Social Marketing Analysis of 2 Years of Hand Hygiene Promotion
Authors: Mah MW, Tam YC, Deshpande S
Objective: To assess published hand hygiene behavioral interventions that employed a social marketing framework and to recommend improvements to future interventions.
Methods: We performed a systematic literature review by searching the PubMed database and the Cumulative Index to Nursing and Allied Health Literature for published articles about hand hygiene behavioral interventions in healthcare facilities, schools, and community settings. Our analysis included articles that describe multifaceted interventions and evaluated them with predefined social marketing benchmark criteria.
Results: Of 53 interventions analyzed in this review, 16 (30.2%) employed primary formative audience research, 5 (9.4%) incorporated social or behavioral theories, 27 (50.9%) employed segmentation and targeting of the audience, 44 (83.0%) used components of the "marketing mix," 3 (5.7%) considered the influence of competing behaviors, 7 (13.2%) cultivated relationships with the target audience, and 15 (28.3%) provided simple behavioral messages. Thirty-five (66.0%) of the interventions demonstrated a significant improvement in performance, but only 21 (39.6%) were considered to have a strong evaluative design. The median duration of the interventions was 8.0 months.
Conclusions: From a social marketing perspective, the promotion of hand hygiene could be improved in several ways. The effectiveness of social marketing in hand hygiene promotion should be tested in future interventions.
Comment: While the title suggests a review of studies in which a social marketing approach was used for hand hygiene interventions, the abstract suggests that this review included any behavioral intervention and used social marketing benchmarks to determine how many used one of more components of a social marketing approach (unfortunately, another journal that does not allow for an online read of the full text of the article to get the details without paying the price). It looks from their reporting that very few, if any, of the 53 interventions they reviewed would be classified as a social marketing one. With the limited information available from the abstract, it seems that the authors could have made a stronger case for any efficacy of a social marketing approach by comparing studies that met multiple benchmarks (see the NSMC model, pdf file) vs those that had few or none. Reading between the lines, the analysis is done to set up recommendations that can be summed up as more social marketing is needed.
The report does little to address whether social marketing interventions are useful or more effective than traditional behavioral or health communication interventions in addressing this public health problem. One question the analysis raises for me is what are the most useful benchmarks to use to decide whether an intervention is a social marketing one or not? Having a standard tool for investigators to use to assess the relative advantages of approaches that incorporate many elements of social marketing may help us establish an, albeit indirect, empirical base to support assertions that social marketing is indeed an improvement upon other approaches for many different health behaviors.
These types of reviews can be useful to highlight where social marketing could be employed to strengthen behavioral interventions aimed at achieving public health impact. However, one would hope that more can be done with the available data that simply ticking off benchmarks. Whether the social marketing 'dose' or strength of a public health program (e.g., how many elements are incorporated into the program design) has an incremental impact on behavior change is an interesting question that this type of meta-analysis could be examining. But then again, having individual studies to work with that have a robust enough research design and report statistics that allow you to draw these types of conclusions is always the Achilles heel in this line of work.
And a note to authors: In the digital age, good abstracts may be your only chance to have an online presence with your work. Make the most of them!