marketing needs to focus on ‘pushing the curve’ of adoption of health practices
among individuals, the adoption of effective interventions among practitioners,
and the adoption of health-promoting and supportive policies among policy-makers.
Adopting diffusion of innovations means that we
understand how and why people adopt (or fail to adopt) healthier,
environmentally conscious or socially beneficial behaviors. These
characteristics include (a) the contextual factors that surround the adoption
of new practices and policies, (b)
people’s perceptions of the innovation as a normative behavior among their
reference group or peers (which studies suggest account for anywhere from
50-86% of the variance in the rate of diffusion of new behaviors), and (c) a
risk-benefit analysis that substitutes certainty of outcomes and familiarity
with the new behavior over costs and benefits of changing current ones.
marketers need to design their behavior, product and service offerings to
answer the questions people have that are associated with adoption or
How is this better than what
I currently do?
How is it relevant to the way
I go about my everyday life?
Is it simple enough for me
Can I try it first?
Can I watch others and see what happens to them when they do it?
Social marketing for behavior
change at scale also needs to explore more extensively the use of audience
segments such as:
Innovators: who have a high tolerance of risk; are fascinated
with novelty; usually viewed by others in their community as mavericks, not
opinion leaders; and whose social networks transcend geographic boundaries.
Early Adopters: who are the community opinion
leaders and well-connected socially and locally; have the resources and risk
tolerance to try new things; and are the people who are watched by others – and
they know it.
Early Majority: the people who are very engaged in local
peer networks; rely on personal familiarity before adoption and continually ask
the question ‘How does this new behavior, product or service help me?’
Late Majority: the group of people who are most sensitive
to peer pressure and norms, yet very cautious about change of any kind; they
seek to minimize uncertainty of outcomes and want to see the proof of relative
advantage locally – not read about it on web sites or see it on television.
Laggards: these are the traditionalists who
believe in the tried and true; they are near isolates in their social networks
which explains why they can be so difficult to reach and influence (versus
having individual deficits); they are often suspicious of innovation and change
agents; and they are seeking assurances that adoption of new behaviors (such as
stopping smoking, driving a low carbon emission vehicle) will not fail.
The diffusion of innovations
literature should also wake-up policy-makers and social marketers that there
are immediate needs to apply marketing principles to such social goals such as
improving evidence-based practices in public health and medicine. Maibach, Van Duyn & Bloodgood (2006)
suggest three marketing-based solutions: (1) conduct consumer
research with prospective adopters to identify their perspectives on how
evidence-based prevention programs can advance their organization’s mission, (2)
build sustainable distribution channels to promote and deliver evidence-based
programs to prospective adopters, and (3) improve access to easily implemented
programs that are consistent with evidence-based guidelines.
There are lessons we have
learned over the years that can be used to re-conceptualize social marketing
strategy to promote diffusion of product and service use as well as adoption of
1. Find sound innovations/solutions. Ones that meet
the criteria noted earlier and are relevant to people’s everyday lives.
2. Provide opportunities for Innovators to discover
3. Engage the curiosity of the Early Adopters.
4. Target the weak ties between Innovators and
Early Adopters through identifying the ‘boundary spanners’ who interact with
5. Promote the work of Early Adopters.
6. Create spanable social distances between groups
through various means including using social media such as social network sites
and blogs and convening meetings of the ‘unlike’ rather than the usual host of
7. Enhance the salience and attractiveness of the
‘positive deviants’ – the people who are already practicing the target behavior
or using the product and service; put the practitioners of ‘new’ behaviors in
contexts and situations that attracts imitation or modeling.
8. ‘If you can’t imitate them, don’t copy them.’ Expect and encourage reinvention.
9. Support time and energy for discovery, testing, networking, adapting, monitoring and preserving the past. Do not write off the traditionalists, especially when encouraging organizational change.
10. It starts with yourselves and your partners.
With respect to this last point, remember that highly linked and centralized coalitions are less likely to adopt new evidence-based public health programs than ones that are less dense and have more decentralized structures. What is important for adopting new practices and programs are 'boundary spanners' or individuals from organizations who are not tightly bound exclusively to the clique (or usual cast of characters). These are the people more likely to be open to innovation; the traditionalists have their own, seemingly immutable, point-of-view.Our challenge in the years ahead, whether it is in HIV prevention or the prevention of childhood obesity, is to apply in a deliberate and systematic way what we have learned from the evidence-base of diffusion research to achieve broad and sustainable change. It seems that very few policy-makers, behavioral change experts and public health officials know how to transform programs focused on individual behavior change to ones scaled for population impact. And few program directors and donors seem willing to take the risk that is inherent in moving from ‘the zoo’ of controlled experiments to ‘the jungle’ of people’s real lives. Social marketing provides us with a framework to fill this gap between knowledge and practice.
Global HIV Prevention Working Group. (2007) Bringing HIV prevention to Scale: An urgent global priority.
Lefebvre, R.C. (2001). Theories and
models in social marketing. In P.N.
Bloom and G.T. Gundlach (eds), Handbook of Marketing and Society.
Newbury Park, CA: Sage
Publications, pp. 506-518.
Maibach, E.W., Van Duyn, M.A. and Bloodgood, B. (2006). A marketing perspective on disseminating evidence-based approaches to disease prevention and health promotion. Preventing Chronic Disease [serial online] July.
Rogers, E. (1995). Diffusion of Innovations (4th
Ed). New York: The Free Press.
Valente, T.W., Chou, C.P. and Pentz,
M.A. (2007). Community coalition networks as systems: Effects of network change
on adoption of evidence-based prevention. American
Journal of Public Health, 97: 880-886.