I begin many talks on social marketing and social media with the 5% solution. The 5% solution refers to the finding that health communication campaigns can, on average, result in increases or decreases of the target behavior by five percentage points (for example, moving from 50 percent prevalence of the behavior among the priority group at the beginning of the campaign to either 45 or 55% at the conclusion of the campaign; Snyder, 2007). My point about the 5% solution is that while a 5% change in market share may send commercial marketing managers into ecstasy, in the public health and social change space 5% is usually seen as a beginning. We need to look at how social marketing, social media and mobile technologies can grow this 5% into a much larger and positive social impact.
However, many people still cling to the hope that mass media campaigns – given enough resources and support – will be the answer to wicked public health and social problems. Indeed it is still common to find many practitioners of social marketing who think of their work as the development and implementation of mass media campaigns. And it is especially these people that I suggest take a close look at the review of mass media campaigns to change health behaviors that recently appeared in The Lancet [link to pdf with free registraion].
In this article, Wakefield, Loken & Hornik (2010) summarize the literature from 1998 that report the use of mass media to change health behaviors such as tobacco use, heart disease risk factors, sex-related behaviors, road safety, cancer screening and prevention, child survival and organ or blood donation. After reviewing the evidence for each of these classes of health behaviors, they conclude that mass media can directly or indirectly produce positive changes or prevent negative changes among large populations (though they do not attempt to estimate an effect size as was done by Snyder). By direct effects they refer to using mass media campaigns to influence the decision-making processes at the individual level – e.g., by targeting knowledge, beliefs, intentions, attitudes, emotional responses. More importantly from my POV, they also highlight the indirect effects of mass media on health behaviors. These indirect effects include (1) set an agenda and increase the frequency of conversations about specific health issues within one’s social network, (2) shift norms in one’s social network about engaging (or not) in specific health behaviors – for more on injunctive and descriptive norms and their influence on different behaviors, and (3) prompt public discussions that lead to policy changes that support or discourage specific health behaviors – see social marketing and the policy maker audience for more on this topic.
A second conclusion they reach is that mass media campaigns are more effective when the target behavior is a one-off or episodic occurrence such as screening or inoculation. More habitual or ongoing behaviors such as making food choices or engaging in regular physical activity are less susceptible to the influence of mass media campaigns.
Their third conclusion is to call for the use of multiple interventions to increase the effectiveness of any attempt to use mass media for health behavior change. They specifically mention the need to ensure the availability and access to services and products that will support behavior change, putting into place supportive public policies, and utilizing media advocacy, entertainment-education and social marketing approaches.
They also note several challenges to the 5% solution (a.k.a. mass media campaigns). These challenges include:
- Achieving adequate exposure to messages in a fractured and complex communication environment
- Competition from competing products or opposing messages
- The power of social norms to maintain the status quo
- The qualities of addictive behaviors that make them particularly difficult to change on a sustained basis
The article directs policy recommendations to national governments, practitioners and professional bodies that include:
- Mass media campaigns should be included as key components of comprehensive approaches to improving population health behaviors
- Sufficient funding must be secured to enable frequent and widespread exposure to campaign message continuously over time, especially for ongoing behaviors
- Adequate access to promote its services or products must be insured
- Changes in health behavior might be maximized by complementary policy decisions that support opportunities to change, provide disincentives for not changing, and challenge or restrict competing marketing
- Campaign messages should be based on sound research of the target group and should be tested during campaign development
Some readers will seize on this article as providing further rationale for their insistence on advocating for more mass media campaigns in public health and social change programs. I suggest instead that we pay attention to the analysis these authors present that provides independent support for the idea that we need new ways of dealing with social problems that have at their core the social marketing model.
The 5% solution should be embedded in programs that are designed around a solid understanding of priority groups, tested (or co-created) with them to ensure they are relevant to their lives, account for and address competitive forces in the environment, ensure access to and availability of products and services that will support positive behavior change, focus on the social elements of behavior change (and not be exclusively directed towards individual behavior change), and include the development of supportive public policies that can both ‘nudge’ change as well as sustain it. And yes, they can also include social media and mobile technology tactics as well.
Snyder, L.B. (2007). Health communication campaigns and their impact on behavior. Journal of Nutrition Education and Behavior, 39 (2 Supplement): S32-40.
Wakefield, M.A., Loken,B. & Hornik, R. (2010). Use of mass media campaigns to change health behaviour. The Lancet, 376:1261-1271.