The application of social marketing to health, environmental and social issues is expanding in scope and depth. This year I was able to curate the best writing in social marketing over the past 40 years into a 6 volume series on Social Marketing. Phillip Kotler wrote about it: "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." And now to continue the journey of social marketing through 2013.
I have selected 13 papers for this year from journals outside the two primary social marketing ones: Journal of Social Marketing and Social Marketing Quarterly. Click through the links to explore their content for the past year. Each of the journals contains a number of articles that could appear on my list here. However, I am assuming that many social marketers already subscribe to or review them regularly (if you don't, make that a 2014 resolution for professional development. Or better yet, join the Australian, European or International social marketing associations and get a member discount on each one).
In curating this list I have gone beyond these two disciplinary journals to give you a sense of what else is occurring in the wider world of marketing for social change. What I have tried to do with this list is sample across the many issues, topics and methods that are represented in the peer-reviewed literature to give you a broad view of what has been happening in the field over the past year. Some articles on the list were experimental studies or reviews of work on specific topics, several tackled new territory for marketing, and others honed in on specific issues that are important to the growth of the field. One of the striking changes I see in the publications this year is that many of these articles are comparison studies of an intervention that is described using social marketing benchmark criteria (for example, those developed by the NSMC). This development can help solidify the fundamentals of the field while also pointing out to editors and reviewers where the 'marketing' is in the manuscripts they recieve.
Enjoy your reading and my very best for a great 2014! This year the papers can be described as making important contributions in one of four areas:
1. Research and Review - there were several research projects reported this year that used comparison populations and rigorous application of social marketing benchmark criteria in designing their interventions. Evers at al describe a social marketing program with well-defined segments. What is notable about this study is that it is one of the few that have documented differential impacts of interventions on specific priority groups (yes, we claim that segmentation is important, but rarely do evaluations demonstrate it!). The Glasson et al study demonstrates how community-based social marketing programs can complement, and enhance the impact of, mass media campaigns (a topic that has been discussed here before). Their finding that increasing exposure to campaign elements is associated with increased likelihood to increase fruit and vegetable consumption among parents of school-aged children is also one of the few to carefully examine this crucial piece of the behavior change puzzle (see also The Team Nutrition Pilot Study (pdf)). Keller et al and Withall et al describe social marketing interventions to increase physical activity among specific population groups. Both studies employed comparison populations and reported positive results in attracting and maintaining engagement with their programs. Carins & Rundle-Thiele review 34 studies that reported using social marketing approaches to influence eating behaviors. More than half of the studies were found, using benchmark criteria, to not meet the requirements of a social marketing program. Their comparison of outcomes between programs that used fewer or more social marketing elements should become part of every social marketer's response to the question: How is social marketing different from what we usually do?
Carins JE, Rundle-Thiele SR (2013). Eating for the better: A social marketing review (2000-2012). Public Health Nutrition; 28:1-12. [pdf]
The authors combed through databases to identify studies that reported on the use of social marketing to address eating behaviors. After applying various exclusion criteria, one set of 16 papers was categorized as using social marketing as a planned consumer-oriented process (met an average of 5 predefined benchmark criteria), and a second group of 18 studies was categorized as social advertising - self-identified as using social marketing but focused on producing communication or advertising materials (mean benchmark criteria = 3). Of the total of 34 studies, 4 reported no changes and 23 reported positive changes in eating behaviors. Seven studies did not report behavioral outcomes - only 1 from the social marketing group and 6/18 social advertising studies. The proportion of studies that found change on at least some of their outcome measures was higher among social marketing compared to communication campaigns (100% v. 67 %, respectively; p=0.04). Behavioral changes were achieved in 15/16 social marketing studies and in 8/18 social advertising studies (including those that did not report behavioral outcomes at all). They conclude: 'The effectiveness of social marketing as a systematic process to change healthy eating can be enhanced. First, a number of behaviours contribute to healthy eating, and care must be taken to select which behaviour to address. Next, social marketing incorporates a mix of strategies, and relying heavily on advertising or communication should be avoided due to limited efficacy of this approach when compared with programmes utilizing more of the marketing mix. Finally, consideration must be given to the changes that can be made to social and environmental influences on behaviour as part of an integrated social marketing programme.'
Evers U, Jones SC, Iverson D, Caputi P. (2013). 'Get Your Life Back’: process and impact evaluation of an asthma social marketing campaign targeting older adults. BMC Public Health; 13:759. [html]
The authors describe the longitudinal evaluation of a social marketing intervention that was developed to increase community awareness of asthma among older adults, and to encourage those with respiratory symptoms to seek medical advice. A pretest-posttest control group design was employed with one intervention and one comparison region. "The behavioural outcomes of the campaign give support to the segmentation of the older adult audience by recent experience of respiratory symptoms and asthma diagnosis…there were significant differences in the outcomes for the different segments. Wheezers were the most likely to take notice of campaign activities, and both target segments – Wheezers and Strugglers – were more likely to visit a health professional as a result of engaging with ‘Get Your Life Back’. The non-target segments of older adults – Breathers and Bloomers – were more likely to report taking no action after seeing the campaign."
Glasson C, Chapman K, Wilson T et al (2013). Increased exposure to community-based education and ‘below the line’ social marketing results in increased fruit and vegetable consumption. Public Health Nutrition; 16:1961-1970. [Abstract]
The authors investigated the question of whether community-based social marketing strategies can augment the effects of mass media campaigns on exposure (recall of any program strategy), knowledge and fruit and vegetable consumption of parents of school-aged children. Pre- and post-intervention surveys were conducted in the intervention and comparison areas. 'The results of the present study show that the Eat It To Beat It programme achieved improvements in fruit and vegetable intake in those parents exposed to the programme. Furthermore, the results demonstrate that increased intakes of fruit and vegetables were significantly associated with increasing exposure to programme strategies…[and] emphasise the importance of local programmes that can engage the community on an ongoing basis to support and sustain the effects of larger mass-media campaigns.
Keller, C, Vega-Lopez S, Ainsworth B et al (2013). Social marketing: approach to cultural and contextual relevance in a community-based physical activity intervention. Health Promotion International. [html]
A controlled trial to test a social support intervention and walking program to increase structured and leisure time physical activity among sedentary Hispanic women who were no more than 6 months postpartum. Measured outcomes included changes in body fat, fat tissue inflammation, postpartum depression (PPD), perceptions of environmental safety and resources for walking, and perceived levels of social support and exercise. "Our efforts in the design, recruitment, retention and implementation of Madres para la Salud integrated all aspects of benchmark criteria for social marketing, and demonstrate the effectiveness of such marketing procedures in recruitment and retention strategies to the cultural and contextual needs of Hispanic women."
Withall J, Jago R, Fox KR (2013). The effect a of community-based social marketing campaign on recruitment and retention of low-income groups into physical activity programmes - a controlled before-and-after study. BMC Public Health; 12:836 [html]
A controlled trial to increase physical activity levels with two low income suburbs of Bristol, UK. The intervention is clearly described by segmentation criteria, marketing mix components and brand considerations. "…this study found that when compared to preexisting sessions and sessions delivered in a control area, monthly attendance patterns indicated that a reasonably well funded social marketing campaign increased recruitment into exercise sessions, maintained good levels of attendance and reasonable levels of adherence."
2. Examining Products and Services - 2013 may have been the year in which social marketers explicitly considered more than behaviors and communication starting with Thackeray et al's review of what is the product in social marketing programs and a critical examination of the influence of cigarette packaging by Stead et al. This latter study is a good example of critical social marketing - applying social marketing principles and techniques to the analysis of the marketing of socially detrimental products and services. The Zainuddin et al study with a national breast cancer screening program highlights how the Service-Dominant Logic idea of value co-production can be integrated into social marketing programs that include health and social services.
Stead M, Moodie C, Angus K et al (2013). Is consumer response to plain/standardised tobacco packaging consistent with Framework Convention on Tobacco Control guidelines? A systematic review of quantitative studies. PLoS ONE; 8 (10): e75919. [html]
The authors identified 25 experimental, observational and survey studies that explored consumer responses to plain packaging of tobacco products on their appeal, salience and effectiveness of on-pack health warnings, and perceptions of product strength and harm. "Studies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample."
Thackeray R, Fulkerson KN, Neiger BL (2013). Defining the product in social marketing: An analysis of published research. Journal of Nonprofit & Public Sector Marketing; 24:83–100.
How social marketers define their product and how often tangible products and services are part of the marketing mix were explored in a systematic review of 92 social marketing intervention articles that appeared between January 1999 and October 2009. All but 1 program focused on behavior change. The most common behaviors were: go see a health care provider to receive a checkup or screening (n = 15); use insecticide treated nets (n = 8); use a form of contraception (n = 8); take a multivitamin or folic acid supplement (n = 5); make better food choices (n = 8); and be more physically active (n = 6). Seven programs focused on stopping a negative behavior, such as not smoking or drinking, or sharing needles."Only 17 articles (18.5%) used the 4Ps or marketing mix-related terminology. Only these studies were analyzed to answer the question about how social marketers define the product... Six of the 17 studies identified the product as an item (35.3%), three as a service (17.6%), and seven as a behavior or focus on awareness (41.1%), with one identifying it as the benefit (5.9%)…The absence of marketing terminology within a research article makes it difficult to determine if the researchers are implementing a marketing strategy or just a general behavior change strategy and labeling it social marketing."
Zainuddin N, Russell-Bennett R, Previte J. The value of health and well-being: An empirical model of value creation in social marketing. European Journal of Marketing; 47:1504-1524. [Abstract]
Consumers as active participants and creators of value, rather than as passive recipients of programs and services, is emerging as a new perspective in marketing circles. This study tests this approach with a study of value creation and service outcomes (satisfaction and behavioral intentions) for a national breast cancer screening program. They provide evidence that "cancer screening services that seek satisfied customers…need to ensure that the value customers perceive encompasses feeling protected, happy, calm and safe, as well as providing consistent screening quality that is reliable and at an acceptable technical standard."
3. Equity in outcomes - Social marketing can become a leader in social change circles by focusing on how its approach can lead to more equitable reach, effectiveness, health status and well-being. This issue received attention in at least two evaluations of social franchising programs this year. Chakraborty et al describe how to assess equity in health outcomes by examining data from three social marketing programs focused on HIV prevention, family planning and malaria control. They go on to discuss how these results can then be used to better calibrate and concentrate resources to enable positive change among the most disadvantaged populations. Montagu et al use national economic data to assess how well a social franchise network cares for poorer people in both rural and urban areas in Myanmar, a type of analysis many other national prorgams should consider in their evaluations.
Chakraborty NM, Firestone R, Bellows N. (2013). Equity monitoring for social marketing: use of wealth quintiles and the concentration index for decision making in HIV prevention, family planning, and malaria programs. BMC Public Health; 13(Suppl 2):S6 [html]
As many social marketing programs are intended to reach the poor, these authors argue that is is essential for social marketing programs to 'monitor the health equity of their programs and improve targeting when the poor are not being reached.' Using cross-sectional surveys from three surveys, the investigators calculated wealth quintiles and concentration indices (the magnitude of socioeconomic inequality) to measure the distribution of health outcomes by wealth and to assess whether interventions had reached the poor. Program-specific results were found for reach and adoption of health practices among the wealthy and poor (use of bed nets, IUDs and condoms). "…[S]ocial marketers simultaneously seek both health impact and market growth, in order to promote long-term access, availability, use, and ultimately, impact of the promoted health product or service. To successfully expand the market, these organizations need to ensure that intervention strategies encompass the different segments of the market - public, socially marketed, or commercial - and appropriately target the individuals they serve, based on socioeconomic status."
Montagu D, Sudhinaraset M, Lwin T et al (2013). Equity and the Sun Quality Health private provider social franchise: Comparative analysis of patient survey data and a nationally representative TB prevalence survey. Journal of Equity in Health;12:5. [html]
This study explores whether the benefits of a branded social franchise network that include increasing case detection and higher treatment completion rates for tuberculosis (TB) directly-observed-therapy (DOTs) are shared equitably. A comparison of national national TB prevalence data with patient data from Sun Quality Health (SQH) providers found that "In rural areas the SQH franchise providers are caring for patients that are not statistically different in wealth than the general population of TB-infected individuals. In urban areas, SQH clinics are treating patients that are poorer than the general infected population. These findings suggest that franchises are successfully reaching low-income TB patients in urban areas, but could improve targeting of lower socioeconomic groups in rural areas."
4. Special topics - Several publications stood out to me for their focus on topics that are not discussed enough in social marketing. Evans-Lacko et al review the impact of a national campaign to change attitudes towards people with mental illness. The authors note the important features of this campaign were a focus on population segments and behavioral outcomes, though it can be debated whether the campaign implementation was very different from a well-done integrated communication effort. As you may already have noted, segmentation was highly visible in many research reports this year. A useful addition to discussions about segmentation (The first critical decision in social marketing) is from Newton et al who carefully evaluate the claims of the usefulness of segmentation, apply ethical theory to examine the arguments for and against it, and use a case study to also demonstrate the impacts of NOT segmenting in public health programs. Finally, Turk et al dispense with the idea that all formative research for program planning must be laborious, lengthy and costly with their description of the use of the rapid assessment and response methodology in planning a physical activity in Tonga.
Evans-Lacko S, Malcolm E, West K et al (2013). Influence of Time to Change’s social marketing interventions on stigma in England 2009–2011. The British Journal of Psychiatry; 202:s77-s88. doi: 10.1192/bjp.bp.113.126672 [html]
The TTC program aimed to make significant improvements across England in public attitudes and to achieve less discriminatory behavior in relation to people with mental illness. The priority group was identified through research as ‘subconscious stigmatizers’: people who do not recognize that discrimination against people with mental health problems happens, or how their actions might contribute to this. Campaign elements included mass and social media, with tips for fighting stigma and stories from people with mental illness on the TTC website. The behavioral outcomes, which the authors claim is a first for an anti-stigma campaign, included starting a conversation about mental health with a friend or co-worker, to helping organize a local event aimed at engaging the community or organizations in fighting stigma and discrimination against people with mental health problems. "Campaign awareness and social contact [with someone who had a mental illness] were the most consistent positive predictors of better knowledge, attitudes and intended behavior towards people with mental illness."
Newton JD, Newton FJ, Turk T, Ewing MT. (2013). Ethical evaluation of audience segmentation in social marketing. European Journal of Marketing; 47:1421-1438. [Abstract]
The authors identify two ethical questions about the use of segmentation in social marketing contexts: (i) can the use of segmentation be ethically justified; and (ii) if segmentation can be justified, what approach should be used to select the groups that are included or excluded from the priority group? They identify three perspectives on the answers to these questions. First are the people who advocate for non-segmented, population-wide programs as a method to be egalitarian and nondiscriminatory. The second group argue for segmentation to serve the needs of the most vulnerable members of a society. A third group, that they refer to as 'consequentialists,' support segmentation when it demonstrably achieves the greatest good for the largest number of people. Using Integrative Social Contracts Theory and Theory of Just Health Care, the authors evaluate these different perspectives on the use of segmentation through the use of a case study of increasing awareness and support for the use of antiretroviral therapy in Kenya. They conclude that both theoretical models '…support the ethics of segmentation in health-related social marketing contexts.' Their findings also provide support for the idea that NOT using segmentation has ethical implications as well - in this case, by strengthening preexisting asymmetries in health knowledge that would disadvantage citizens with limited education.
Turk T, Latu N, Cocker-Palu, E et al (2013). Using rapid assessment and response to operationalise physical activity strategic health communication campaigns in Tonga. Health Promotion Journal of Australia; 24:13-19. [html]
The authors describe the application of a rapid assessment and response (RAR) methodology to identify priority segments for a physical activity program in Tonga. The elicitation research encompassed qualitative fieldwork approaches, including semistructured interviews with key informants (including government and local officials, NGO and religious leaders, and representatives from the media and private sector partners) and focus group discussions with program beneficiaries (women and their male partners).The authors suggest that RAR may be especially useful as a practical approach to data collection and rapid mobilization in low resource environments. "Essential insights for the strategy design were identified from key informants, as well as ensuring future engagement of these stakeholders into the strategy."
I have linked to the full text whenever possible [html and/or pdf available]. In other cases, the link will be to the Abstract. Please contact the author of a paper with any requests for a full reprint (pdf).
And as a bonus reading in social marketing, if you have not already heard about or read my textbook on social marketing and social change, you can get started with some excerpts here. Please consider buying the book, and applying and sharing the ideas and techniques in it to help solve your health and social puzzles in 2014. As Bill Novelli put it: “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.”