Diabetes is the 6th leading cause of death in the US and nearly 7% of the US population (20.8 million) is estimated to have the disease. Beginning in the late 1990s, the National Institute of Diabetes, Digestive and Kidney Diseases and the Centers for Disease Control and Prevention established the National Diabetes Education Program. The latest issue of Social Marketing Quarterly (subscribers get it before it goes up on the website) has an article about NDEP that nicely summarizes this large-scale social marketing effort to reduce the burden of diabetes.
The article provides an historical context, audience research base and theoretical framework for their approach (which, for full disclosure, our social marketing group at Prospect Associates partially supported). What is noteworthy is the focus on a 3-part action plan that encouraged people with diabetes to write down:
- 3 reasons for controlling their diabetes (I would insert the words ‘personally relevant’ to avoid a rote recapitulation of scientific facts)
- 3 things they will do in the next 3 months to improve their control of their diabetes (recognize the movement towards the Preparation stage here?)
- 3 people who could help them with implementing their action plan (social support even snuck in!)
I have been picky in the past about how programs are misrepresented in the literature as being social marketing ones [When is it social marketing?]; in this case the authors do a great job of laying it out. Their identification of the ‘price’ factors involved in diabetes control is particularly well done. One observation I do have is distinguishing between ‘place’ and ‘promotion’ where the blurring of marketing and communications can and does occur regularly.
The authors define ‘place’ as the channels used to reach priority populations (ahhh, someone is listening) with product messages where they live, work, play and receive their health care services. They then define ‘promotion’ as the communication channels and tactics used to reach campaign audiences. From my POV, the problem here is that both terms refer to the same essential feature - reaching audiences with messages - so why use two terms to refer to the same thing? I distinguish between them by reserving ‘place’ to talk about where and when people can engage in the behaviors or can access the products and services we are providing (or promoting). Caution needs to be taken to make clear the distinction between the distribution of messages (which in a communications plan is more appropriately the ‘place’ question) versus the distribution of products and services and providing the opportunities to engage in behaviors (more appropriate, I believe, the ‘place’ variable in a marketing plan). While the distinction may at first looked semantic, it has very real implications for strategy and the development of tactics that are often overlooked in many efforts.
For those interested in the success of social marketing programs, the NDEP paper also provides data to document the increase in awareness of the program and self-reported prevalence of blood glucose testing practices and use of the A1C test. A final section on lessons learned provides a useful summary of generalized principles that any program designer can benefit from. The most useful and least talked about one in my experience is: The most effective way to get buy-in is to involve partners early in the process and give them productive roles. The part of this lesson that the authors don’t spend time on is that these productive roles and responsibilities evolve over the life cycle of the project. In particular I find that the roles of organizers and developers of a program are much different from the later programmatic stages where roles are more concerned with implementation and management. The other lesson is that the same organizations are not necessarily the best at both, and giving space and permission in your programs to allow partners to engage, disengage and join later in the process is an important expectation to have and communicate early and often. And yes, partnership development and management can be a marketing process [pdf file] as well.
BTW – diabetes is not just a US problem: While diabetes affects persons of all ages and all races, it disproportionately afflicts people living in the developed world, where prevalence is higher. However, the number of 20– to 79–year–olds with diabetes is expected to jump 72 percent by 2025 most notably in the Middle East and North Africa, South Asia, and Sub–Saharan Africa. [From the Disease Control Priorities Project.]
So the work on population-based methods for diabetes control has just begun. This paper will quickly get you up to speed on using social marketing to get started.