraps up the first year in which FDA regulatory approval popped up on many developers’ radar; he notes that at least 75 mHealth apps were approved by the agency.

Before shifting to the list, a quote from the Whittaker summary of stakeholder interviews captures my appraisal and mood about mHealth at the end of 2012:

“Several informants raised the concern that many mHealth applications available in practice may not be effective, engaging, usable, or meeting the needs of users. Few applications have been evaluated, and those that have often involve complex interventions where the components or mechanisms have not been examined. Many felt that not a lot is known as yet about what aspects of mHealth work, for whom, and why. Few published health interventions delivered via mobile technologies discuss a theoretical basis or evaluate theoretical components hypothesized to be important in the intervention. It was stated that there is much hype and lots of players all “doing their own thing.” Some informants felt that some mHealth developers may have a bias toward developing programs for people like themselves using the technologies they like, rather than starting with the problem and working with end users to develop the most useful and usable solution. Some pointed to statistics in the media showing that many smartphone applications are downloaded but not used. More recently, reviews have found poor quality in terms of accuracy, usability, consistency with national practice guidelines, and effective practices.”

I suspect that if you read and apply the insights and lessons from this top ten list, you might make significant contributions to the solutions for these and other issues that perplex the field.

Leon N, Schneider H, Daviaud E. Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa. BMC Medical Informatics and Decision Making, 2012; 12:123 doi:10.1186/1472-6947-12-123 Full Text - pdf

Applies a framework of government stewardship and the organizational, technological and financial systems of a health care system to assess the opportunities and challenges to effectively implement mHealth interventions at scale. Stewardship includes strategic leadership and creating a learning environment; organizational issues include having a culture for use of health information for management, and a capacity for implementation; technological components include usability, interoperability and privacy and security safeguards; and financial system variables are demonstrating the cost-effectiveness of mHealth approaches and having in place sustainable funding sources.

Whittaker R, Merry S, Dorey E, Maddison R. A development and evaluation process for mHealth interventions: Examples from New Zealand. Journal of Health Communication, 2012;17: 11-21. Abstract

Using examples of the development of a video messaging smoking cessation intervention and a mobile phone multimedia messaging depression prevention intervention, the authors describe a series of steps for developing mHealth interventions: conceptualization, formative research to inform the development of the intervention, pretesting content, pilot study, pragmatic randomized controlled trial, and further qualitative research to inform improvement or implementation. Several themes underlie the entire process, including the integrity of the underlying behavior change theory, allowing for improvements on the basis of participant feedback, and a focus on implementation from the start. The strengths of this process are the involvement of the target audience in the development stages and the use of rigorous research methods to determine effectiveness.

Gurman TA, Rubin SE, Roess AA. Effectiveness of mHealth behavior change communication interventions in developing countries: A systematic review of the literature. Journal of Health Communication, 2012; 17 (sup1): 82-104. Full Text

The authors reviewed 44 articles; 16 (36%) reported evaluation data from mHealth interventions, mostly in Africa and Asia. HIV/AIDS and family planning/pregnancy were the health topics most frequently addressed by interventions. Studies did not consistently demonstrate significant effects of exposure to mHealth interventions on the intended audience. The majority of publications (n = 12) described interventions that used two-way communication in their message delivery design. Although most publications described interventions that conducted formative research about the intended audience (n = 10), less than half (n = 6) described targeting or tailoring the content.

Fanning J, Mullen SP, McAuley E. Increasing physical activity with mobile devices: A meta-analysis. Journal of Medical Internet Research, 2012; 14(6):e161 Full Text

The aims of this review were to: (1) examine the efficacy of mobile devices in the physical activity setting, (2) explore and discuss implementation of device features across studies, and (3) make recommendations for future intervention development. After searching electronic databases, four research studies were considered to be of "good" quality and seven of "fair" quality, involving a total of 1,351 participants. Their meta-analysis of outcomes, duration of moderate to vigorous physical activity and/or pedometer steps, provide some preliminary support for mobile technology (SMS) interventions to increase physical activity behavior. They also note that that much can be added to current theoretical models of behavior change so that they are better suited to design mobile interventions and interpret results.

Baron J, McBain H, Newman S. The impact of mobile monitoring technologies on glycosylated hemoglobin in diabetes: A systematic review. Journal of Diabetes Science and Technology, 2012; 6:1185-1196. Abstract

The investigators used database searches to identify studies that investigated the clinical effectiveness of mobile-based applications that allowed patients to record and send their blood glucose readings to a central server; 24 papers were reviewed. Results for patients with type 1 and type 2 diabetes were examined separately. Study variability and poor reporting made comparison difficult, and most studies had important methodological weaknesses. Evidence for the effectiveness of mHealth interventions for diabetes was inconsistent for both types of diabetes and remains weak.

de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Systematic Review, 2012;12:CD007459 Abstract

The authors conducted a review of experimental studies that assessed the effects of mobile phone messaging applications on health outcomes and patients' capacity to self-manage their condition. Four RCTs with a total of 182 participants were the focus of their analysis. They concluded that because of the small number of trials included, and the low overall number of participants, the quality of the evidence for positive impacts of SMS on health outcomes or self-management capabilities can at best be considered moderate. Furthermore, the usefulness and potential negative consequences of mobile phone messaging over extended periods of use for self-managing long-term conditions are not yet known.

Spring B, Duncan JM, Janke, A et al. Integrating technology into standard weight loss treatment: A randomized controlled trial. Archives of Internal Medicine, Published online 10 December 2012. doi:10.1001/jamainternmed.2013.1221 Full Text

Notable for being an RCT of a mHealth intervention, the current study demonstrates the feasibility of using mobile connective technology to interface with a hospital based, standard-of-care weight loss treatment. Adding technology and coaching to the standard-of-care group obesity treatment significantly enhanced weight loss outcomes at 3, 6, 9, and 12 months. More than 36% of participants using the mobile technology system and coaching, compared with 0% in the standard-of-care condition, lost at least 5% of their initial body weight at 3 months and this effect was significant, though less pronounced at 12 months (29.6% vs 14.8%).

Katz R, Mesfin T, Barr K. Lessons from a community-based mHealth diabetes self-management program: “It’s not just about the cell phone.” Journal of Health Communication, 2012; 17: 67-72. DOI: 10.1080/10810730.2012.650613 Abstract

An unflinching look at the many lessons learned from a pilot study of a cell-phone assisted diabetes self-management program carried out in an urban community clinic. There were high no-show rates for the baseline visit (49%) and the drop-out rate for participants was 50%. Six measures of diabetes standard-of-care improved; hospitalizations and emergency department visits were reduced during the study period in comparison with baseline.

They identified challenges to a mobile health chronic care program as including: (a) cell phones, (b) disease management software (in this case, Diabetes Manager), (c) support staff, (d) patients, (e) case managers, and (f) primary care providers (PCPs).

Cell phone factors include (a) type of handset and service, (b) size of screen, (c) type of keyboard, (d) length of message, (e) ease of access to software system, and (f) passwords. Disease management software factors include (a) literacy; (b) frequency of messaging, reminders, tips, questionnaires; (c) ease of access of the disease management software application to case managers and PCPs; and (d) interface with the medical record. Support staff factors include (a) assisting with cell phone arrangements, (b) registration and cell phone set up of the Diabetes Manager, (c) training and retraining patients in the use of the diabetes cell phone system, (d) monitoring patient system usage and confirmation of cell phone payments, (e) arranging patient incentives, (f) updating patient medical information into Diabetes Manager, and (g) providing Diabetes Manager monthly reports to PCPs. Patient factors include (a) literacy, (b) belief in medications/medication adherence, (c) affordability/incentives of cell phone service, (d) access to working glucometer/ medications/testing supplies, (e) creating and maintaining strong relationships with case managers and PCPs, (f) encouraging patient responses to Diabetes Manager messages, and (g) use of advanced Diabetes Manager features. Case manager factors include (a) staff turnover, (b) diabetes knowledge, (c) WellDoc Diabetes Manager training, (d) relationship with patients, (e) relationship with PCPs and a defined role and responsibility in patient care, (f) access to patient chart/labs, (g) and integration of the cell phone activities into case manager work flow. PCP factors include (a) identifying a PCP champion for program, (b) ease of access to WellDoc information, (c) integration into the PCP usual workflow, (d) communicating Diabetes Manager information to the consulting diabetologist, (e) improving PCP diabetes knowledge, (f) overcoming PCP inertia, and (g) fostering a relationship with patients and case managers.

Whittaker R. Issues in mHealth: Findings from key informant interviews. Journal of Medical Internet Research, 2012; 14(5):e129 doi:10.2196/jmir.1989 Full Text

The author conducted semi-structured interviews with 27 key informants from across the health sector and mHealth sector in the US to determine the important issues facing the implementation of mHealth. The most common issues included privacy and data security, the regulation of mHealth tools and programs as medical devices, the fragmentation and large number of wireless providers that makes comprehensive implementation difficult, the costs of mHealth services to the public, the proliferation of proprietary systems and multiple platforms, funding, a lack of good examples of the efficacy and cost-effectiveness of mHealth in practice, and the need for more high quality research.

Dolan B. Analysis: 75 FDA-cleared mobile medical apps. MobiHealthNews, 20 December 2012. Full Text

The emergence of FDA regulatory guidance this past year has led more mHealth developers to submit their apps for review and approval. At least 75 510(k) clearances included a mention or description of a mobile software component. Most FDA cleared apps are focused on chronic condition management — often taking the form of a digital logbook that receives data from a companion medical device. This group includes diabetes, asthma, and blood pressure management apps. The next largest contingent of FDA-cleared apps are related to electrocardiographs (ECGs), and typically take the form of a remote, mobile viewer for ECG data. Vital sign monitoring apps, imaging apps and medication adherence apps round out the group with a few apps that don’t fit any of those categories. These findings are compiled in the MobiHealthNews Research report: 75 FDA Regulated Mobile Medical Apps.

The Top 10 Social Media Papers of 2012

2012-12-20T12:15:14-05:00

I don’t have the time or capacity to sort through the many articles that appear in the academic journals on social media, and I suspect many of you don’t either. But shifting the practice of social media marketing from stories to evidence is, in the long run, a more sustainable model to have impact.

John Wihbey of the Journalist’s Resource (JR), Shorenstein Center on the Press, Politics and Public Policy at the Harvard Kennedy School, has done an admirable job for us this year in putting together a top 10 list of social media research articles (and thanks to @jbenton for bringing it to my attention!).

You can find the full list and links at the Neiman Journalism Lab site.

What I focus on here are the results of one of these studies on “Structural diversity in social contagion” that involved 10 million Facebook users. It has significant implications for using social media for behavior change. As described at JR:

The study’s findings include:

A person is much more likely to join Facebook if that person has friends on Facebook who do not know each other — a structurally diverse network — than if that person’s friends are all connected on the site. “The number of distinct social contexts represented on Facebook … predicts the probability of joining.”
An invitation to join Facebook that listed four unrelated site users sent to a potential user was more than twice as likely to prompt the individual to join than an invitation that listed four connected users. “It is not the number of people who have invited you, nor the number of links among them, but instead the number of connected components they form that captures your probability of accepting the invitation.”
Once a user joins Facebook, the structural diversity of his or her network also impacts the level of engagement: more active Facebook users have friends on the site spanning numerous social circles. “Simply counting connected components leads to a muddled view of predicted engagement…. However, extending the notion of diversity according to any of the definitions above suffices to provide positive predictors of future long-term engagement.”

The researchers conclude that “these findings suggest an alternate perspective for recruitment to political causes, the promotion of health practices and marketing; to convince individuals to change their behavior, it may be less important that they receive many endorsements than that they receive the message from multiple directions.”

What caught my attention is the validation of an idea I have talked about for several years – media multiplexity. Three points I have made bear repeating for social media practitioners, especially those engaged with using social media for behavior change:

People are rapidly learning how to incorporate new media and social networking into their daily lives. As they become more comfortable, and in control, of these experiences, it will be the change agents and organizations that learn how to work with the 'social' context of these media that will be most successful. [Social media and social ties]
Social technologies succeed when they fit into the social lives and practices of those who engage with the technology. [Introduction to social media]
Focus on using social media to take advantage of the connections people have with each, not to reach people in new ways. [Developing strategies for social media]

What the findings of this study suggest is that we need to understand people’s social networks (online and off) and then uncover ways in which the disparate networks a person has can be engaged for change. The other implication is that people who are fairly insular in the networks they have (for example, all their friends know each other) are going to be much less open to our offers for change and also less likely to be participating on social network sites. Shifting from thinking about 'messages that will change people' to 'networks that support people changing' is a big change for many researchers and practitioners. To start thinking about social networks and change, take a look at Maybe IT IS all about social networks.

The Best of Social Marketing in 2012

2012-12-18T16:01:38-05:00

The people who take the time to develop, write, review and publish papers on social marketing in the peer-reviewed literature are some of my heroes. It takes time, careful and deliberative thought, and commitment for an author or collaborators to craft a paper, volunteers to serve as peer reviewers, editors to sort through submissions and select ones that are published, and publishers who make the investment and support the enterprise of building a discipline of social marketing. As the year closes, here is my list of the top 10 papers in social marketing in 2012. Some are selected because they pull a lot of information together into one place, others for their demonstration of unique or benchmark applications of social marketing, and still others because they made me think more about what we are doing as marketers for social good. As we enter the holiday season, and you begin imagining your plans for next year, I hope one or more of these articles will prepare you for doing even better in 2013!

The list of papers is not in any particular order. Note that links to either the Full Text or Abstract of each paper are provided as available. Please contact the author of a paper for full reprint (pdf) requests.

1. Chandon P, Wansink B. Does food marketing need to make us fat? A review and solutions. Nutrition Review, 2012; 70:571-93. Full text

“Overall, all the studies reviewed here clearly show that pricing is one of the strongest – if not the strongest – marketing factors predicting increased energy intake and obesity, and this is why lower-income consumers are predominantly affected by these conditions. Conversely, the power of pricing means that it holds the key to many of the “win-win” solutions…”

2. Skinner K, Hanning RM, Sutherland C, Edwards-Wheesk R, Tsuji, LJS. Using a SWOT analysis to inform healthy eating and physical activity strategies for a remote first nations community in Canada. American Journal of Health Promotion, 2012; 26:e159-e170. Abstract

“The SWOT analysis proved to be a beneficial tool for incorporating local contextual data and community input into the determination of relevant health promotion strategies… In addition to planning programs, SWOT analysis can be used as a framework for evaluation. Therefore, it could be used to both plan and evaluate strategies in the same community, which can act to streamline the intervention process from the initial community analysis to the improvement of evaluated strategies."

3. Yamey G, Schäferhoff M, Montagu D. Piloting the Affordable Medicines Facility-malaria: What will success look like? Bulletin of the World Health Organization, 2012; 90:452-60. Full Text

“The success of the AMFm will be measured according to the following objectives:

reduces the price of ACTs to a price comparable to that of other antimalarials;

increases the availability of ACTs in public and private outlets;

increases the market share of ACTs among antimalarials;

increases the use of ACTs, including among poor rural communities.

To provide benchmarks on the potential impact of these supportive interventions, we examined the literature on the social marketing of other subsidized health commodities, to determine how a national-level social marketing campaign can change commodity coverage and use.”

4. Sweat MD, Denison J, Kennedy C, Tedrow V, O'Reilly K. Effects of condom social marketing on condom use in developing countries: a systematic review and meta-analysis, 1990-2010. Bulletin of the World Health Organization, 2012; 90:613-622A. Full Text

“There is evidence that condom social marketing can increase condom use, although such evidence comes from studies lacking sufficient rigour. Community-randomized controlled trials of condom social marketing would provide much stronger evidence, but they are expensive, so large-scale condom social marketing programmes are supported by little evidence. More studies in subpopulations would also be valuable to the field. Our meta-analyses did show a positive and statistically significant effect of condom social marketing on increasing condom use, and all individual studies showed trends for a positive effect.”

5. Ngo AD, Alden DL, Pham V, Phan H. The impact of social franchising on the use of reproductive health and family planning services at public commune health stations in Vietnam. BMC Health Services Research, 2010;10:54 doi: 10.1186/1472-6963-10-54 Full Text

“The study finds positive associations between GSF [Government Social Franchise] membership and client volumes as reported by the clinics at the end of the evaluation period. It also documents a positive relationship between GSF membership and self-reported visit frequency. Given growing interest in RHFP [Reproductive Health and Family Planning] franchising in developing countries, this study provides preliminary evidence regarding a new approach - the Government Social Franchise model - that has tremendous potential for effective use of physical and human capital investments to improve RHFP capacity of smaller public sector clinics.”

6. Aschemann-Witzel J, Perez-Cueto FJ, Niedzwiedzka B, Verbeke W, Bech-Larsen T. Lessons for public health campaigns from analysing commercial food marketing success factors: A case study. BMC Public Health, 2012; 21;12(1):139 doi: 10.1186/1471-2458-12-139 Full Text

“…the major contribution of this study is pinpointing which factors are particularly crucial for success and, more specifically, which ones might be of greatest relevance for the area of nutrition and health. The present study also provides a model that can serve as a checklist for evaluating future public health nutrition campaigns…”

7. Harris JR, Cheadle A, Hannon PA, Forehand M, Lichiello P, Mahoney E, Snyder S, Yarrow J. A framework for disseminating evidence-based health promotion practices. Preventing Chronic Disease, 2012; 9:E22 PMCID: PMC3277406 Full Text

“The analysis evaluates 5 key areas:

Consumers: the needs of the organizational and individual consumers of the practice(s).

Competition: the salient alternatives that serve as competition for the practice(s).

Company: the capacity of the company…to support dissemination of the new practice(s).

Collaborators: the strengths of collaborators — potential support networks or other partners — that can offer input on the constraints of real-world settings and facilitate dissemination in much the same way that a retailer helps distribute products to consumers.

Context: the sociopolitical context…

By conducting a full market analysis, the disseminator will be prepared to decide which segments of potential user organizations to target and how to best position the evidence-based practice(s) for these targeted segments.”

8. Wilkie WL, Moore ES. Expanding our understanding of marketing in society. Journal of the Academy of Marketing Science, 2012; 40:53-73. Full Text

“It is interesting that, rather than a single unified presence, there are at least eight organized subgroups at work on research dealing with marketing in society issues, most with their own journals and conferences… Persons who wish to focus on social change and help those managing these efforts (social marketing), persons who strive to assist the poor to develop their own sustainable markets (subsistence marketplace initiative), and others who wish to focus on helping corporate marketers make more ethical decisions (marketing ethics). Another set of researchers focuses on efforts to attain a “fair and efficient marketplace for consumers and competitors,” and in helping government decision makers and marketers devise more efficient and effective legislation as well as regulatory actions (public policy and marketing). Further, some persons are approaching problems within different cultural and political contexts (international consumer policy), and some with different aims and methods (consumer interest economists). Meanwhile, macromarketing is focused on larger questions having to do with marketing as a provisioning system for a society. The newest of the groups, transformative consumer research (TCR), as reflected in its name, stresses empirical research undertakings with consumers, but here with the purpose of promoting actions that will help to enhance quality of life.”

9. Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W. Addressing access barriers to health services: An analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy and Planning, 2012; 27:288-300. Full Text (pdf)

"The analytical framework can be used as a template to identify interventions, or a combination thereof, that can tackle specific access barriers, or to analyse why interventions do not achieve the desired result of increasing access."

10. Biglan A, Flay BR, Embry DD, Sandler IN. The critical role of nurturing environments for promoting human well-being. American Psychologist, 2012; 67:257-271. doi: 10.1037/a0026796 Full Text (pdf)

"This article builds on the 2009 Institute of Medicine report by proposing an integrative framework to effectively organize both research and practical action. Biological, behavioral, etiological, and intervention evidence converges on a fairly simple and straightforward principle: If we want to prevent multiple problems and increase the prevalence of young people who develop successfully, we must increase the prevalence of nurturing environments."

And as a bonus item, and so as not to insert myself into the top 10, you can also download:

Lefebvre, RC. Transformative social marketing: Co-creating the social marketing discipline and brand. Journal of Social Marketing, 2012; 2: 118-129. Full Text (pdf)

“How do we move out of the social marketing box we have placed ourselves in for so long? I suggest it is by first moving towards creating more permeable walls with disciplines that share our motives, values, interests and approach. An openness to new ideas will also occur as we embrace the transdisciplinary nature of marketing and the wicked problems we often tackle. And it also means thinking about what we do in new ways.”

What would you list as the best papers, books and resources you have seen in 2012? Leave a comment here, or continue the conversation at the International Social Marketing Association site. And if you missed the top social marketing papers of 2011.

Social Marketing: A Six Volume Series

2012-12-11T16:55:43-05:00

I have been working with SAGE to prepare a set of volumes that contain original articles and chapters to document the past, current and possible future directions of social marketing across the world. This work is expected to be released in February 2013. Pre-publication discounts are now available at their website.

I had several guiding principles for the selection of work to be included in this series. First, all papers have appeared in English language, peer-reviewed journals across the globe. A few book chapters are also included to develop a more complete picture of the published literature. Most of this work does not appear in introductory textbooks, and are often behind pay walls that prevent their broad awareness and use among academics and practitioners. Second, I have gathered examples from many parts of the world and on many different topics. I do not claim to be exhaustive in this curating, but have tried to be illustrative of many different points of view and experiences. Third, the papers in each volume form both a narrative of the development of the field of social marketing and to document many of the important milestones that have contributed to its growth and vitality. As you will discover for yourself, there is much we know about applying social marketing to specific health and social issues, but even more areas that remain unexplored. I hope that this series provides inspiration for the searchers for solutions to these and many other puzzles.

This series is especially intended for people and organizations that desire a comprehensive set of papers in social marketing. Be forewarned, the intended purchasers of this series are primarily libraries and organizations, not individuals (though you will make a great friend if you decide to gift it to them for the holidays!). Pass this post, flyer and/or website along to the people who make these kinds of purchases for your company, foundation, NGO, university, donor or government agency.

In the end, our intention is to provide a collection of papers that any student of social marketing, or any seeker of knowledge, can find insight and inspiration for how to address any of the wicked problems they confront in their communities or countries.

I want to extend a special thanks to several colleagues who responded to my request for help and for their suggestions of papers to include in this series: Alan Andreasen, Kelli Brown, Steven Chapman, Nancy Lee, Aarti Sewak and Alan Tapp.

Volume One: Social marketing: Conceptual frameworks and common ground

Volume Two: Social marketing in the developed world

Volume Three: Social marketing in developing countries - Part One

Volume Four: Social marketing in developing countries - Part Two

Volume Five: Applications of social marketing for sustainable behavior and environmental protection

Volume Six: Social marketing: Deepening and expanding the impact

"This collection is a superb reference source for anyone involved in promoting better health, education, environments, and communities to start their search for great ideas and guidance." Philip Kotler, Kellogg School of Management, Northwestern University

Sample articles that are included in the volumes:

The Pioneers - Philip Harvey

Social Marketing - Philip Kotler and Gerald Zaltman

Problems and Challenges in Social Marketing - Paul Bloom and William Novelli

Cultural and Structural Impediments to Social Marketing - Richard Manoff

Social Propaganda and Social Marketing: A Critical Difference? Nicholas O'Shaughnessy

A Method for Selecting Target Audiences for Public Health Interventions: Culturally and Linguistically Diverse Population Health Social Marketing Campaigns in Australia - Andrew Milat, Tom Carroll and Jennifer Taylor

An In-Depth Interview Study of Health-Care Policy Professionals and Their Research Needs - Sharyn Sutton and Elizabeth Thompson

The Influence of the National Truth Campaign on Smoking Initiation - Matthew Farrelly et al

The Shoreline Project for Street Drinkers: Designing and Running a Supported Housing Project for the 'Unhouseable' - Steve James and Heather Skinner

A Social Marketing Model for Disseminating Research-Based Treatments to Addictions Treatment Providers - Garth Martin et al

Community-Based Distribution: The Distributive Potential and Economics of a Social Marketing Approach to Family Planning - T.R.L. Black

The Importance of Socioeconomic Context for Social Marketing Models for Improving Reproductive Health: Evidence from 55 Years of Program Experience - Dominique Meekers and Stephen Rahaim

Social Marketing of Oral Rehydration Therapy and Contraceptives in Egypt - Karen Fox

Social Marketing Improved the Consumption of Iron-Fortified Soy Sauce among Women in China - Xinying Sun et al

Reduction of Childhood Malaria by Social Marketing of Insecticide-Treated Nets: A Case-Control Study of Effectiveness in Malawi - Don Mathanga et al

The Impact of a Hybrid Social Marketing Intervention on Inequities in Access, Ownership and Use of Insecticide-Treated Nets - Sohail Agha et al

Community Involvement in Social Marketing: Guineaworm Control - W.R. Brieger, J. Ramakrishna and J.D. Adeniyi

Behavioral Indicators of Household Decision-Making and Demand for Sanitation and Potential Gains from Social Marketing in Ghana - Marion Jenkins and Beth Scott

Promotion of Physical Activity in a Developing Country: The Agita São Paulo Experience - Victor Matsudo et al

Social Franchising of T.B. Care through Private G.P.s in Myanmar: An Assessment of Treatment Results, Access, Equity and Financial Protection - Knut Lönnroth et al

Implementing a Community-Based Social Marketing Program to Increase Recycling - Tracey Haldeman and Jeanine Warisse Turner

Integrating Social Marketing into Sustainable Resource Management at Padre Island National Seashore - Po-Hsin Lai et al

An Application of the Social Marketing Perspective to Environmental Policy Development: Information, Incentives and Pro-Environmental Consumer Behaviors - Paul Stern

Ready to Fly Solo? Reducing Social Marketing's Dependence on Commercial Marketing Theory - Sue Peattie and Ken Peattie

Extending the Vision of Social Marketing through Social Capital Theory: Marketing in the Context of Intricate Exchange and Market Failure - Alicia Glenane-Antoniads et al

Behavioral Economics and Marketing in Aid of Decision-Making among the Poor - Marianne Bertrand, Sendhil Mullainathan and Eldar Shafir

New Ways to Make People Save - Annamaria Lusardi, Punam Anand Keller and Adam Keller

Condom Social Marketing in Sub-Saharan Africa and the Total Market Approach - Steven Chapman et al

From Family Planning to HIV/AIDS Prevention to Poverty Alleviation: A Conversation with Mechai Viravaidya - Glenn Melnick

For more information about the series and price, and to see the complete list of articles that are included in the series.

Or download the flyer.

Examination Questions for Advanced Social Marketers

2012-12-10T16:36:23-05:00

What if social marketers began tackling the really wicked problems around health and health care? Where might we start?

More than 100 CEOs were recently convened by The Wall Street Journal to discuss and prioritize the most pressing public policy and business issues. One of the task forces focused on remaking health care. Here are their top four recommendations.

Population Health Management
Explicitly gear our system around population health. Create public-private partnerships to encourage healthy behavior, and identify specialty populations with unique needs, such as the seriously mentally ill. Reshape financial incentives to meet the goal of population health, and build capacity and reimbursement systems to support it. Have the administration clarify how to deal with the huge shift into insurance exchanges.

Transparent Standards
The Center for Medicare and Medicaid Services should develop, and require all public-health programs to adopt, uniform standards for health-care service quality, performance and price transparency so consumers can make value choices. And it should encourage states to follow suit.

New Delivery Models
Use the full continuum of care givers, such as nurses and other professionals. Create uniform standards for licensing care givers across the country, and encourage more care in retail clinics, pharmacies and other sites. Require patients' medical data to be available electronically.

Primary Care
Provide incentives to correct the imbalance of specialists to primary-care doctors by changing reimbursement rates, increasing funding for undergraduate and graduate medical education for primary care, and forgiving medical-school loans. Increase focus on advanced nurses and nurse practitioners as care providers.

If I were giving an essay final examination for advanced social marketers, it would look something like this:

Assume this group of CEOs has asked you to help them design an approach to address one of these four issues. Select one of them and draft a situation analysis that includes important individual, organizational and marketplace variables that are contributing to the current situation. What are some of the major competitive forces to consider? Identify any existing practices, programs or policies that might shed light on possible solutions to the puzzle. List up to five 3-5 year potential objectives. What are possible strategies to consider?
Based on this analysis, identify up to five priority groups that would be the focus of your social marketing approach.
Describe three research studies you would conduct to better inform your strategy and approach – especially questions they would each address and among what group(s).
From what you currently know (given the results of your research projects are not yet available), outline a social marketing approach for at least three priority groups that moves towards solutions for this issue.

Yes, this would be a “take-home” and “open book” examination and you have a week to complete it. Are you ready?

The Introduction to Social Marketing and Social Change

2012-11-15T17:33:46-05:00

"Daniel Pink (2010) has said: 'When the profit motive gets unmoored from the purpose motive, bad things are likely to happen.' Social marketers use marketing to serve the purpose motive.

The first reaction to the idea that marketing can be harnessed for good is often incredulity. Many people have the belief that marketing has a power that intrinsically corrupts and undermines their core philosophy of building a better world. As I will show in this book, that belief is incorrect.

Social marketing has evolved as well-intentioned people searched for innovative ways to address large-scale health and social issues, a search that began with trying to slow population growth in southern Asia and sub-Saharan Africa through better use of family-planning products and services and reducing the burden of cardiovascular diseases in communities in the United States and other developed countries through reducing risk behaviors. The ways in which marketing can negatively and positively affect society have been a long-running concern in the academic community. Much research has focused on questions about applying marketing to social issues. In contrast to other books you may have read in which social marketing is depicted as a series of steps in a program planning process and is buttressed by case studies to demonstrate that it works, this book takes a very different approach.

Social marketing is a discipline that has a variety of viewpoints on theoretical models, a multidisciplinary and substantial research base, and applications in many different fields. In this book I outline how these theoretical approaches have developed and are evolving. Psychological, or individual, theories of change must give way to social and community-based ones if we are to cross the micro-macro gap and have scalable impacts on the wicked problems and puzzles we are faced with in all contemporary societies. Previous social marketing textbooks have devoted little, if any, space to describing the research base of the discipline. Indeed, I have had academic colleagues say that social marketing is a practice without evidence. By the conclusion of this book, you may (finally) have a more positive view of the evidence base for social marketing. And as for the topic of practice, I have shifted its scope beyond employing social marketing to change the behavior of groups and segments of people, and I describe in detail how social marketing can change organizations, including your own, and the ways we think about and do innovation and dissemination - areas that receive little notice in the literature of the field or other texts...

For academics - if you are in a school of business, environmental sciences, public health, social work, or other discipline and are intent on contributing to positive social change, and preparing your students to be effective at it, this book presents a marketing perspective on how to approach health and social puzzles. Yes, there are many other ways of looking at such puzzles, and I hope this book will complement other approaches you use in your work. I also hope that as you read this book, some of the questions I raise might inspire you and your students to develop research studies to more thoroughly investigate these questions...

For students - there are many books to choose from to learn about social marketing. This book encapsulates how I have taught my students, by preparing them to be 'chefs,' not 'cooks.' Most social marketing texts are good at showing you ways to 'cook,' or prepare, a social marketing program with a basic menu of steps and tactics. My aim is higher - to provide you with frameworks you can use to create menus, new combinations of tastes, and most important, to assist you to learn a variety of ways to understand and work with the people you wish to serve…

For change agents - even if you are not teaching or taking a course in social marketing, you can pick up this text and apply its contents to your program and in your organization tomorrow. Yes, it addresses history, theory, and research, but throughout you will also find checklists and practical advice and ideas. One intention behind this book is to help you reflect on what’s missing from your organization’s efforts and also what’s getting in the way of its doing better at doing good. How can your project or organization create more effective, efficient, sustainable, and equitable solutions to public health and social puzzles? How can it address scaling up programs and diffusing (or better yet, increasing adoption of) evidence-based practices and policies? You should find some new ideas about possible answers here.

For managers - whether you work in the private, public, or nonprofit (NGO) sector, if your mission is to solve social puzzles then you will find in this book the ideas that are important for designing, implementing, and evaluating your programs from a marketing point of view. I have carried out much of my work side by side with senior managers in each of these sectors; the questions you have are different from the operational ones other textbooks address. Indeed, the importance of strategic social marketing is a guiding principle for this book. I present a marketing-based, strategic framework for addressing social puzzles that is elaborated in each chapter. You may find the discussions of program monitoring, balanced scorecards, and organizational marketing audits particularly useful. I also dedicate a chapter to the concerns that managers, and people who want to become managers, can or should have when it comes to organizing and implementing big change programs. If nothing else, perhaps this book will help you and your staff to spend more time understanding and really knowing the
people you serve and the ones important to your success...

I hope that many of you will decide to read this book because of your interest in and passion for improving the ways in which you approach changing your own corner of the universe. This book is a distillation of what I have learned in twenty-five-plus years of research and practice in co-creating social marketing. In deciding what to include, and what to leave for another time and place, I have tried to select what is currently important in social marketing, what will matter for the next few years, and most of all, what will improve your ability to innovate solutions to wicked problems. When you finish this book, you will find that the scope of social marketing is broader than using concepts such as the 4Ps and having a set of steps to follow. Indeed, one person who reviewed an early draft of this textbook began their commentary with this story:

'Two frogs met in the woods. One very proudly takes the other to its pond, and shows off the pond. The other frog is very courteous and admires the pond. It tells the first frog that it comes from the ocean, and asks if the first frog would like to see it. They hop through the woods and around a corner to the beach. The first frog sees the ocean - and its head explodes!'

Welcome to my ocean."

From: Lefebvre, R.C (in press). Social marketing and social change: Strategies and tools for improving health, well-being and the environment (San Francisco: Jossey-Bass, expected 2013).

NOW AVAILABLE FOR limited time pre-order at a 20% discount. Use code MPH20 at checkout.

Reference

Pink, D. (2010). Drive: The surprising truth about what motivates us.

Social Marketing: Shifting from Individual Skills to Organizational Competence

2012-11-12T14:25:04-05:00

"Slater & Narver (1994) stated that a marketing orientation is a particular form of organizational culture. This culture can be characterized as having a focus on interactions with one’s customers and then looking within the organization to explore how the knowledge gained from these interactions can be integrated with existing capacities and experience to build organizational responses - whether they be product or service offerings, communication campaigns, or policy initiatives (Ind & Bjerke, 2007). Several surveys of businesses that vary in their consumer orientations have found that in addition to achieving the stated objective of delivering more value to customers, a market orientation is positively related to overall business performance, the commitment of employees to the organization, and those employees’ overall attitude and job satisfaction. The same surveys also identified that without top management support, an ability to tolerate risk among top managers, interdepartmental connectedness, a moderate level of centralization, and the orientation of reward systems that support a consumer focus, most organizations will not be able to adopt this cultural practice (Ind & Bjerke, 2007).

Even with the best of intentions, the introduction of social marketing practice - one centered around people - can run into a number of problems. Among the major barriers identified by Lefebvre (1992) are:

♣ A poorly defined organizational mission and objectives (usually due to a lack of consensus and inadequate consumer assessment.

♣ A lack of understanding about and focus on key priority groups and stakeholders.

♣ Political and professional pressures that supersede consumer needs.

♣ Organizational biases that favor expert-driven programs.

♣ The influence of intermediaries who seek to shape program objectives and offerings to meet their own agendas.

♣ A sense of urgency that often accompanies new initiatives and serves as a rationalization for shortcuts.

Ind and Bjerke (2007) outlined a three-step process for addressing some of the barriers to achieving what they refer to as a participatory market orientation within an organization.

1. Recognize the organization-wide responsibility to gather information about, and especially insights into, the various markets that could be better served.

2. Develop the ability and systems to connect people internally in developing responses to this market information that are consistent with the organization’s vision and values.

3. Mobilize organizational and stakeholder resources into action.

Ind and Bjerke also pointed out that the inability to collect meaningful and usable insights, the failure to share them with others in the organization in a meaningful and timely fashion, and the further failure to galvanize organizational actions to deliver resources in response to these insights are additional barriers to achieving a market orientation.

Although there are dozens of books about managing the marketing functions in nonprofit and commercial organizations, there is very little in the social marketing literature that addresses management questions. Lefebvre (1992) suggests the use of a marketing audit to identify organizational strengths and weaknesses as they relate to social marketing functions. The results of this audit do not necessarily lead to a wholesale reorganization of the agency; rather, staff can focus on addressing as many, or as few, areas that need attention as resources and other agency demands allow. In addition, such a process should have its own internal marketing plan with achievable objectives for adopting certain social marketing practices and time frames for their accomplishment."

From: Lefebvre, R.C (in press). Social marketing and social change: Strategies and tools for improving health, well-being and the environment (San Francisco: Jossey-Bass, expected 2013). Link

References

Ind, N., & Bjerke, R. (2007). The concept of participatory market orientation: An organization-wide approach to enhancing brand equity. Brand Management; 15:135–145.

Lefebvre, R. C. (1992). Social marketing and health promotion. In R. Bunton & G. Macdonald ( Eds.), Health promotion: Disciplines and diversity. London: Routledge, pp. 153–181.

Slater, S.F., & Narver, J.C. (1994). Does competitive environment moderate the market orientation-performance relationship? Journal of Marketing; 58:46-55.

Natural Helper Networks in Community Social Marketing Programs

2012-11-07T03:14:00-05:00

"The notion of using volunteers or, more generally, natural helper networks, is a popular method in advocacy and social cause campaigns but seems woefully neglected by many social marketers. The idea of using informal helping networks in public health programs traces its roots to studies of South African primary health care centers in the 1940s and 1950s. These studies focused on the ways in which engaging natural helping networks in health care delivery led to a variety of positive changes in health among patients as well as positive changes in health center staff ’s ability to understand and empathize with the daily lives and challenges of their patient population. This work was later transplanted to rural communities in North Carolina and spawned a number of church-based interventions in the 1980s aimed at serving black populations (Eng, Rhodes & Parker, 2009). By the 1990s, the idea of natural helpers was being adopted by public health researchers as a way of working effectively with Hispanic populations and other specific population groups and segments.

Natural helpers include family and friends; neighbors; people whom others naturally turn to for advice, support, and tangible aid; role-related helpers (including ministers, hairstylists, and shopkeepers who come into contact with people in the course of their work); people with similar problems; and volunteers. Lay health advisors is a term used to describe a more formal role these natural helpers might play in an intervention. One review of the literature found that lay health advisors have been used to address specific health needs of priority populations in HIV/AIDS and other sexually transmitted disease prevention programs, mammography screening programs for women, other cancer detection efforts, cardiovascular risk reduction projects (smoking, weight loss, nutrition, blood pressure management, and physical activity programs), and perinatal education efforts (Fleury, Keller, Perez & Lee, 2009). More recently, in the context of a community-based social marketing effort, Hill, Hill, and Moore (2009) recruited and trained volunteer peer activist facilitators to deliver parenting programs to parents and caregivers of children up to four years old.

As we consider social marketing programs operating in community settings where resources are constrained and where innovating sustainable and equitable solutions to puzzles is a priority, we see that these natural helper networks are not only delivery agents of behavior change programs but also proactive agents for social change as well. This means that the people whom we think of as potential or actual volunteers need to become part of our marketing program and assume the status of an important priority group: people critical to success. These are people that we need to understand in terms of their perceived benefits for participating and also the value they receive from that experience; to track in terms of their involvement, contributions, and satisfaction with our programs; and to give serious consideration to in terms of offering them appropriate ways to serve our program and their communities.

Roncarati et al. (1989) presented a detailed marketing approach to volunteer development that included identifying program needs; developing relevant recruitment strategies; providing screening and training procedures; and establishing ongoing communication and evaluation processes between volunteers and staff, including recognition and reinforcement, participation tracking, and bidirectional evaluation of both the volunteers and their experience of program support. These authors also note the various reasons, or motivations, people have for volunteering for specific roles in a program, including affiliation, power, and achievement. These reasons need to be considered in recruitment and retention efforts. Boehm (2009) described a social marketing perspective to volunteer efforts operated by a nonprofit organization in Israel. He points out that conceiving of volunteering as a social product is important because it can lead to segmentation strategies for the potential pool of volunteers, the positioning of volunteer activities to each segment, a reduction in the costs of volunteering, an emphasis on the unique incentives for different groups of potential volunteers, the creation of available and appropriate volunteer opportunities, and diversity in promotional activities."

From: Lefebvre, R.C (in press). Social marketing and social change: Strategies and tools for improving health, well-being and the environment (San Francisco: Jossey-Bass, expected 2013).

References

Boehm, A. (2009). Applying social marketing in the development of a volunteer program. Social Marketing Quarterly; 15:67–84.

Eng, E., Rhodes, S. D., & Parker, E. (2009). Natural helper models to enhance a community’s health and competence. In R. J. DiClemente, R. A. Crosbyb& M. C. Kegler (Eds.), Emerging theories in health promotion practice and research (2nd ed.). San Francisco: Jossey-Bass, pp. 303–330.

Fleury, J., Keller, C., Perez, A., & Lee, S. M. (2009). The role of lay health advisors in cardiovascular risk reduction: A review. American Journal of Community Psychology; 44:28–42.

Hill, A., Hill, R., & Moore, S. (2009). Product evaluation in a social marketing and community
development context: A case study and initial report. Social Marketing Quarterly; 15:92–104.

Roncarati, D. D., Lefebvre, R. C., & Carleton, R. A. (1989). Voluntary involvement in community
health promotion: The Pawtucket Heart Health Program. Health Promotion; 4:11–18.

Incentives for Change in Public Health and Social Marketing Programs

2012-10-31T16:25:20-04:00

"The idea of price as an incentive mechanism for social marketers can be traced back at least to Lefebvre and Flora (1988; link to pdf). The two cases they used to illustrate their approach to incorporating social marketing into public health interventions included charging people nominal fees for participating in community blood cholesterol screening programs and awarding prizes for participating in a quit smoking contest. Charging fees for this screening service is much like the product pricing models used in social marketing programs in developing countries. The latter approach of offering prizes has been successfully diffused around the world to attract community and workforce participants into behavior change programs and to reward some successful achievers of the behavioral goal with prizes, which are usually determined through a random drawing (Nelson et al.,1987; O’Connor et al., 2006)...

[Ed Note: Here is a summary of some of the work in using incentives for behavior change since then].

In reviewing the results of eleven Quit & Win smoking cessation contests conducted throughout New York State that enrolled over 5,504 adult smokers, with each program offering a cash prize of $1,000, O’Connor et al. (2006) found that nine out of ten smokers who enrolled in a contest reported making a quit attempt, and between 53 percent and 72 percent reported quitting for the full month of the contest. Maintenance of nonsmoking status at four to six months ranged from 22 percent to 49 percent, with an average of 31 percent. Based on a statewide population survey, eight of the eleven programs showed quit rates that were significantly higher than the estimated quit rate of 21 percent reported by smokers who made a quit attempt in the past year. These authors concluded that for a relatively modest investment (ranging from $4,345 to $91,441), promotional contests with a monetary incentive can recruit thousands of smokers to make a serious quit attempt, with many remaining smoke-free months later...

A systematic review of forty-seven studies that evaluated the effects of economic incentives on consumers’ preventive health behaviors was conducted by Kane, Johnson, Town, and Butler (2004). They categorized the preventive behaviors as complex when a sustained behavior change was required and as simple when the behavior was more of a one-off proposition, such as an immunization. They found that economic incentives worked 73 percent of the time (74 percent for simple behaviors, and 72 percent for complex ones) and were most effective for short-term changes or simple preventive care with well-defined behavioral goals. They were unable to ascertain whether such effects would last over the long term...

Wall, Mhurchu, Blakely, Rodgers, and Wilton (2008) found support for using economic incentives to modify dietary behaviors including food purchases, food consumption, and weight loss. Their evidence came from four randomized trials they identified in the literature that compared interventions using incentives to comparable interventions without incentives or control conditions. They noted that small sample sizes and the short duration of the studies limited the generalizability of their findings. Thus these promising results point to the necessity of supporting larger-scale studies, especially ones aimed at high-risk population groups…

In a review of research using financial incentives across a diversity of groups for various health behaviors, Marteau, Ashcroft, and Oliver (2009) reported that the evidence for incentive effectiveness may be strongest in drug abuse treatment programs but that incentives seemed to have little effect on smoking cessation or weight loss efforts (also see Paul-Ebhohimhen & Avenell, 2007). As others have noted, economic incentives do appear to increase discrete, infrequent behaviors such as attending clinic appointments or receiving vaccinations - especially among people from lower-income groups. What is encouraging is that adherence to treatment protocols, particularly for tuberculosis and antipsychotic medications, seems to be responsive to economic incentives as well.

However, Marteau and colleagues (2009) found that among the unintended consequences of economic incentives for behavior change, when studied in classrooms and workplaces, is that intrinsic motivation is weakened. Whether this effect holds true for health behaviors is unknown. These authors also note that the exchange relationship is altered when switching from social rewards to financial ones. The ways in which service relationships (such as those between health care providers and patients) may be altered by incentives or Conditional Cash Transfer programs is also unexamined.

The issue of whether financial incentives are appropriate, even when they do work, is a concern among many groups of people, especially when the behaviors involved relate to health or other prosocial choices. Among the concerns about using financial incentives that Marteau et al. (2009) identify are that offering incentives is bribery or paying people do things against their own wishes, it is implicit or explicit coercion, it is a waste of public monies, it creates a sense of unfairness in that people should be expected to act in the preferred manner without monetary rewards, and it encourages a sense of dependence or entitlement among various socioeconomic groups. Marteau et al.’s conclusion is that even though financial incentives have been shown in some cases to be effective in changing behavior, under what conditions, for whom, and with what unintended outcomes remain to be determined. Yet Marteau et al. also offer these insights about using incentives:
♣    Using payments can be more powerful than providing information and less restrictive than legislation in changing behaviors.
♣    Targeting habitual behaviors such as smoking cessation and physical activity with schemes that provide valued incentives on an intermittent basis and are embedded in effective behavior change programs can lead to initial as well as sustained behavior change.
♣    Relatively simple behaviors such as clinic attendance and participation in vaccination programs can be increased through offering small incentives that are immediately available.
♣    An incentive program must be acceptable to the general population, health care professionals, and policymakers."

Adapted from: From: Lefebvre, R.C (in press). Social marketing and social change: Strategies and tools for improving health, well-being and the environment (San Francisco: Jossey-Bass, expected 2013).

References

Kane, R. L., Johnson, P. E., Town, R. J., & Butler, M. (2004). A structured review of the effect of economic incentives on consumers’ preventive behavior. American Journal of Preventive Medicine; 27:327–352.

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

Marteau, T. M., Ashcroft, R. E., & Oliver, A. (2009). Using financial incentives to achieve healthy behaviour. British Medical Journal; 338:b1415.

Nelson, D. J., Sennett, L., Lefebvre, R. C., Loiselle, L., McClements, L., & Carleton, R. A. (1987). A campaign strategy for weight loss at worksites. Health Education and Research: Theory and Practice; 2:27–31.

O’Connor, R., Fix, B., Celestino, P., Carlin-Menter, S., Hyland, A., & Cummings, K. M. (2006). Financial incentives to promote smoking cessation: Evidence from 11 Quit and Win contests. Public Health Management and Practice; 12:44–51.

Paul-Ebhohimhen, V., & Avenell, A. (2007). Systematic review of the use of financial incentives in treatments for obesity and overweight. Obesity Reviews; 9:355–367.

Wall, J., Mhurchu, C. N., Blakely, T., Rodgers, A., & Wilton, J. (2008). Effectiveness of monetary incentives in modifying dietary behavior: A review of randomized, controlled trials. Nutrition Reviews; 64:518–531

Social Marketing and Marketing Social Services

2012-10-22T16:58:37-04:00

"Given the sheer numbers and ubiquity of social services available to meet people’s needs and work toward a better society, there have been few documented efforts to integrate social marketing into service delivery... One shortcoming many social marketers have is that they are unaccustomed to designing services. It is often the case that marketers are brought into a service delivery environment to solve what is framed as a communication problem - typically having to do with recruitment or retention of clients - that “needs” a communication or advertising campaign. What goes unexamined from a marketing perspective is the nature and quality of the service offering, its place and price variables, and client satisfaction with the service (would clients recommend it to a friend?). In some instances the organization may commission research among the priority population for the service (prospective clients), current clients, and even past ones. The default objective is to seek insights that can inform development of a persuasive messaging campaign. But what if we could help service providers to offer services that require almost no organized promotion effort on their part? What might that look like? With whom do we really need to conduct our research to solve the puzzle?

The illustration identifies the topics of the key marketing questions that need to be addressed for the three groups most involved in the development and success of any service offering. The first circle in the diagram, Us, represents the organization responsible for developing, implementing, and managing the service offering. Three key questions that the organization must continually pose and answer for itself are:

•    Is the service effective in meeting organizational objectives (for example, in the composition and number of people served, in addressing unmet needs in the community, and in achieving equitable behavior change outcomes)?
•    Is the service efficient in its use of resources (for example, in terms of transparent and accountable allocation of public funds, best use of staff time, and costs per outcome—however defined—that are less than the costs of other viable alternatives)?
•    Is the service distinctive (for example, does it serve a unique priority group, does it offer unique services or value, and do potential users and stakeholders view it favorably in relation to similar programs or competitors)?

The second circle represents clients. The three core questions that a service offering must answer from clients’ point of view are:

•    Is the service provided useful for people in meeting their basic needs, solving a situational or chronic problem, making daily life a bit easier (and perhaps more fun), or helping them achieve goals for themselves or for people they care about?
•    Can they use the service (for example, is it tailored to their culture and literacy level; is it accessible and convenient; and is it affordable, not just with respect to money but in terms of opportunity, psychological, social, and temporal costs as well)?
•    Is the service program desirable or something they would want to engage with (for example, is it promoted to them in a way that makes it seem like a worthwhile experience, do people they know talk about it and recommend it to them, and is what it is offering valuable for them in their daily life)?

The third ring in the diagram represents our colleagues (including stakeholders), the people with whom our service interacts throughout the client journey of discovering our service, being referred to it, concomitantly receiving services from other agencies, or being referred by us to other agencies for follow-on services. Thus the perspectives of colleagues—especially those who are promoters of our service, referral sources, collaborators on service offerings, or agents for continuation of services—also need to be considered in designing our service offering. Colleagues and stakeholders have at least three key questions we need to address:

•    Are the services reliable (for example, are qualified people delivering the services, are service offerings based on evidence and professional recommendations and guidelines, and do staff respond to my inquiries promptly and follow through on promises they make to me)?
•    Are the services dependable (for example, when clients are referred are they seen within a reasonable period of time, are their needs and problems being addressed, and am I kept abreast of what the service organization is doing and any change in its scope or plans)?
•    Is it helpful (for example, does it reduce or streamline my work-flow burden, is it offering value to my clients and organization, and can I count on it when I need help)?

In developed countries, I see the need for marketers and change agents to become more involved in service design and marketing. This requires increasing the value placed on marketing and also service providers’ perceived need for marketing beyond communication campaigns. It also requires marketers and change agents to become more knowledgeable and experienced with service delivery and not just message design... As the saying goes, if all we have is a hammer, everything looks like a nail. Likewise, if all we know how to do is design and test messages, then everything looks like a communication problem."

Creating Personas for Priority Groups of Social Marketing Programs

2012-10-17T15:46:48-04:00

"Most agencies and organizations rely on the collection and analysis of demographic data from secondary sources, such as demographers in census bureaus, national or local epidemiological studies, or commercial market reports and databases, to make decisions about segmentation and selection of priority groups. Much of the thinking of most marketers, not just the social ones, is colored by questions about age, gender, race, ethnicity, martial status, occupation, size of household and by other demographic information that also lends itself to easy questions (for surveyors) and quantitative analysis. Though relied on for all sorts of health and social policymaking, these data do not provide the understanding of a priority group that leads to insight and effective marketing and communications efforts.

One way to address this shortcoming is to design segmentation and consumer research efforts that have as a primary objective the creation of archetypes or personas (these terms are interchangeable and are used by many advertising, design, and communication professionals). An archetype or persona represents the essence of a priority group, often captured and presented in caricature form, though it is not unknown for agencies to hire actors, develop scripts, and videotape scenarios to develop an in-depth understanding of a group and also be able to communicate that understanding and empathy to clients and stakeholders. These personas or archetypes might be developed for current or desired users of products or services as well as for people who engage in a behavior we are trying to change or who are open to trying a new behavior.

A persona representing a priority group we have identified might include
♣    A fictitious name (“Harry,” for example) and picture or photograph.
♣    Demographics and life stage (such as age, education, ethnicity, family status, children in home, career focus).
♣    A description of Harry’s values or approach to life.
♣    Harry’s emotions and attitudes toward the behavior being targeted or the product or service being offered.
♣    Actions Harry would likely take when interacting with our organization or as a consequence of exposure to our marketing activities.
♣    Places (life path points) and media where Harry can be reached.
♣    Personal traits that are relevant to the puzzle we are addressing and to how we and Harry might solve it together. These traits should help staff and partners connect with the type of person who is your program priority. Examples might include Harry’s hobbies or interests, attitudes toward health or climate change, a source of pleasure or inspiration for him, a habit Harry deserves, a habit Harry wants to kick, something in Harry’s life that is under control or out of control.
♣    A fictitious quotation from Harry that sums up what matters most to him with relevance to our offering (for example, the underlying benefit or value proposition Harry is seeking or what motivates him to try new things).

This archetype distills our understanding of the priority group members, insight into what motivates them, what emotions resonate with them, and what actions they are ready to undertake. However, describing the persona is also a creative opportunity for staff and collaborators to bring the person to life for themselves and others. Any and all data sources can provide valuable inputs for the development of a persona. Data should not be limited to what is gathered in formal research activities but can include things we learn from interactions we have with people from a priority group in our daily lives. Some research purists will take issue with this last point, but that makes my point. Developing understanding and empathy is not a research project - it comes from experiences we have with people.

Personas for Priority Groups to Address Concurrent Sexual Partnerships

As an example, the following three personas were generated to synthesize research findings for a campaign developed by PSI to increase discussions about concurrent sexual partnerships (CSP) and encourage reductions in CSP prevalence among three priority groups (PSI, 2010).

Married and/or Cohabiting Urban Man

Munya is 35 years old, married with two children. He values his children and aspires to send them to better schools. He lives in a low income suburb and runs a small business fixing cars. He owns a modest car and aspires to buy a better car to improve his “status” especially among his friends. He also aspires to own a home in one of the affluent low density suburbs. Munya’s life is very busy, as running his own small business is demanding. He finds his sex life boring and seeks extra marital partners to meet his sexual needs. Munya has two “small houses” Nancy and Rutendo. Nancy has been Munya’s “small house” for about 5 years and she really understands him. Rutendo is beautiful and fun to be around. He normally sees both of them every day. Munya does not use condoms with Nancy as he “trusts” her though he uses them inconsistently with Rutendo. Munya occasionally spends time with his drinking buddies, watches television and listens to the radio. He occasionally worries that maintaining small houses is expensive, but at the same time thinks the girls are worth it.

Single Never Married Woman

Fadzi is in her early 20s, single and a college student. She lives in a one room rented accommodation. She likes to party, braai, dance and drink at places such as outdoor entertainment spots that include Mereki, Globe Trotter, Car Wash and IBs. She loves having the 3 C’s (cash, car and cell phone) and other luxuries. She has several friends that she hangs out with and confides in her closest friend, Mona. She has several partners and uses condoms with some of them because she does not trust them. She is more worried about pregnancy and the disappointment and embarrassment to herself and her family. Fadzi does not believe that being involved in overlapping sexual relationship will prevent her from realizing her full ambition of being a graduate, running her own business and getting married. She believes that having more than one sexual partner at the same time makes her more popular among her peers.

Married and/or Cohabiting Rural Man

Gibson is a 32 year old married man living in the rural areas. He has three children and also looks after his brother’s children. He runs a butchery at a rural business centre in Mhondoro. He spends most of his time at the bottle store, drinking beer with friends and relatives. Gibson has several girlfriends and occasionally sleeps away from home and his grandmother covers up for him. He trusts his “small house” Ropa and his “sweet sixteen” Rachie and does not use condoms with them as he believes he is the only man in their lives. He uses condoms with Audrey and Nyasha and other casual girlfriends because he worries about the risk of HIV infection. He wants to succeed in life and provide well for his family. Gibson hopes to expand his business and looks forward to a healthy life. His sex life at home is boring and he spices it up by having extra marital affairs though he is worried about being discovered by his wife and mother. He listens to the radio and reads the newspaper whenever he gets access to one.

Many social marketing and social change projects overlook the development of a persona. Yet if we are to create programs that serve people it is important for us to have a person in mind - not a collection of numbers - before developing a marketing plan and designing relevant strategies and tactics. The practice of developing a persona is virtually sacrosanct among advertising creative staff, designers, and social marketers, where a vivid portrayal of a typical member of the priority group is a necessary precondition to the development of products, services, and communication campaigns that will have an emotional resonance with that group (Brown, 2009; Lefebvre et al., 1995; Roberts, 2005; Sutton, Balch & Lefebvre, 1995). The challenge is to create a persona that rises above a stereotype and is someone with whom staff can engage. That is, we need to construct a persona that is not met with “so what?” responses but that inspires people to ask, “What would Harry (or Munya, Fadzi or Gibson) say about that idea?”

An understanding of our priority population that is assisted by a vivid persona, or spokesperson, will also help us communicate internally about priority groups in policy and strategy discussions. Numbers in a data table communicate one set of attributes about people; photos or drawings, names, hobbies, passions, and a vivid understanding of people’s daily lives (or life flow) convey a quite different set of attitudes and feelings to employees, partners, and stakeholders. Archetypes and personas help to create a shared understanding and empathy among all of the concerned parties about the people they wish to serve. And as with other processes described in this book, it is highly desirable to make the development of the persona a co-creation exercise with representatives from the priority group as well as with employees, existing customers, partners, and stakeholders. All of these perspectives can contribute knowledge and understanding to create a platform for the design of the social marketing program."

References

Brown, T. (2009). Change by design: How design thinking transforms organizations and inspires innovation. New York: HarperCollins.

Lefebvre, R. C., Doner, L., Johnston, C., Loughrey, K., Balch, G., & Sutton, S. M. (1995). Use of database marketing and consumer-based health communication in message design: An example from the Office of Cancer Communications’ “5 A Day for Better Health” program. In E. Maibach & R. Parrott (Eds.), Designing health messages: Approaches from communication theory and public health practice. Newbury Park, CA: Sage, pp. 217–246.

PSI. (2010). Concurrent sexual partnerships in Zimbabwe: Using DELTA to develop a marketing plan for a complex behavior. Washington DC: PSI, Global Social Marketing Department.

Roberts, K. (2005). Lovemarks: The future beyond brands. Brooklyn, NY: Powerhouse Books.

Sutton, S. M., Balch, G. I., & Lefebvre, R. C. (1995). Strategic questions for consumer-based health communications. Public Health Reports; 110:725–733.

Image from Slice|Works.

Does Marketing Make Us Fat?

2012-10-12T18:28:27-04:00

"Does food marketing need to make us fat? A review and solutions" by Pierre Chanson and Brain Wansink in this month's Nutrition Reviews is a long needed reality check for public health professionals and social marketers who are working on obesity prevention and management.

The authors examine the question: "How [can] food marketers could continue to grow their profits without growing their customer’s body mass index (BMI)?" They provide an integrative review of marketing, consumer research, social science disciplines that rarely appear in health and medicine publications on the topics of food, obesity and health (269 references!). It is a welcomed piece to start removing the blinders, or changing the frame, that too many people bring to the subject.

They state the case clearly:
"Food marketers influence the volume of food consumption through four basic mechanisms that vary in their conspicuousness. 1) The short- and long-term price of food, as well as the type of pricing (e.g., a straight price cut or quantity discount), can influence how much people purchase and eventually consume.Pricing efforts are generally conspicuous and lead to deliberate decisions. 2) Marketing communications, including advertising, promotion, branding, nutrition, and health claims, can influence a consumer’s expectations of the sensory and nonsensory benefits of the food.Marketing communications comprise the most recognized form of influence and the one most closely scrutinized by marketing and nonmarketing researchers. The influence of marketing communication can sometimes be as conspicuous as price changes, but consumers are not always aware of some of the newest forms of marketing communication (e.g., “advergaming,” package design, or social media activities) and, even when they are aware of the persuasive intent behind these tools, they may not realize that their consumption decisions are being influenced. 3) The product itself, including its quality (composition, sensory properties, calorie density, and variety) and quantity (packaging and serving sizes) also influence in a variety of ways how much of the product consumers eat. This area has been frequently researched as marketing communication. 4) The eating environment, including the availability, salience, and convenience of food, can be altered by marketers. Compared to the breadth of the domain, this is the least frequently studied area, yet it is the one most likely to be driven by automatic, visceral effects outside the awareness and volitional control of consumers." (p.572).

This review should be required reading for anyone who is working on obesity prevention and thinking about public health interventions. Their insights into how food marketers can improve their financial and social bottom-lines may also lead to some interesting collaborative opportunities. For example,

Provide quantity discounts through bulk packaging of fruits and vegetables like at membership warehouse clubs such as Sam’s Club and Costco.
Offer “free quantity” promotions for healthy food (e.g., larger packs, buy-one-get-one-free, etc.).
Give coupons or discounts on fruit and vegetables, such as $1 off salads; buy salad get a free small fry; buy one salad get another half off.
Increase healthy eating in the media; in movies and TV shows portray characters eating healthily, especially in media geared towards children.
Co-brand healthy items with popular brands (that may not necessarily be known for being healthy).
Co-brand and add licensed characters onto produce packaging.
Advertise produce websites on fruit stickers.
Develop foods that contain textures, ingredients, and nutrients that accelerate satiation (so that people stop eating faster) but extend satiety.
Use multi-sensory displays to help people imagine what it will feel like to eat aromatic, soft, complex, visually appealing fruits. For example, pipe in the smell of fruit to a supermarket produce section.
Add a smaller size on the menu. Even if nobody chooses it, it will make other sizes look bigger and will lead people to choosing smaller sizes.
Restaurants should display fruits and vegetables or other healthy options near the entrance and slice and package them in an appealing way.

"For-profit food marketers are not focused on making people fat but on making money…[T]he mission assigned to most food marketers is to understand what different consumer segments desire and to profitably offer it to them. In general, what many people want in the short term is tasty, inexpensive, varied, convenient, and healthy foods – roughly in that order of benefit importance. The marketer’s mandate is to help identify and create foods that deliver these benefits better; to communicate these benefits; to profitably package, price, and distribute these foods; and to protect these innovations by branding the food so that it acquires unique and positive associations in the mind of consumers." (p. 587).

Thanks to Nutrition Reviews for making a free pdf of the article available to all of us.
Further Reading: I have a number of posts about social marketing and obesity prevention.

Note: Brain Wansink will be a plenary speaker at the World Social Marketing Conference in Toronto, 21-23 April 2013.

The Empathy Link in Social Marketing

2012-10-11T12:23:30-04:00

"Practitioners of the design discipline use the idea of empathy as a key driver for their research; social marketing research should do the same. Brown (2009) identifies connecting with people as the most important distinction between academic thinking and design thinking. Indeed, many design research techniques are crafted to put designers in front of, and more important alongside of, people whose lives they hope to improve in some way. Such empathetically directed techniques, in contrast to data-driven ones, can help to uncover both the needs people have that they may not be aware of and the emotions that guide their behaviors. Social marketing can learn from these structured efforts to see the world through the eyes of others, understand it from their experiences, and feel it through their emotions. Designers deeply believe that when they make this connection their work becomes more relevant and effective in addressing social concerns. It is a world away from sitting behind one-way mirrors, using software to analyze transcripts, and reviewing survey data tables.

Roberts (2005) stated the case for empathy this way: “Embrace emotion. Feel it yourself, don’t just analyze it in consumers. This is how long-term relationships are made” (p. 190). He believes that we understand people’s emotions and inner workings not by asking about them but by listening. The struggle I often see in social marketing research is over how many questions can be fitted into an interview session or focus group guide. Perhaps we need to start asking a different question in such discussions: why should we ask any questions at all? And if we do ask questions, which ones will create a space in which we can listen, and not simply be doing satisfaction research?

Finding Empathy (by Mistake) in Focus Groups

My colleagues and I were conducting focus groups with eighth-grade girls to develop some perspectives for a sexual health education curriculum. The idea was to get them to tell us about the sexual health topics they would talk about among themselves, or with boys (none!), and to learn the language and approach they use in order to inform the development of our materials. Early on in one of the groups it became obvious to me (but unfortunately not the moderator) that one girl who had initially offered several perspectives on sexual behaviors in school suddenly became very quiet after two other girls dismissed her ideas as not what they had experienced. For the next ten minutes or so, she simply checked out of the session. It was her reaction, more than the conversation that continued, that stuck with me, until finally I asked for the moderator to be called out of the room for a quick consult. (Some people believe that moderators should finish a session before consultants or program developers talk to them, but in my experience, by that point the opportunity to learn something has passed.) I needed to know what was behind this girl’s behavior, and I asked the moderator to go back in, directly ask her what had happened, and try to reengage her in the group process.

The moderator did as I asked, and the girl was quite willing to share what she was thinking: “These girls have no idea what they are in for!” As it turned out, this young woman had met the age eligibility for the focus group but was a ninth grader. And as she quickly began describing the sexual harassment she was suffering as a high school freshman, not only did the other girls in the group become very quiet but so did everyone in the observation room. What became obvious to us was that the eighth-grade girls, who were now at the top of the pyramid in the power structure of their elementary schools, were going to find a whole different reality at the bottom of the high school one. And while the girls in this eighth-grade group could not now imagine themselves being in such a lowly position, it was impossible for the rest of us not to empathize and understand from this one young ninth-grade woman that sexual health education in eighth grade needed to be all about sexual health survival in ninth grade. It remains my firm belief that no probe or survey could have told us that. Indeed, if not for the happenstance that she was inadvertently included in the focus group, we would not have had that experience or insight at all. We nearly engineered insight and empathy out of the process through our recruitment procedures - and how many times is that done around the world in too many research projects?"

From: Lefebvre, R.C (in press). Social marketing and social change: Strategies and tools for improving health, well-being and the environment (San Francisco: Jossey-Bass, expected 2013).

References

Brown, T. (2009). Change by design: How design thinking transforms organizations and inspires innovation. New York: HarperCollins.

Roberts, K. (2005). Lovemarks: The future beyond brands. Brooklyn, NY: Powerhouse Books.

Segmentation to Address Racial and Health Inequalites

2012-10-08T14:18:30-04:00

"The use of segmentation to identify specific groups of people has become a well-known tactic of many commercial marketers. In their efforts to sell more products to consumers, these commercial marketers may also be increasing behaviors that pose a risk to individuals’ health. Evidence for this effect has been found for food and beverage marketing to the African American population (Grier & Kumanyika, 2008); for the alcohol industry’s marketing to young people (Hastings, Anderson, Cooke & Ross, 2005; Jackson, Hastings, Wheeler, Eadie & MacKintosh, 2002); and for tobacco marketing in low- and middle-income countries, which has been linked with observed increases in smoking prevalence in these countries (Glynn, Seffrin, Brawley, Grey & Ross, 2010). That corporate marketers use segmentation and targeting to increase risky behaviors - and thus the morbidities and mortality associated with these behaviors - is not an argument against the use of segmentation by social marketers and social change agents in their programs. If anything, corporate use of marketing makes it all the more important for social marketers to harness marketing to counter negative effects in these nations and communities and to apply critical marketing to expose and reduce corporate marketing practices (Hastings, 2012).

Hornik and Ramirez (2006) examined the use of segmentation to address racial and ethnic disparities. They noted that many large-scale projects build racial or ethnic segmentation into their efforts by developing specific program components aimed at groups such as African Americans, Asian Americans, Hispanics (or Latinos), or Native Americans (cf. Institute of Medicine, 2002). They concluded that segmentation might have a number of implications for program strategy:

Different behavior change objectives might be established for different groups.
Different branding and positioning strategies might be used to reflect and appeal to cultural differences and values.
Different messages (and, I would add, products and services) might be selected and focused on to facilitate behavior adoption or discontinuance.
Different channels of message, product, and service distribution and access might be employed.
Different types of promotions might be used to reflect or appeal to cultural or linguistics characteristics of each group.

Note that the purpose of segmentation is not to answer the question of whether we can distinguish different subgroups of a larger population. The question for segmentation is whether identifying differences among groups will drive how we approach our marketing solution. That is, does it make sense to have different behaviors, messages, products, and services aimed at specific subgroups of people? Or are there certain common characteristics that supersede these distinctions? And just as important, if we do uncover such differences, do we have the resources to develop the specific marketing mixes each group deserves?

Hornik and Ramirez (2006) point out that we also need to consider untoward consequences of segmentation. Might we be stigmatizing a group in the eyes of the general public if we explicitly focus on that group? Are the observed inequalities in health status or in the choices people make based on social determinants that are beyond their individual control; that is, are we setting them up for failure if we only encourage them to change their behavior? Will we dilute the scarce resources we have for our program by trying to be all things to all people - even if we are doing it serially by addressing a few groups at a time - and thus not have much reach for or impact on any group? Do we really want to divide up the population for our program if we are seeking broader social changes, such as changing norms that affect binge drinking or home energy use? Of course a simple yes or no response to such questions should not immediately preclude a segmentation approach. Nor is it suggested that all social marketing programs must segment in order to be effective in achieving social goals. Rather, a deliberate and thoughtful process of considering the potential role of segmentation in each program is proposed...

Hornik and Ramirez (2006) also highlight how the segmentation decisions we make can have implications for the design and conduct of outcome evaluations. These evaluations need to focus on answering the question, did the segmentation approach lead to comparatively greater changes in the segmented groups than in comparison ones? Hornik and Ramirez go on to note that they could not identify a single instance where racial or ethnic segmentation approaches were compared to nonsegmented approaches. Thus even though segmentation is held out as a hallmark of social marketing (and health communication) campaigns, there is no evidence that it results in superior outcomes (nor is there any research to suggest that it is less effective than other approaches). However, rather than accept this dismal conclusion, we need for social marketing research to begin to address this research question. And in our practice we need to subscribe to the idea that at the center of every program should be people, and the better defined and understood they are, the more relevant and effective our strategy and tactics will be for them."

From: Lefebvre, R.C (in press). Social marketing and social change: Strategies and tools for improving health, well-being and the environment (San Francisco: Jossey-Bass, expected 2013).

References

Glynn, T., Seffrin, J. R., Brawley, O. W., Grey, N., & Ross, H. (2010). The globalization of tobacco use: 21 challenges for the 21st century. CA: A cancer journal for clinicans; 60:50–61.

Grier, S. A., & Kumanyika, S. K. (2008). The context for choice: Health implications of targeted food and beverage marketing to African Americans. American Journal of Public Health; 98:1616–1629.

Hastings, G. (2012). The marketing matrix: How the corporation gets its power – and how we can reclaim it. New York: Routledge.

Hastings, G., Anderson, S., Cooke, E., & Ross, G. (2005). Alcohol marketing and young people’s drinking: A review of the research. Journal of Public Health Policy; 26:296–311.

Hornik, R. C., & Ramirez, A. S. (2006). Racial/ethnic disparities and segmentation in communication campaigns. American Behavioral Scientist; 49:868–884.

Institute of Medicine, Committee on Communication for Behavior Change in the 21st Century: Improving the Health of Diverse Populations. (2002). Speaking of health: Assessing health communication strategies for diverse populations. Washington, DC: National Academies Press.

Jackson, M. C., Hastings, G., Wheeler, C., Eadie, D., & MacKintosh, A. M. (2002). Marketing alcohol to young people: Implications for industry regulation and research policy. Addiction; 95:597–608.

Segmentation: The First Critical Decision.

On 'Rediscovering Market Segmentation:' Part A

On 'Rediscovering Market Segmentation:' Part B

The Micro-Macro Problem in Social Marketing

2012-09-14T15:08:05-04:00

"Social marketing has been presented and understood as an approach to individual behavior change in which psychological stage models, such as the transtheoretical model, are used to segment audiences, and the marketing mix is used to identify and reduce barriers or costs and increase benefits for behavior change. This theory has guided many marketers’ approach to discovering what the desired behavior might be, its possible determinants, the context in which it occurs - or not, and the consequences that people and society incur. I offer that to fully develop the discipline of social marketing and its promise to be a positive force for social change, we must think about change as it occurs among groups of people (segments, social networks) and at different levels of society (organizations, communities, physical environments, markets, and public policies)…[Ed Note: See Transformative Social Marketing (pdf)].

I start with Duncan Watts, a physicist and sociologist, who presents two problems that bedevil people faced with the challenges of large and complex puzzles. He calls these the frame problem and the micro-macro problem (Watts, 2011). Both of these problems highlight the need for social change programs to adopt theoretical perspectives that are broader than individual determinants. The frame problem proposes that it is impossible to know all the potentially relevant facts and determinants of a puzzle, given the overwhelming number of possibilities and combinations of variables. Consequently, it is then difficult to selectively focus on only certain ones and ignore the others, to look for example at only psychological determinants or to consider only solutions that employ persuasive communications. What the frame problem poses to social marketers is that we cannot know for certain whether we have selected the right set of variables when we choose a theory, or frame, to guide us in thinking about our puzzle.

The second problem Watts (2011) discusses is the micro-macro problem: one that goes at the heart of the social marketing dilemma. This dilemma emanates from our desire to achieve macro outcomes, ones that involve changes among large numbers of people, among population segments, or in society as a whole. Yet these outcomes are driven by the micro actions of individuals (for example, it is individuals whose voting behavior determines the outcome of policy options, individuals’ behavior that sets the tone for an organizational culture, and individuals who connect through social network sites to organize and plan social action). This problem is embedded in definitions of social marketing as changing individual behaviors in order to achieve social good. Although the intentions are commendable, the actual process of moving from individual behavior change to changes at the societal level is ignored, as if this transition will occur automatically - that it is simply a matter of increasing the numbers of people practicing the behavior. As Watts (2011) notes, how micro behaviors become macro solutions is a puzzle in search of an explanation in many disciplines, and this puzzle cannot be simply dismissed or explained away as inconsequential. Moreover, this process does not occur in a simple linear manner, as is suggested by phrases like “increasing the numbers.”

An analogy from biology helps to illustrate the problem. What if we were to consider the entire span of human existence? How do atoms become molecules? How do molecules form amino acids? How do amino acids and other chemicals interact to create a living cell? How do some of these cells organize and specialize to become the brain? And how does this brain develop consciousness and contemplate its eternal existence? The point Watts is making is that many disciplines work with many different scales of reality and they are difficult to integrate. For example, how can we explain consciousness by the chemical activity of a single neuron? The short answer is that we do not. Instead, biologists and other scientists invoke the idea of emergence to describe the shifting from one scale of reality to the next, and use ideas such as complexity, interactions, and systems to consider more than one scale at a time (an atomic scale versus a biochemical or physiological one).

To bring this problem back into the social marketing world, believing that social change will happen “one person at a time” does not conform to what we know about emergence in many other disciplines. It is analogous to believing that consciousness can be explained by the action of a neuron or even many neurons; it may be convenient to think like this, but throughout his book, Watts (2011) takes on these logical fictions with data. Changes in complex social systems involve interactions between people and systems, just as neurons must be connected and interact with each other in systematic ways to create what we refer to as consciousness. This means that social change programs need to consider more than one scale of reality at a time, including scales relating to individuals, social networks, formal and informal organizations, markets, and government regulations and policies."

From: Lefebvre, R.C (in press). Social marketing and social change: Strategies and tools for improving health, well-being and the environment (San Francisco: Jossey-Bass, expected 2013).

Reference

Watts, D. (2011). Everything is obvious: Once you know the answer. New York: Crown Business.