On Social Marketing and Social Change

Social Cognitive Theory for Social Marketing Research and Practice

 As social marketers and change agents, our theories drive how we understand and describe problems and propose and test different solutions to them. What is a theory? In science, it is a way in which we think about how the world works - what are the problems, what questions do we ask in our research, what interventions do we design, how do we evaluate outcomes (either positive or negative), and do the expected outcomes really make a difference in the big picture? While there are many theories to choose from, many change agents have only the slightest idea about a few of them if they had a survey course of ‘behavioral theories.’ If they haven’t had a such a course, the use of any commonly agreed upon, and research-tested, framework to think about and change the world plummets. If every social entrepreneur and change agent has their own “theory of change” - good luck with that. Innovation in tackling wicked problems also suffers from unfamiliarity with theories of change as people simply repeat what others have done: there is little exploration of insights that different theories can guide us towards. Learning about other ways of thinking about the world, call them ‘theories,’ can help us adopt different points-of-view about a problem, provide different analogies for thinking through possible solutions, weigh the benefits and risks of selecting one strategy over another, and broaden our perspective (Ness, 2015). And perhaps the bottom line is the conclusion reached by Hornik (2002) that the use of the wrong theory to define and solve a problem is one of the key sources for program failure.

Let’s look at the evidence for using theory in solving problems. Hornik & Yanovitsky (2003) argue that designing interventions and evaluations of complex interventions such as social marketing are extremely difficult without a theory of change to guide what variables to measure/change and how to attribute success to the intervention. I suggest you consider that social change is so complex that, without a theory of change (with the caveat that it has research evidence to support it), you are wandering in the wilderness of what and how to develop interventions. Noar et al (2012) reported that only 15/34 (44%) of HIV/AIDS mass communication campaigns reported using theory on which to ground their approach - an improvement from <20% of interventions in the previous decade. Yet, the use of theories in social marketing is largely unexplored despite several systematic reviews of its application. The key reason is that creators of benchmark criteria for social marketing did not include use of theory. Thus, reviews of social marketing interventions by Stead et al. (2007), Fujihira, et al. (2015), Carins & Rundle-Thiele (2014) and Xia et al. (2016) are silent on this basic scientific question - are social marketing interventions based on explicitly stated theories or just made up? I found one review of the use of branding in social marketing programs. Evans et al (2015) found that of 69 articles they reviewed that used branding, 77% of them contained enough information to identify one or more theories that were used in the design and implementation of the branding effort. In one study that did not use benchmark criteria to qualify 155 articles of “social marketing effectiveness,” Helmig & Thaler (2010) found that nearly 2/3rds did not explicitly reference a theory on which the intervention was based. So are theories being applied in social marketing programs? So far most reviewers don’t consider them important when asking the question ‘what makes social marketing effective?’ Perhaps the new definition of social marketing that includes “[an integration of] research, best practice, theory, audience and partnership insight, to inform the delivery of competition sensitive and segmented social change programs that are effective, efficient, equitable and sustainable” may lead more program designers and researchers to consider this element of intervention effectiveness when designing and reviewing them.

This post is not a review of all the possible theories that could be used in social marketing [see my chapter of theories in social marketing], but the only one I believe can add a broad and valuable lens in your research and practice. And thanks to a recent article in Translational Behavioral Medicine (Riley et al, 2016), a road map for social cognitive theory (SCT) has finally appeared. The article is the first to present SCT graphically. The authors’ purpose is to create a model for testing dynamic computational modeling of SCT hypotheses. You might not be interested in those details, so ignore the math in the figure below. But the key pieces of the theory, and how they relate to behavior, is what I’m focusing on here. We’re going to walk through it in a moment.

First the disclaimers: I am an ardent social cognitive theorist and practitioner. My ‘academic grand-father’ is Albert Bandura, the formulator of the theory who consulted on my PhD dissertation that was under the guidance of one of his students, Dave Rimm. I have been quoted as saying that if every public health person read Bandura’s Social Foundations of Thought and Action the world would already be a better place (but as friends have pointed out, it’s a really thick book - the best ones always are). But enough qualifications: this is the approach that encompasses a broad perspective to learning and behavior change that should be the hallmark of social marketing; not some isolated ideas about benefits and costs, increasing intentions to act, nudges or changing peer and social norms.

As shown in the figure (reprinted by permission of the publisher, and you can click on it to see an enlarged version), the key variables in SCT that are important for both intervention and evaluation actions are:

Self-efficacy: how confident someone is that they can perform a given behavior is the central issue. Self-efficacy for a given behavior will vary over time, and in different situations. the behavior must also be specifically described. For example, how confident are you that you can eat a fruit with breakfast this morning? Yes, the context is breakfast, and if you don’t eat breakfast, your efficacy is likely zero. But what if you do eat breakfast, what kind of fruit are you confident you could eat - a banana, a papaya, a pomegranate? I don’t know about you, but the differences in my confidence for eating some fruits over others at breakfast is pretty dramatic. Ask me to eat the wrong fruit, in the wrong context, and I’m likely to say “pass.” Confidence in ability to perform the behavior = self=efficacy —> behavior.

Self-efficacy can be influenced by several different variables shown on the left; the most important may be by observing other people’s behavior (or vicarious learning). Every time you, or someone else, sees someone do something (and that ‘seeing’ may be through directly watching them in real life, through an audio-visual media such as television or YouTube, hearing about it on a radio or podcast, or reading about it in a book or blog), that person becomes a model for a behavior you might decide to avoid, try, maintain or change. Several factors influence whether you imitate the behavior or not, not least of which is whether you see that person experience positive or negative outcomes.

Another important contribution to self-efficacy is a person’s prior experience with the behavior. If I’ve never eaten a pomegranate (as opposed to bananas and papayas), or even tried to prepare one to eat, asking me to eat one for breakfast is going to get you many quizzical looks and questions. Do you peel it? Wash it? Cook it? Slice it? Of course, once I’ve done it a few times - or even watched a video of someone else doing it, my confidence (self-efficacy) for eating one goes up. And then the consequences for my engaging in the behavior, positive or negative, also contribute to my sense of self-efficacy (I’m told a pomegranate stain is difficult to remove, are they as tasty as a banana or papaya?). Also,it’s important to remember that what I define as ’success’ may be different from how someone else defines it for themselves (or me!).

Then there are things like obstacles and barriers - variables that inexplicably receive laser focus from social marketers and other change agents but which, in the scheme of things, are really nuisances. If a person has a high sense of self-efficacy, more times than not they do not need our help to remove or overcome most of the barriers and obstacles to eating a pomegranate (or banana or papaya) for breakfast. Yes, they may need a Price (affordable to purchase) and Place (access and availability to purchase them) intervention to assist them at key steps. Other than that, we don’t give people enough credit for being resourceful if they truly want to eat pomegranates for breakfast - or do almost anything else they believe that they can do - and want to.

The last point, that they are motivated to do something, can come from an array of internal factors that the model lumps together as physical, mental and emotional interpersonal states. There are too many possible variables that exist in this space to review them all here. To continue the example of the pomegranate though, if I wake up tired and late, have a major presentation to give first thing when I arrive at the office, the dog decides it’s a nice day to smell the flowers rather than get her business done, and all that is churning up more frustration and anxiety (“Will I get to the office in time for the presentation?”)… then no, I’m probably not having a pomegranate for breakfast. If I’m preparing Sunday brunch for some friends, then there may be a another set of motivations to be sure to include pomegranates (show off some culinary curiosity and talents and wait for the applause?).

Then there’s the issue of perceived social support and/or persuasion. If other people in my social networks (for example, family members, peers or colleagues) talk about and practice eating five servings of fruits and vegetables a day and say “You can do it, we’ll help,” then I may be more inclined to believe I can do it too. If they are encouraging me, so much the better for my confidence level. If one of them is an aficionado of pomegranates, I have it made.

Now I have to have the self-management skills: can I make the changes necessary to eat more fruits and vegetables - and especially pomegranates? The questions here are: Can I monitor, at least somewhat accurately, how many servings of fruits and vegetables I eat each day (maybe use a camera to photograph them if necessary)? Can I set a goal - is it to increase what I eat by one serving a day, try a pomegranate at least once a week? Will I set up some kind of reinforcement or reward system up for eating fruits and vegetables? If I can do this, my confidence level shoots up again, as opposed to feeling too busy and frantic to pull it all together.

Exiting from the self-efficacy box (yes, I see others doing it, I sense social support for it, I can manage it and tackle the barriers, and I am motivated), then I wonder what the payoff will be? Positive effects on my health, status among my foodie friends, or energy level? Negative effects on my enjoyment of meals, bank account, or family members who have to eat what I eat? These, and others, are the Outcome Expectancies - what do I expect to happen if I start changing and adopt new eating behaviors?

Now, will someone or something remind me to eat a fruit or vegetable - or more specifically a pomegranate? Can I create some internal cues that do the same thing - Think: “always have pomegranate juice with my cereal.” How about some environmental cues: pomegranates are always on my shopping list and on a shelf in my refrigerator. These are the cues to action. If the cues are there - whether it is a person telling me, a sign at the grocer or my own reminders to myself - then I’m more likely to do it. If the cues aren’t there, or worse, even contradictory to eating fruits and vegetables (“New health alert: pomegranates may be dangerous to your health”), then guess what? Not even thinking about eating that!

These are the key factors that influence whether I adopt or learn new behaviors - I hate the word “change!” - as do most people. And if I try a pomegranate, and it tastes bad and takes too long to prepare, these negative Behavioral Outcomes make it less likely I’ll try it again. But maybe having it in a restaurant (environmental context) is easier and better than doing it at home. OK, order more pomegranates when I’m out eating. Or try different fruits and vegetables. Maybe one of my dear social supporters will show me a way to buy and prepare them more easily - or I’ll search and find recipes on the internet. Those actual experiences of trying the new behavior influence my Outcome Expectations, my Self-Efficacy and my future behaviors.

In summary, social cognitive theory is the road map I always trust to give me a large picture of helping people learn new behaviors (NOT change them). When I hear people talk about focusing on nudges (cues to action), or social support, or peer and social norms, or barriers to ‘change,’ I always cringe. If you look at social cognitive theory, you will see all of those variables are important - including environmental constraints to, and facilitators for, action. Learning new behaviors is the service we are providing for people when we talk about 'behavior change.' There are many factors that go into learning. Map out for yourselves what your priority group currently does, and what they could do, and use this graphic as your roadmap. I suggest that you will be surprised at the insights and interventions it may help you discover.

The SCT Questions You Need to Answer for Helping People Learn New Behaviors

Have I seen or heard about other people doing it?
Have I done it before (or something like it)?
Am I motivated to do it?
Are there obstacles or barriers in the way for doing it?
Do I have support from others to try it?
Do I have the skills to try and practice the new behavior?

AND - How confident am I that I can do the behavior?
What do I expect to happen (positively or negatively)?
Are there reminders or cues to do it?
Is the environmental context right for making that choice?

OK - now I’m ready to try something new.

Which answers are most important for your priority group is your formative research question. How many answers you line up and address is your intervention design issue. Whether it leads to desired individual and social change is your evaluation question. The more deliberate you are when thinking through what theory to use, the more likely your are to have an effective social marketing intervention.

References

Carins, J.E. & Rundle-Thiele, S.R. (2014). Eating for the better: A social marketing review (2000-2012). Public Health Nutrition; 17(7):1628-1639.

Evans, W.D., Blitstein, J., Vallone, D., Post, S. & Nielsen, W. (2015). Systematic review of heath branding: Growth of a promising practice. Translational Behavioral Medicine; 5:24-36.

Fujuhira, H., Kubacki, K., Ronto, R., Pang, B & Rundle-Thiele, S. (2015). Social marketing physical activity interventions among adults 60 years and older: A systematic review. Social Marketing Quarterly; 21(4):214-229.

Helmig, B. & Thaler, J. (2010). On the effectiveness of social marketing - What do we really know? Journal of Nonprofit and Public Sector Marketing; 22(4):264-287.

Hornik, R.C. & Yanovitzky, I. (2003). Using theory to design evaluations of communication campaigns: The case of the National Youth Anti-Drug Media Campaign. Communication Theory; 13(2):2014-224.

Ness, R.B. (2015). Promoting innovative thinking. American Journal of Public Health; (105; Suppl 1): S114-118.

Noar, S.M., Palmgreen, P., Chabot, M., Dobransky, N. & Zimmerman, R.S. (2009). A 10-Year systematic review of HIV/AIDS mass communication campaigns: Have we made progress? Journal of Health Communication: International Perspectives; 14(1):15-42.

Riley, W.T., Martin, C.A., Rivera, D.E et al. (2016). Development of a dynamic computational model of social cognitive theory. Translational Behavioral Medicine; 6:483-495. doi: 10.1007/s13142-015-0356-6

Stead, M., Gordon, R., Angus, K. & McDermott, L. (2007). A systematize review of social marketing effectiveness. Health Education; 107(2):126-191.

Xia, Y, Deshpande, S. & Bonates, T. (2016). Effectiveness of social marketing interventions to promote physical activity among adults: A systematic review. Journal of Physical Activity and Health; 13:1263-1274.

Science Communication and Social Marketing

Applying marketing to improve communications about social issues is an important part of social marketing for me. While I do not like to see mass communication campaigns or social media projects passed off as ‘social marketing,’ I do believe that marketing can help make health communication, risk communication, or any other type of science communication more effective, efficient, sustainable and equitable. And, some times, theories and research in communication have lessons to be learned and applied by social marketers as well.

The new report from the US National Academy of Sciences, Communicating science effectively: A research agenda [pdf], is one that you should read. Chapters are devoted to using science to improve science communication; the complexities of communicating science; the nature of science-related public controversies (which some of our work also gets embroiled in); communicating science in a complex, competitive communication environment (note the use of the word ‘competitive’); and building the knowledge base for effective science. In most social marketing programs, what we are working with is how to translate science-based evidence and findings into products, services, messages, policies and, yes, behavior change programs. In one form or another, we are science marketers. So what can we learn from those who communicate about science?

I am not going to review each section in detail. Rather, I am going to share some statements and paragraphs that resonated with this social marketer - maybe they will for you too.

“…the most widely held, and simplest, model of what audiences need from science communication—what is known as the “deficit model”—is wrong. A common assumption is that a lack of information or understanding of science fully explains why more people do not appear to accept scientific claims or engage in behaviors or support policies that are consistent with scientific evidence. The research on science communication, however, shows that audiences may already understand what scientists know but, for diverse reasons, do not agree or act consistently with that science. People rarely make decisions based only on scientific information; they typically also take into account their own goals and needs, knowledge and skills, and values and beliefs. A related widespread assumption in both the scientific and science communication communities is that if only science communication were done “better,” people would make choices consistent with scientific evidence. This assumption has not been fully tested in diverse situations. And although people may need to have more information or to have information presented more clearly, a focus on knowledge alone often is insufficient for achieving communication goals.” (p. 3)

Think about this the next time you are discussing objectives, benefits, value, barriers or challenges to behavior change or picking over the phrasing of your messages to ‘make them better’ or ‘more persuasive.’ How many social marketing programs, articles and textbooks can you think of that subscribe to this deficit model in one form or another? Communication, knowledge change, or understanding risks and benefits, are not enough, period.

"Audiences for science sometimes are blamed when science communication appears to have failed (“the public does not care”; “they were too uneducated to understand”). However, communicators themselves can introduce barriers to effective communication. For example, they may fail to identify clear and feasible goals for their communication, including what information people need to know. At the same time, communicators tend to overestimate what most people know about a subject, as well as to overrate the effectiveness of their efforts." (p. 12)

The ‘blame-the-victim’ mentality is pretty common across public health - and science in general. The key point about how communicators (or marketers) can introduce barriers to change should be carefully considered when planning programs. In particular, assumptions about what people need to know, do know, and what to do as a result should be challenged. That’s the value of design or formative research-to test our assumptions and not simply do ‘satisfaction research.’

"The decision to communicate science always involves an ethical component. Choices about what scientific evidence to communicate and when, how, and to whom are a reflection of values. This fact becomes especially salient when the science pertains to an individual decision or policy choice that is contentious." (p. 20)

For many social marketers, especially those who profess to be ‘science-based’ in their program's development, should reflect on the proposition that ‘science-based’ is an ethical standard and choices about how to design and deliver programs are laden with values that have potential consequences on people we serve.

“…the deficit model assumes that if a message about scientific information is well crafted for one audience, it should meet the needs of other audiences as well. In fact, effective science communication is affected by the context and requires engagement with different audiences in different places at different times, taking account of what they want to know and already know, understand, and believe.” (p. 22)

If you need another support, or reference, for why segmentation is important when talking with people - try this one, and be sure to emphasize THE National Academy of Sciences report says…” And what are other ways to think about people rather than 'knowledge-deprived human beings?'

"Making sense of scientific information is not easy. Consumers, for example, are faced with parsing complex and contradictory claims about the risks and benefits of fat, salt, added sugar, and genetically modified organisms (GMOs) in food. They must decide whether to agree with science-based advice about avoiding obesity, to listen to those who say the causes of obesity are not yet well understood, or to ignore science-based debates altogether. Likewise, patients must make choices about treatments and drugs—a task that often requires judging among contradictory claims about what “science says” and wrestling with inevitable uncertainties about the aftermath of any decision they make." (p. 24)

Too many social marketing programs revolve around explaining risks and benefits to people, but do they really do so in a way that helps people make informed decisions - or is the presentation or risks and benefits framed to ‘persuade’ or convince people to change? And what’s ethical about the latter approach? Also, and here I’ve been spending a lot of time over the past year or so, how do we talk about the uncertainties of scientific knowledge about obesity, health screenings, and all of the other evidence-based behaviors and outcomes we market? Articulating the uncertainties of science and scientific recommendations so they are understood by people, patients and policymakers is now considered an essential part of any communication activity. Even the uncertainties that surface when experts disagree on the science need to be faced. How many social marketing programs even acknowledge there is some uncertainty in their recommendations and ‘benefits’ for acting differently?

“…public engagement offers opportunities to facilitate transparency and informed consent among stakeholders and for each stakeholder to both learn from and teach others involved in the debate. An essential component of mutual teaching and learning is the opportunity to clarify one’s beliefs and understanding, revise one’s opinions, gain insight into the thinking of others, and articulate values amid uncertainty about the societal implications of a decision. A key benefit of such processes is building and maintaining trust through a fair, open, and transparent process.” (p. 25)

There has been a shift among some social marketers to talk about, and practice, civic engagement and activation, or co-creation, as part of their approach. There is a lot to be learned from risk communication science and practice, especially in the field of environmental protection, about what works and what doesn’t in this regard.

"One form of mental shortcut is motivated reasoning, defined as the 'systematic biasing of judgments in favor of one’s immediately accessible beliefs and feelings [that is] built into the basic architecture of information processing mechanisms of the brain.' Most, and perhaps all, people possess this natural reluctance to accept facts, evidence, and arguments that contradict the positions they hold." (p 34)

How does motivated reasoning, as opposed to nudges and ‘barriers,’ get in the way of your social marketing programs (maybe better, have you even considered this idea before)? How do we identify and address motivated reasoning in our research and program designs? “Because individuals tend to engage in motivated reasoning, the source of communication about a science-related topic and how that information is presented are likely to trigger specific associative pathways and patterns of thinking that will influence their attention to and interpretation of all subsequent information.” (p. 34)

"Research has shown that the use of science in policy making is not a straightforward process involving a simple, traceable relationship between the provision of information and a specific decision. Even when policy makers have access to and understand all the relevant sources of information, they will not necessarily weigh science heavily or use it to identify and select among policy options. There is a paucity of evidence, however, on effective practices and structures for affecting policy makers’ understanding, perception, and use of science." (p. 39)

This quote is for the ones who believe that, or act as-if, policy-makers make more rational decisions than other people. Working at the policy level requires a marketing approach with as much attention, if not more, to the formative research process.

Then there are a few points they make in the section “applying the lessons of large scale science communication efforts, including health communication campaigns and social marketing programs:"

"Too little attention often is paid to providing sufficient exposure to information to reach enough of the target audiences to effect change. An exposure strategy involves defining how often, through what methods, and over what period of time a message should be disseminated and who the intended audiences are." (p. 48)

"Research suggests that communication intended to educate may have more impact if provided before people form strong opinions about the topic… Observed 'inoculation effects' in other areas of communication suggest that early communication about science, including equipping people with counterarguments that expose flaws in misinformation, also may 'inoculate' the public from the spread of misinformation by those with a stake in misrepresenting the science." (p. 48)

"Long-term and comprehensive approaches may be needed to achieve certain communication goals…a strategy of repeated exposure to a message delivered in multiple formats by diverse actors via various platforms is effective for conveying a message of consensus to many segments of the public." (p. 49)

All equally applicable to social marketing efforts as well.

"Tailoring scientific messages for different audiences is one approach to avoiding a direct challenge to strongly held beliefs while still offering accurate information. People tend to be more open-minded about information presented in a way that appears to be consistent with their values." (p. 56)

I’ll just note here that the authors go on to say how tailoring strategies have drawn from research in social marketing and audience segmentation. However, the authors also call for more research on audience segmentation models to understand how much of an effect can be expected, among which kinds of people, and in what contexts. So...let's move from describing segments to discovering how they shift our approach and the effects we observe.

"When individuals are asked to describe the issues that are of most concern to them or are the most important facing the country, or to reflect on how worried they are about a risk, their responses are most likely to reflect the extent of their media exposure to the issues, as well as whether the issues affect them directly." (p. 71)

The simplest answer to why every social marketers trying to achieve ‘social change’ needs to understand and apply mass communication research, especially agenda-setting effects. Yes, social marketing is more than a mass media campaign. But though I have done population-level change without mass media, it's much better to have it in the marketing mix. And thinking about mass media as an agenda-setting tool, not a behavior change one, is an idea I find that few social marketers understand.

Their last chapter sets out the beginnings of a research agenda that provides many ideas about the types of research social marketers could also be undertaking. For example, How do the various elements involved in communicating science at the individual, group, community, and societal levels interact to affect how people understand, perceive, and use science? Social marketers also need to think about the total marketing system and not focus on the ‘level du jour’ (the so-called downstream, mid-stream and upstream approaches; or micro, meso and macro-levels). Thinking about how social marketing can help address, and learn from, the challenges in science communication will provide us with not just better ways to communicate science and market evidence-based practices and policies, but how to reach the shared objective of improving the health and well-being of all people and our planet.

Reference
National Academies of Sciences, Engineering, and Medicine. (2017). Communicating Science Effectively: A Research Agenda. Washington, DC: The National Academies Press. doi: 10.17226/23674.

How well do you utilize marketing in your social media and mHealth efforts?

It seems like a good time to revisit some big ideas about our mental models and the use of social, mobile and other technologies for helping people adopt new behaviors. How well do you utilize the 5Es?

"...it is not the technologies we use in our programs that need to change, but our frames for looking at the world and thinking about what we do. In designing interventions that will effectively lead to behavior change, we have to ask ourselves: 1) Do we harness the ability to educate people about issues and problems that are relevant to them (not us); 2) Is what we do engaging them in positive and meaningful ways; 3) Is there an entertainment value to our offerings; 4) Do people believe and feel empowered as a result of their experiences with our programs (products and services); and 5) Do we take advantage of every opportunity to let our customers and clients become our evangelists? If we fail to do all five, we are failing them and ourselves. And failure in our work is not an option."

Read the full article here.

The Best of Social Marketing in 2016

What are some of the best papers published in social marketing this past year? This list of 10 represent the best work I came across in journals outside of the social marketing journals - Journal of Social Marketing and Social Marketing Quarterly. Hopefully these papers will expand your awareness of what is happening in social marketing theory, research and practice. The papers are selected from journals outside of social marketing to remind us that social marketing is indeed a multi-disciplinary and far-reaching enterprise. The articles present a breadth of interests (feeding programs for infants and young children; reducing obesity among youth; health disparities; global health concerns of HIV, reproductive health, child survival, malaria and tuberculosis; physical activity), insights and processes for improving social marketing programs (see Longfield et al and Venturini); different levels of intervention focus (macro-level social marketing programs and mobile health apps); and a critique of the 'upstream-downstream' metaphor (one that I believe since its use as a wake-up call to social marketers to focus on more than "blaming the victim' has outlived it usefulness for social marketing theory and practice). For those new to these reviews, here are the links to the 2011, 2012, 2013 and 2014 selections - yes, I missed 2015.

Each of the papers is presented in an extended format that draws from their abstracts as well as details in the papers. I'm interested in your feedback, especially if you have other papers you would like to recommend (use the Comments box or email me). Happy 2017 and I hope that you find inspiration for your work in one or more of these papers.

Aaron et al. (2016). Assessing program coverage of two approaches to distributing a complementary feeding supplement to infants and young children in Ghana. PLoS One; Oct 18;11(10):e0162462. doi: 10.1371/journal.pone.0162462

Two strategies were evaluated for distribution of a food supplement to infants and young children in Ghana. The supplement was designed for point-of-use (home fortification) as a micronutrient powder added to children’s food. Each approach was designed to reach different populations: Delivery Model 1 for the rural poor and Delivery Model 2 for more affluent and more populous urban and peri-urban populations, with the aim of developing programming models suited for use as context-specific components of a scaled-up program. Delivery Model 1 was conducted in the Northern Region of Ghana and used a mixture of health extension workers (delivering behavior change communications and demand creation activities at primary healthcare centers and in the community) and petty traders recruited from among beneficiaries of a local microfinance initiative (responsible for the sale of the complementary food supplement at market stalls and house to house). Delivery Model 2 was conducted in the Eastern Region of Ghana and used a market-based approach, with the product being sold through micro-retail routes (i.e., small shops and roadside stalls) in three districts supported by behavior change communications and demand creation activities led by a local social marketing company. Both delivery models were implemented sub-nationally as 1-year pilot programs, with the aim of informing the design of a scaled-up program. Behavior change communication and demand creation activities included promotion of generic infant and young child feeding practices by Ghana Health Services (both models), cookery demonstrations and tastings (both models), billboards and posters (both models), house-to-house sales (specifically in model 1 as door-to-door hawkers were not targeted by model 2), songs-based and street-theatre based messaging (model 1 only), nutrition and health education (model 1 only), distribution of free samples to beneficiaries at health facilities and at points of sale (model 2 only), distribution of free samples to potential sales outlets (model 2 only), radio news and talk-shows (model 2 only), product placement in radio soap operas (model 2 only), community discussions with consumer groups (model 2 only), and mobile public address system (model 2 only). A series of cross-sectional coverage surveys was implemented in each program area. Results from these surveys show that Delivery Model 1 was successful in achieving and sustaining high (i.e., 86%) effective coverage (i.e., the child had been given the product at least once in the previous 7 days) during implementation. Effective coverage fell to 62% within 3 months of the behavior change communications and demand creation activities stopping. Delivery Model 2 was successful in raising awareness of the product (i.e., 90% message coverage), but effective coverage was low (i.e., 9.4% of children had been given the product in the past 7 days).The work reported here indicates that product availability and brand recognition, while necessary, are not sufficient to deliver effective coverage and impact. Future programming efforts should use the health extension / microfinance / petty trader approach in rural settings and consider adapting this approach for use in urban and peri-urban settings. Ongoing behavior change communications and demand creation activities are likely to be essential to the continued success of such programming.

Aceves-Martins, et al. (2016). Effectiveness of social marketing strategies to reduce youth obesity in European school-based interventions: A systematic review and meta-analysis. Nutrition Reviews; 74(5):337-351.

Thirty-eight publications were included in the systematic review and 18 of these studies were randomized controlled trials (RCTs) that were included in the meta-analysis. All RCTs reported using four social marketing benchmark criteria (SMBC): participant orientation, behavior, segmentation, and methods mix. All but one of the 12 RCTs included the competition domain, four based their intervention on a theoretical framework, two included the insight domain in their design, and five included the exchange of the intervention. Overall, the inclusion of at least 5 SMBC in the school-based interventions resulted in a reduction in the prevalence of overweight and obesity of approximately 28%. The inclusion of SMBC when designing interventions represents a valuable methodological tool that may increase the quality and effectiveness of school-based interventions aimed at improving healthy habits, ultimately resulting in positive changes in outcomes such as weight, BMI, or prevalence of overweight and obesity. The current evidence is sufficient to support the notion that at least 5 SMBC domains, regardless of which domains are chosen, must be included in the design of school-based interventions so that these interventions can benefit weight-related measures in young people.

Firestone, R., Rowe, C.J., Modi, S.N. & Sievers, D. (2016). The effectiveness of social marketing in global health: A systematic review. Health Policy and Planning. doi: 10.1093/heapol/czw088

Social marketing is a commonly used strategy in global health. Social marketing programmes may sell subsidized products through commercial sector outlets, distribute appropriately priced products, deliver health services through social franchises and promote behaviours not dependent upon a product or service. We aimed to review evidence of the effectiveness of social marketing in low- and middle-income countries, focusing on major areas of investment in global health: HIV, reproductive health, child survival, malaria and tuberculosis. We searched PubMed, PsycInfo and ProQuest, using search terms linking social marketing and health outcomes for studies published from 1995 to 2013. Eligible studies used experimental or quasi-experimental designs to measure outcomes of behavioural factors, health behaviours and/or health outcomes in each health area. Studies were analysed by effect estimates and for application of social marketing benchmark criteria. After reviewing 18,974 records, 125 studies met inclusion criteria. Across health areas, 81 studies reported on changes in behavioural factors, 97 studies reported on changes in behaviour and 42 studies reported on health outcomes. The greatest number of studies focused on HIV outcomes (n=45) and took place in sub-Saharan Africa (n=67). Most studies used quasi-experimental designs and reported mixed results. Almost one-half of studies reported positive, statistically significant results.. Much of the evidence on the effectiveness of social marketing was concentrated in HIV/AIDS, with 45 included studies. Most of these studies focused on the ability of social marketing interventions to influence condom use and other sexual behaviours. Child survival had proportionately the greatest number of studies using experimental designs, reporting health outcomes, and reporting positive, statistically significant results. Most programmes used a range of methods to promote behaviour change. Programmes with positive, statistically significant findings were more likely to apply audience insights and cost-benefit analyses to motivate behaviour change. Key evidence gaps were found in voluntary medical male circumcision and childhood pneumonia. Social marketing can influence health behaviours and health outcomes in global health; however evaluations assessing health outcomes remain comparatively limited. Global health investments are needed to (i) fill evidence gaps, (ii) strengthen evaluation rigour and (iii) expand effective social marketing approaches.

Longfield, K., Moorsmith, R., Peterson, K., Fortin, I., Ayers, J., & Lupu, O. (2016). Qualitative Research for Social Marketing: One Organization’s Journey to Improved Consumer Insight. The Qualitative Report, 21(1), 71-86. http://nsuworks.nova.edu/tqr/vol21/iss1/7

The authors describe a 10-year journey by their organization to improve their ‘traditional’ qualitative research program through the use of more appropriate data collection methods to develop insight into the emotional barriers and motivators driving consumer behavior (methods fit for purpose). These methods allow marketers to shape new brands and campaigns that resonate with consumers and to reposition concepts to connect with new consumers. They moved away from ‘thin’ interviews and focus groups to more ‘deep’ methods of narratives of consumers’ personal histories of behaving and not behaving, embedded in a relatable context. They began to emphasize data collection methods, like spoken and photo narratives, where researchers could develop a rapport with consumers and focus on story-telling rather than interview guides. Using photos and oral histories to learn about consumers’ lives, behaviors, hopes, fears, and decision-making within the given context yielded deeper consumer insight than asking consumers what they think usually happens in their community, as they had done in focus groups. They also found that using peer interviewers allows them to gain an insider’s perspective on risk behavior and factors associated with that behavior. Peer interviewers was especially helpful for studies about family planning needs among indigenous and ethnic minority couples; concurrent sexual partnerships among young women; condom use among clandestine groups of men who have sex with men, transgendered women, and female sex workers; and use of reproductive health services among young women who had experienced abortion. Small group discussions, like dyads and triads, were helpful when consumers felt nervous or unsafe meeting interviewers and they would benefit from the company of a friend, such as people who inject drugs and youth. Direct observation techniques are useful with caregivers of children and medical providers. In other cases, documenting experiences through life histories, sexual histories, and diary keeping were appropriate; one study in Kenya explored multiple concurrent partnerships through life histories and relationship maps. The authors also describe the formal interaction between researchers and marketers during an interpretation workshop. Researchers typically lead these workshops, which last approximately two days and are an opportunity to explore the data together and become immersed in the consumer’s experience. The marketing planning process then became one of understanding the consumer together rather than researchers simply presenting their data analysis to marketers. These workshops give marketers the opportunity to process consumers’ own words, images, and other inputs, and challenge any pre-conceived notions they had about consumers’ behavior and motivations. The final phase of the workshop is to synthesize descriptive information as well as data about consumers’ values, needs, and aspirations to create an archetype or persona, the “typical” consumer on which to anchor findings. The research and marketing teams then generate a short document (dashboard) that contain the archetype’s beliefs to change; beliefs to reinforce; strategies previously used to behave; perceptions of the product/service/behavior’s current position and personality; their frames of reference or competition; and the archetype’s opportunity, ability, and motivation to process communications. This information fed into the audience profile, positioning statement, marketing strategy, and eventually the program design. Marketing teams reported that FoQus helped them in several ways. The primary benefit of this process for the marketing team was the development of the archetype and dashboard. Consumers now came alive as people; they were no longer just demographic groups, like women of reproductive age. With this simple but clear window into consumers’ lives, marketing teams were able to find new ways of speaking with consumers that were more relevant and emotionally engaging. They were also able to design brands that spoke to consumers on a deeper level, promising emotional benefits rather than just functional ones.

Newton, J.D., Newton, F.J. & Rep, S. (2016). Evaluating social marketing’s upstream metaphor: does it capture the flows of behavioural influence between ‘upstream’ and ‘downstream’ actors? Journal of Marketing Management; 32(11-12):1103-1122.

The ‘upstream/downstream’ metaphor has been used to disparage the tendency for social marketers to focus their efforts on modifying the behaviour of ‘downstream’ consumers without first considering whether the actions of ‘upstream’ actors placed such behaviours beyond consumers’ volitional control. Such discussions would be relatively uncontentious if the metaphor was simply being used to focus attention on the fact that ‘upstream’ forces may impede ‘downstream’ consumers in their pursuit of healthy, sustainable lifestyles. However, many social marketing textbooks extend the metaphor beyond this relatively circumscribed use, applying it instead to justify the targeting of social marketing interventions at these ‘upstream’ forces. For example, many social marketers advocate with varying levels of intensity the targeting of regulators and legislators who can compel firms to act in ways more consistent with supporting the health and sustainability of ‘downstream’ consumers. To use an untested metaphor to guide the strategic direction of social marketing interventions may unnecessarily limit or constrain the types of interventions being proposed. Using a case study, the authors demonstrate how ‘downstream’ actors do exert control over ‘upstream’ actors and that the relationship between the two is often bi-directional. The authors also note how different ‘upstream’ actors influence each other’s actions. “We believe that the upstream/downstream metaphor has reached the end of its usefulness in that the assumptions underlying the metaphor may restrict how social marketers conceptualise or approach efforts to change the structural impediments to behaviour. What is needed instead are new frameworks that can explicate the multidirectional relationships that give rise to the ill-defined problems facing society and provide guidance as to how these problems could be addressed.”

Singh et al. (2016). Many mobile health apps target high-need, high-cost populations, but gaps remain. Health Affairs; 35(12):2310-2318.

The authors evaluated 137 patient-facing mHealth apps—those intended for use by patients to manage their health—that were highly rated by consumers and recommended by experts and that targeted high-need, high-cost populations. They found that few apps address the needs of the patients who could benefit the most. Patient engagement functionalities were limited; many apps provided educational information and reminders or alerts while very few apps focused on providing guidance based on user-entered information or support through social networks, or on rewarding behavior change. The authors also found that consumers’ ratings were poor indications of apps’ clinical utility or usability, and that most apps did not respond appropriately when a user entered potentially dangerous health information.

Thornton et al. (2016). Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Affairs; 35(8):1416-1423.

The opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. The authors review scientific evidence from promising interventions focused on the social determinants of health and discuss how such interventions can improve population health and reduce health disparities. They found sufficient evidence of successful outcomes to support disparity-reducing policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. The complex interplay of factors that has resulted in persistent health disparities cannot be reversed with short-term investments. Interventions focused on the health sector are insufficient to address population level health disparities. Social determinant–related interventions designed to create structural changes must be coordinated with long-term efforts to change social and cultural norms, build on existing community strengths, and change the opportunity costs associated with healthy behaviors to make the healthy choice the default choice. For such interventions to have sustained, intergenerational positive health impacts, they must be coupled with attention to social marketing, behavioral economics, social services, and other supports.

Truong, V.D. (2016). Government-led macro-social marketing programs in Vietnam: Outcomes, challenges, and implications. Journal of Macro-Marketing; 1-17. DOI: 10.1177/0276146716660833

Although social marketing is regarded as an effective consumer-oriented approach to promoting behavioral change and improved well-being for individuals and communities, its potential for generating societal change is still under-researched. The use of social marketing by governments and other upstream actors within a systemic approach to engender social change is referred to as macro-social marketing. This article examines government-led macro-social marketing in Vietnam, a country where the national government is interested in using social marketing to engender societal change. The author identified four macro-social marketing programs that target smoking cessation (since 2002), helmet use (since 2001), drunk driving prevention (since 2008), and nutrition (2011-2015). Delivery of these interventions includes a wide variety of interventions. Education campaigns raise public awareness of the harmful impacts of smoking, drunk driving, driving motorcycles without helmets, and micronutrient deficiencies on the health of individuals and social development as a whole. Education activities include tailored training programs (e.g. workshops, community meetings) and documents (e.g. toolkits, guidebooks, posters) for individuals, health professionals, community health workers, media professionals, leaders and staff of state- and private-owned organizations. Dissemination of program messages is through national and provincial television channels, radio, print and online newspapers and magazines, social media, brochures and posters. Community health workers, loudspeakers, and members of community-based civil organizations (e.g. youth unions, women’s unions) are more popular in rural areas, particularly remote and mountainous ones. All four programs also have adopted measures to restructure marketing systems to avoid the undesirable consequences of commercial marketing practices on society, either by restricting marketing practices that are detrimental to public health (such as with tobacco) or supporting marketing practices that are beneficial (tax reductions for producers of quality bicycle helmets and prioritized advertising schedules - prime hour spots are reserved for them on national television and radio). The author cites data showing steady declines in tobacco use and deaths and injuries from road traffic accidents, increases in the use of bicycle helmets (over 95%), and the participation of 10 leading food producers in the micronutrient food fortification program. the author concludes that an effective combination of different interventions involving many stakeholders and agencies and targeting multiple layers of long-term behavior change is required if such problems are to be eliminated or ameliorated on a macro level. Education, community engagement and mobilization, and policy and legislative initiatives are complimentary rather than mutually exclusive strategies.

Venturini, R. (2016): Social marketing and big social change: Personal social marketing insights from a complex system obesity prevention intervention. Journal of Marketing Management; 32(11-12): 1190-1199. DOI: 10.1080/0267257X.2016.1191240

The author presents insights into using social marketing within a systems approach that is described as ‘A strategy to tackle obesity needs a comprehensive portfolio of interventions targeting a broad set of variables and different levels within the obesity system. Although, alone, each component part of the strategy may not create significant impact, their complementary and reinforcing action is critical to achieving the significant shift required in population obesity trends if the strategy is not to fail.’ His five insights include (1) positioning social marketing to stakeholders as a critical decision-making tool that could be used to innovate and support evidence-informed business decisions in a way that would drive big social change; (2) using behavioural data and insight, mapped against traditionally available data sets, to gain a better understanding of the viewpoint of the citizen and a deeper understanding of the problem – what influences individuals to act, what may motivate them to change their behaviour and ultimately what can be used to drive population health change; (3) creating a brand aligned with the need to create a systems intervention that groups of people could relate to and trust, something that could inspire action, something that multiple stakeholders across a range of interests could see value in and something they could be inspired to be a part of; (4) using ‘sociall marketing’ to attract stakeholders’ curiosity, we created opportunities for stakeholders to reflect and challenge their role and consider how they could best contribute to the overall obesity prevention effort; (5) focusing on knowledge capture - the development of a number of key resources that included a behavioural segmentation model, various strategies and implementation plans, literature reviews, guides on how to conduct research, guides on developing messages and narratives, guides on managing the brand and case studies. Individually these resources did not hold the key to success. However when they were brought together as part of other tools and resources that supported the delivery of Healthy Together Victoria, they proved to be powerful assets. They were powerful in the way that these assets represented a tangible means of translating theory into practice. They became tools that nurtured talent, enabled a workforce to take action, and supported stakeholders and broader networks to deliver efforts that ultimately contribute to the common goal of creating a healthier Victoria.

Xia, Y., Deshpande, S. & Bonates, T. (2016). Effectiveness of social marketing interventions to promote physical activity among adults: A systematic review. Journal of Physical Activity, 2016; 13(11):1263-1274. doi: http://dx.doi.org/10.1123/jpah.2015-0189

The authors proposed benchmarks, modified from those found in the literature, that would match important concepts of the social marketing framework and the inclusion of which would ensure behavior change effectiveness. In addition, they analyzed behavior change interventions on a social marketing continuum to assess whether the number of benchmarks and the role of specific benchmarks influence the effectiveness of physical activity promotion efforts. To avoid becoming embroiled in the debate on the appropriateness or inappropriateness of social marketing labels, they decided to examine the effectiveness of all types of physical activity promotion interventions that displayed at least one of the marketing mix benchmarks. A systematic review of social marketing interventions available in academic studies published between 1997 and 2013 revealed 173 conditions in 92 interventions. A Logical Analysis of Data (LAD-WEKA) revealed that when more than 6.5 benchmarks were used, 81.82% of the interventions were successful, while all interventions were successful when more than 7.5 benchmarks were employed. Through several statistical analyses and modeling, six benchmarks emerged as predictors of program success in improving levels of physical activity: primary formative research (e.g., identify the target group’s attitudes, beliefs, barriers, and enablers regarding physical activity), core product (e.g., highlight that participating in physical activity strengthens work performance), actual product (e.g., offer a gym facility), augmented product (e.g., offer consulting sessions), promotion (e.g., “Get Firefighters Moving”), and behavioral competition ((e.g., watching TV at home, identify and address social-ecological factors competing with physical activity). The authors note that other benchmarks that did not predict success may have been due to their low use among all of the interventions under study.

 

Why Everyone Needs Marketing Skills

There is a palpable tension in the behavior and social change worlds between people who believe that all marketing is evil and those who believe marketing can be used for good. This tension gets played out in program planning meetings, conferences, policy debates and resource allocations (such as found in RFPs and TORs). Not everyone who works to solve wicked problems needs to be a social marketer; yet, learning some basic marketing skills may work to their advantage.

I just came across this article by Liz Elfman in which she describes 5 reasons for why everyone needs marketing skills. I've lightly edited it to better frame it for a social change world. I have also included links to other posts that provide you with more ideas.

1. You’ll Learn to Listen
Marketers are constantly listening, looking for ways to maximize opportunities, leverage relationships, and connect to people. And while anyone can be a good listener, doing so as a marketer requires a fair amount of analysis—it’s an active process, not a passive one. By being trained in customer analysis, focus groups, and audience alignment, you’ll start to learn how to really listen to what your priority groups and stakeholders want.

2. You’ll Make Better Decisions
Knowing how to find and interpret data about your priority groups and stakeholders means that you’ll better understand your problem - and how to address it in new ways. Not to mention, you’ll also get in the habit of cutting through a lot of extraneous noise and honing in on the numbers and consumer insights that are most important.

3. You’ll Gain Tact
The best marketers learn how to gain insight into different personality types and take different approaches for engaging with them, based on what makes them tick. In other words, they learn how to be tactful.

4. You’ll Get Scrappy
Everyone is on a shoe-string budget. Ruthless prioritization of resources is a must for small and large governments and NGOs. Being creative about who you select and concentrate on, how you reach them, and how to do more with less will ultimately help you turn into an efficiency machine.

5. You’ll Become More Aware

Marketers have to be aware of what’s going on in their world. This means they read, go to parties, try to figure out what’s going on in pop culture, and generally pay attention to the zeitgeist. No matter what industry you operate in, learning to check in with your surroundings can only help you. While it’s tempting to get bogged down in the details of your specific position, training yourself to focus on the bigger picture will ultimately help you do better in that role. Not to mention, you’ll probably end up getting interested in a lot that’s going on around you, which makes you a more interesting person all around.

If you want more reasons why you and your colleagues should learn to think and act more like marketers, consider reading Daniel Pink's To sell is human: The surprising truth about moving others.

And if you're ready to dive deeper in how you can apply marketing to your environmental, public health, transportation or social issue, explore the USF Social Marketing Conference and Training Academy to be held 15-18 June 2016 in Clearwater Beach, Fl.

The Marketing Mix: Ps, Cs and Everything Else

.. any marketing element in a program, whether it starts with a “P” or not, needs to be modifiable to meet the unique needs, problems, and aspirations of a priority group. If a P is so complex or ubiquitous as to defy a fit with the priority group, then it is no longer a marketing variable. (Lefebvre, 2013, p.310).

Many social marketing academics and practitioners like to propose, argue and otherwise distract themselves from people's concerns by talking about 5, 6...(up to 20 I've read) Ps - adding things like Politics, Purse strings, Partners, People, Positioning...you get the idea. Other people contend that this 'producer' oriented "P" approach (what 'we' do for 'them') needs to be rethought as a customer-centric set of Cs - Customer (wants and needs), Convenience, Cost and Communication to which more Cs can easily be appended - collaborators, co-creation, co-operation, etc. And yes, they don't seem like more than semantic differences - the core issues are the same. Many other proposals for how to think about the marketing mix are out there as well.

Yes, there can be some dogmatism about whether you use Ps, Cs, Vs, or any other set of attributes to describe your marketing mix - usually expressed by peer reviewers and people at podiums. The important thing to remember is that the use of a single letter, or even an acronym, is in an effort to help us to remember to touch all the bases. However, when they shift from focusing on what's important to members of our priority group to what's important (or clever) to us, and don't have obvious implications for how to design our program, then I think it's time to put your head down and ignore them [and yes, I can make arguments for including or excluding Ps and Cs with the best of them, but why bother].

The marketing mix is near the core of the social marketing approach. A marketing effort is more than a mass media or advertising campaign (a 1P or 1C effort), a nudge or removing a barrier (another type of 1P or 1C effort), or designing opportunities to try a new behavior or making products and services more accessible (yet another 1P or 1C approach). The marketing mix is there to remind us that we have to tailor offerings to different groups of people based on their shared needs, problems, aspirations and other characteristics; that is, we have to segment them first. Then we develop a unique marketing mix for each priority group - it's not one size fits all. If Ps and Cs help you remember to do that, and not default to your typical 1P solution, then it works. Now test your ideas with your priority groups.

Let's take as an example the many conversations I have with people over social media and mobile phones. Early on in these conversations the question comes up, "How are you going to use it?" More often than not it's to be used to 'communicate messages' or perhaps 'nudge' people in a priority group - a 1P solution. What if that social media or mobile tool was thought about as a product (or app) or a service - not simply a new channel for messages? How could this technology be used to make information or action more convenient or accessible? How would it reduce current barriers to action, or provide incentives to try? How could it be harnessed for peer learning or support when making behavior changes (oops! Not in those Ps and Cs)? How would someone use it to solve a problem (find value using it) - and what exactly is their problem that this social media or mobile technology is suppose to solve? Oh, and how will your priority group learn about it? Too often the answers are along the lines of "Well, we haven't thought about that." The marketing mix is a decision aid to get you thinking about those things - those are the questions marketers think about.

...the 4Ps concept should not be a straitjacket that includes certain strategies and excludes others; instead, I refer to it as a heuristic to acknowledge its value as an aid in considering major leverage points for change and developing a more comprehensive strategy and program than might otherwise occur. (p. 310-311).

That's all it is. You can keep it simple or make it complicated. In the end, it's what is important to your priority group, not your beliefs or mnemonics.

Lefebvre, R.C. Social marketing and social change: Strategies and tools for improving health, well-being and the environment. San Francisco: Jossey-Bass, 2013.

12 Features for Successful Obesity Prevention and Control Programs

Rapid changes in dietary habits, coupled with a decline in levels of physical activity, have led to an increase in the prevalence of overweight and obesity in the US and around the world. The consequence of these changes has been an increase in noncommunicable diseases (NCDs). The challenge for health authorities is to benchmark their efforts to slow and eventually reverse these trends. What to benchmark to? I suggest to what has been found to work, not what fits into rhetorical frameworks.

In reviews of over 300 studies on the use of health communication, social marketing and community-based approaches to address health risk behaviors, especially poor dietary habits and increasing levels of physical activity, across a wide range of socio-demographic groups around the world, a number of lessons have been learned about what constitutes the more successful programs (Carins & Rundle-Thiele, 2014; Garcia-Marco et al, 2012; Snyder, 2007; Wakefield et al, 2010). I have added to their findings several other features that more recent experiences suggest can improve program effectiveness. Note that while many of these studies have focused on nutrition and physical activity behaviors, the ‘Ideal Features’ list below could be applied relatively well across efforts to change many different behaviors and address other wicked problems.

For your consideration and comment:

The Ideal Features of Social Change Programs (with links to previous posts)

1. Select and concentrate on priority groups
2. Identify the value each priority group finds in adopting healthier behaviors
3. Understand and address the incentives and costs of change – financial, opportunity, psychological, social, scarcity, etc
4. Design products, services and behaviors that fit people’s reality
5. Position the new behavior as more compelling, relevant, and potentially more valuable to people when they practice it, in comparison to the alternatives
6. Test program strategies and elements before implementation
7. Not rely only on mass communication campaigns
8. Increase access to information, places, food choices and services that reinforce desired behaviors
9. Locate a service, distribute a product, and create opportunities for members of our priority group to engage in healthier behaviors
10. Utilize community-based programs and citizen engagement to facilitate collaborations and create healthier environments and policies
11. Consider policies that include incentives and disincentives for specific dietary and physical activity behavior
12. Explore how social networks and social media can influence norms about, and diffusion of, healthier behaviors and lifestyles

References

Carins, J.E. & Rundle-Thiele, S.R. Eating for better health: a social marketing review. Public Health Nutrition, 2014; 17(7):1628-1639. 

Garcia-Marco, L., Moreno, L.A. & Vicente-Rodriguez, G. Impact of social marketing in the prevention of childhood obesity. Advances in Nutrition, 2012; 3:611S-615S.

Ogden, C.L., Carroll, M.D., Kit, B.K. & Flegal, K.M. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 2014; 311(8):806-814.

Snyder, L. (2007). Health communication campaigns and their impact on behavior. Journal of Nutrition Education and Behavior; 39(Suppl.):S32–S40.

The GBD 2013 Obesity Collaboration, Ng, M., Fleming, T., et al. Global, regional and national prevalence of overweight and obesity in children and adults 1980-2013: A systematic analysis. Lancet. 2014;384(9945):766-781.

Wakefield, M. A., Loken, B., & Hornik, R. (2010). Use of mass media campaigns to change health behaviour. Lancet; 376:1261–1271.

Creating Special Moments for Controlling and Preventing Obesity

Social marketers should note the Coca-Cola company announcement of its new 'One Brand' global marketing strategy yesterday in Paris. It's something worth taking a careful look at, especially if your work encompasses trying to change eating patterns, reduce consumption of sugar-sweetened beverages (SSBs) and/or tackle the wicked problem of obesity.

There are several points in their strategy that are useful to consider when developing social marketing and public health campaigns.

First: 'Drinking a Coca-Cola, any Coca-Cola, makes the moment special.' The intent here is not to worry so much about selling a specific brand (regular, diet, caffeinated or not). As long as it's a Coke, it's the right choice. Now think about how you talk about alternatives to unhealthy eating patterns, SSBs and other behaviors related to obesity prevention and control (such as physical activity). Does your program focus on just one behavior or several? Are they somehow connected with each other - or could be? Do any of those behaviors 'make a moment special?' If not, how do you expect to compete (short of trying to ban all Coca-Cola advertising)?

The 'One Brand' strategy is articulated as:

• Extends the global equity and iconic appeal of original Coca-Cola across the Trademark, uniting the Coca-Cola family under the world’s number one beverage brand.
• Comes to life in a global campaign - “Taste the Feeling” – that uses universal storytelling and everyday moments to connect with consumers around the world.
• Features the product at the heart of the creative, celebrating the experience and simple pleasure of drinking a Coca-Cola, any Coca-Cola.
• Underscores the Company’s commitment to choice, allowing consumers to choose whichever Coca-Cola suits their taste, lifestyle, and diet.

With obesity and SSBs becoming a global concern, are there ways of creating global equity and iconic appeal either with an existing brand (for argument's sake, such as the UN or WHO)? Thinking more locally, are there cities, states or countries that have invested in a 'brand' that could lead social marketing efforts in this space? If you don't think you have a brand, maybe you need to look around and find one that already exists in the minds of your priority group.

How can we use story-telling, not facts and certainly not fear appeals, to position options in the context of people's everyday moments? Again, not the facts, and not the typical exhortations to 'don't eat or drink that!' How do healthier choices connect with people around the world (what are some of the universal situations and experiences you could use to connect with people and not just communicate to target audiences)?

What are the 3-4 specific behaviors you could focus on that would help people celebrate their experiences and the simple pleasures of trying something different?

And finally, note that there is a commitment to choice (yes, as long as it's a Coke) - but the idea of choice is one that resonates with most consumers and is sadly one that too many public health people are abandoning.

But remember, it's not a 'healthy choice' that most people are looking for (the ones that want to make those choices don't need our programs). 

Many times I have talked about Coke's strategy of 'being within an arm's reach of desire' and how social marketers (and public health professionals) need to focus on distribution of, and access to, opportunities to engage in healthy behaviors.

... what if instead of focusing so much of our efforts on changing the rules (policies), we thought harder and more deeply about how other behaviors could make the moment even more special for people. Here's how Coke is doing it.

Concept Testing: The Most Important Step for Social Marketing Research

The biggest change in formative research that social marketers are still learning how to do well is concept testing. As I described it in my book, concept testing is the phase of research “in which options for the target behavior and its associated value or benefits are validated among members of the priority group” (p. 185). It is VERY different from pretesting draft messages (in all their formats) and prototypes of products and services before putting them into final form. If I can do only one type of formative research, I always choose concept testing. Why?

Concept testing pits the ‘expert-driven’ decisions of what behavior people ‘should’ engage in and the theoretical hypotheses of ‘why’ they are (or are not) motivated to do so against the realities of the priority group we seek to serve. Concept testing focuses social marketers on being close to people, audience-driven versus maintaining an expert role in which decisions are made and carried out without considering the POV and voice of people. Decisions about what people are expected to be able to do, versus what their capabilities, resources and circumstances allow them to do are rarely examined by these experts. What motivates people to do what they do, or decide to engage in a new behavior, are presumed to be ‘determinants’ of behavior – not the actual thoughts, emotions and experiences people have when confronted by our messages, products and services. If our assumptions about what’s feasible and desirable for people to do are not challenged with concept testing, our messages, materials, products and services are doomed. Too many ‘pretests’ are in reality ‘disaster checks,’ and while the participants in these tests are often kind to us in their responses, lukewarm receptions do not bode well for effective behavioral, organizational or social change. And receiving negative feedback on our work often comes too late in the planning and budgeting of projects to allow for much else than cosmetic changes. The fundamental flaws in the strategy are beyond repair.

Concepts are the ‘big ideas’ for your campaign or program. They bring your positioning statement to life (and if you aren’t crafting a positioning statement before starting down the implementation path, that’s another challenge you can read more about here). For example, the VERB^TM campaign to increase physical activity among preteens had the positioning statement: “We want tweens to see regular physical activity as something that is cool and fun and better than just sitting around and watching TV or playing video games all the time.”

The first key issue that the ‘big idea’ or concept needs to grapple with are what are these ‘regular physical activity’ behaviors – walking, team sports, bicycling, swimming, etc...? Experts will decide which ones to focus on by, as more common than you think, what they see their kids doing, or their kids’ classmates, or what a recent survey has found as the most popular ones. They’ll then go on to create materials and programs that feature these activities – or just a single one – and then pretest them.

The second question a concept needs to address is: How do we make these physical activity behaviors more compelling, relevant and valuable (beneficial) to tweens than the alternatives (TV and video games)? Yes, our research may tell us that ‘cool & fun’ are the answer, but what exactly is cool & fun to tweens – and more importantly, how do we present cool & fun to tweens in a credible way and not come across as saying ‘this is what we think you think cool & fun are.’ The big idea, or concept, isn’t usually one answer to these two questions, it may be several creative ideas that we then have to choose from. And this is where people get tripped up – trying to create one concept for everybody. If you aren’t focusing on a well-defined segment, or priority group, creating concepts is nearly impossible as you try and become all things to all people. The options you create will be all over the place rather than focused and tailored to specific needs, problems, aspirations, values, lifestyles and circumstances of a priority group (formerly known as a target audience).

So what is concept testing?

Concept testing is getting the priority group’s input into the decision of which big idea to go with in designing your program. Concepts are often presented on simple display boards with a top line (header) that specifies the behavior we think fits our priority group (is potentially do-able by them in their circumstances) and a bottom line (footer) of what the motivation or value is in doing it from what we think is their POV. I deliberately used ‘think’ twice in the last sentence to highlight that concept testing is hypothesis testing; we experts are trying to find out if we have guessed, deduced, or intuited the correct answers to our two questions of behavior and motivation/value. In many practices of concept testing, a simple header and footer is the first step – one set for each concept. Wordiness is not a virtue for a concept. If you can’t express a header and footer in a few words, your priority group probably won’t pay attention to, understand or act on your eventual message or product. Inserting a stock photo, or drawing, between the header and footer to capture the tone, personality or brand attributes you want each concept to convey is the last step in creating a concept board. Don’t get too fixated on the image or design at this point, save the expense and labor for great graphic design after you get the right approach identified. Concept testing is not a design critique session.

I like presenting at least 2-3 (no more than 5) concept boards in focus groups because what we want is for people to be talking with each other about the ideas (and not responding to a list of questions from a moderator). It is not an ‘up or down’ vote on each concept board or idea and choosing the winner. I’ve had focus groups where people preferred that the behavior (header) on one board people be matched up with the value/benefit (footer) on another board. They might even suggest to lead with the value (make it the header and focus the big idea around the value or benefit) and put the behavior in the footer. In at least one case, the behavior that emerged from the concept testing sessions was not the one we originally had on a concept board. In another case, the PSA script that was eventually developed consisted entirely of verbatim excerpts from the transcripts of the concept testing sessions.

What we’re interested in learning in concept testing are the answers to these questions:

• Does the behavior make sense to them – is it something they can see themselves doing?
• Is the value or benefit of doing that behavior realistic in their lives – could they see that happening to themselves?
• Are there other behaviors that make more sense to them than what we present?
• Is there a better reason for engaging in the proposed behavior that we didn’t mention?
• What do they think the image says about the behavior and the expected value/benefit?
• How does each concept board make them feel? Inspired to change? Bored?
• What elements do they especially like – what are their favorite header, footer and image and why?
• Which ones seem to go best together for them (it may a total concept board, or they may rearrange them)?
• How would they explain each concept board to a friend? What is it saying (this is why you don’t want too many words explaining the concept yet)?

As the last question hints at, the other value of concept testing is that we get the opportunity to listen to how the priority group talks about the problem, potential solutions (behaviors) and the compelling motivation to do something different as they discuss the concepts. This content is the goldmine of concept testing, not just emerging with a sense of which big idea around which to design a campaign or program. Copywriters, art directors and other creative staff can find a lot of inspiration, if not the exact words and images to use, by reviewing transcripts or recordings of concept testing sessions.

Concept testing is the closest formative research method to having participants co-create content with you and not just pass judgment on your work. While actively engaging members of the priority group in on-going campaign and prototype development is a goal for some organizations, in other settings it may not be practical or feasible. Before you jump into action as the expert after doing a few exploratory focus groups or a literature review, think about what you are missing by not listening to the ideas of your priority group. Concept testing will get your closer to the goal of being audience-centered and responsive to their needs, problems and aspirations. As I tell my students and workshop participants, if I have time and a budget for only one set of formative research activities, I will always choose concept testing.

 

Being More Creative

How can social marketers put more creativity and innovation into their work to inspire and move people and communities to better health and improved well-being? That is a question that bedevils many staff, managers and administrators who find that they need to stop the insanity of doing the same thing over and over again to achieve the same small effects. Being ‘creative’ or ‘innovative’ doesn’t happen by simply giving people permission to do so. Especially in the public and nonprofit sectors, it’s not that easy. Many managers and staff come from academic backgrounds where creativity and innovation are never directly addressed in their coursework, field (work) placements or internships (though there are exceptions). Others work in organizations where the fear of failure, and CYA, keeps people from taking chances. Unless you have had direct experience working with one or more creative directors (and that only happens in well resourced environments that can contract with outside agencies), the mystery of what they do can seem impenetrable and difficult to do on your own.

People who work on environmental, public health or social issues have the ‘research evidence’ beat into them: stray from the evidence base and there will be consequences. 'Being creative' is not in most of our job descriptions - yet each of us deeply believes that, if given the chance, “Hey, I can be creative!” When the opportunity to ‘show some creativity’ is offered, in my experience the results usually fall not far from the evidence tree.

Those programs come from the cooks who follow the beaten path of program development protocols and apply the evidence with a sprinkling of ‘creativity’ (often seen these days as trying to use a new social media channel - Meerkat anyone?) - preferably in the original, science-based language so that everyone else in their bureaucracy will ‘approve’ it. These planners rarely have the calling to seek the perspective of people they wish to serve. Yet many of them are sometimes very open about their wish that they could break out of their usual approach and be more creative, to do something different and potentially more valuable for the people they serve. For those of you who have similar yearnings, an article in this month’s PharmaVoice (March, 2015) on Creative directors’ secrets to success has some concrete suggestions.

1. The very first one is to gather and keep resources for inspiration, not just journal articles from your professional organizations and affiliations, but creative ones as well. Try design magazines and websites, marketing websites, and groups that feature campaign reviews and awards (see Warc prize for social strategy, PRSA anvil winners, Clios and Osocio).

2. Learn the fundamentals of strategy, branding, copywriting, and design - maybe someday we’ll see courses like these in schools of business, engineering and public health, Until then, try those last four links. And if you have opportunities to work with people who have these skills, respect them and don’t try and turn them into one of you. Unfortunately, I have seen public health people do that to creatives more often than not. Embrace them as part of your interdisciplinary team who are bringing new ways to think about problems and solutions. You may not think that their approach makes sense, but withhold your judgment until you see what people who are the priority group think about it.

3. When working with creative projects concern yourself with directing and guiding the work, putting the right people in place, and then letting them do their thing. Some creatives like to go off and work by themselves, more of them are realizing that working with you and members of the priority group is a better approach (co-creating). Try and keep in mind that these are opportunities for you to listen, observe and learn - not to be the censor or devil’s advocate.

4. Strong positioning leads to strong, creative ideas. Find a distinctive place in the mind of your priority group that differentiates what you are asking them to do from other competitive offerings (both from other marketers and the alternative behaviors). If you can do that, then you have a chance to come up with the break through idea - the ones you see in other campaigns and wonder “How did they do that?”

5. Your job is getting people in the real world to attend to, remember and act on your efforts. Nothing else (should) count.

6. You can do that by creating experiences (the mix of messages, product and service) that touch people emotionally, enlightens them, inspires them AND shows them the way to new behaviors. As one CD put it; “Powerful words, pictures, and ideas — no matter what channel they’re circulated through — remain magical things that can move hearts and minds.” 

7. Keep your positioning statement, key insights, and strategy front and center throughout the process (you do have these, don’t you? They should be in your program or creative brief). Too often what is used as the touchstone for whether a creative idea is appropriate is how well it fits the theory and evidence, not how well it fits into people’s lives and experiences.

8. To get the most effective creative ideas and work, customer insights need to be the core of your creative brief. Research and data are important, but they can handcuff you to the usual approaches. Talking with and learning from members of your priority group are where insights happen - if you give them the space to tell them to you and not always be answering your questions. As another CD put it: ‘An insight is a relevant truth, nothing more and nothing less,… It’s not a secret that only you’ve managed to uncover. It’s what the customer already knows, be it consciously or not.’
See Aspiring to Audience Insights - Part I
Aspiring to Audience Insights - Part II

9. The best, most effective creative begins with a single-minded and inspirational brief. Not from the ones that are diffuse and mired in data and theory.

10. Get rid of fear of failure. Constantly challenge yourself and your team to consider the costs of fear. Think dangerously!

SO if you want more creativity in your program activities, it doesn’t start by ‘being more creative.’ Being creative means having a process that starts with deeply listening to and understanding your priority group, uncovering the insight that leads to world-changing ideas, creating a positioning statement that drives strategy by offering a compelling reason why your offering (or behavioral choice) is superior to the other options that are available to someone, putting it all down in a program or creative brief to refer to consistently through the process, and aim to shift hearts, minds and behavior. It’s a creative approach that doesn’t have to wait for a new initiative or inspiration; look at one your existing programs and start asking dangerous questions.

Image from Denise Krebs on Flickr.

Scarcity and Social Change

Scarcity is more than an economic idea of there being limited resources to meet everyone’s every need. Having less than what we perceive we need – whether it is food, money, friends or time – is having less than we feel we need. What makes scarcity an important idea for social marketers and other change agents is that it captures the mind; scarcity changes the way we think. Scarcity causes us to ‘tunnel’ – to adopt a mindset that focuses only on what seems, at least at that moment, to matter most. Scarcity, as you might expect, can lead us to do some not so smart things.

That is the core of the book, Scarcity: Why having so little means so much. It extends the insights from behavioral economics beyond the nudges and defaults we are now so familiar with to how we think and feel when we have too little; it changes our thoughts, choices and behaviors. While we recognize how scarcity can make us more attentive and efficient in managing immediate needs – think of the last deadline that was looming over you – it also reduces what the authors refer to as ‘bandwidth.’ They consider bandwidth as a short-hand for our cognitive capacity and executive control that are currently available for use. Simply put, when scarcity captures our mind it helps us focus on doing a better job with our most pressing needs; yet it also makes us less insightful, less forward-thinking and less controlled. The bad news is that the associated reduced bandwidth can lead to more scarcity as we continue to ‘tunnel,’ or neglect other, less immediate concerns that then becomes tomorrow’s, or next month’s or next year’s pressing need. It is the tunneling phenomenon that is the central culprit for poor decision-making and behavior choices.

They illustrate the scarcity and tunneling problems through reference to several studies in both the laboratory and in the field of how poverty is a major contributor to reducing bandwidth. Consider some unsuspecting shoppers in a mall who were asked to imagine a scenario in which they either had (a) a $300 estimate, or (b) a $3,000 estimate to repair their damaged car of which their insurance would pay half the cost. Do they get the car fixed, or take the chance that it will continue to run a little longer? They were given a test of cognitive ability, the Raven’s Progressive Matrices, before being given the scenario and then a few minutes after considering their response. In the $300 scenario there were no significant differences in participants' test performance, regardless of their reported income level.  But as you might now suspect, there were significantly lower scores for the people with lower incomes than for those with higher ones in the $3,000 scenario. The authors’ explanation is simple, yet may provide the insight for many programs serving the poor: the $3,000 scenario got poorer people to consider their own money scarcity (“How could I come up with that?”) and this tunneling (or preoccupation) carried over to their performance on the Progressive Matrices in the post-test. Their performance was, in fact, worse than for people who have been sleep deprived. The authors note that these differences correspond to a drop in IQ of 14 points (a shift in an intelligence score of this magnitude can result in a person of average intelligence being reconsidered as ‘borderline deficient’ – just because of the bandwidth tax imposed by thinking about one’s tight financial situation). The same effect, they show in another study, holds true for farmers in India before harvest (when times are lean) and then after it (they have now been paid for their crops). “We would argue that the poor do have lower effective capacity than those who are well off. This is not because they are less capable, but rather because part of their mind is captured by scarcity” (p. 60). Other research demonstrates the same effects for people who are dieting or are lonely.

“…preoccupations with money and with time cluster around the poor and the busy, and they rarely let go. The poor must contend with persistent monetary concerns. The busy must contend with persistent time concerns. Scarcity predictably creates an additional load on top of all their other concerns” (p. 62).

Scarcity, and the cognitive load it puts on people who dwell on immediate concerns to the detriment of other issues, literally makes us dumber and more impulsive. Think about that the next time you wonder why people who are poor do some of the things they do – to your utter exasperation. Scarcity forces people to engage in trade-offs; having slack in money and time (disposable income and free time) makes decision-making (and life!) so much easier.

A related paper by Datta and Mullainathan (2012) also discusses ideas of scarcity in a policy development context. They talk more about the limited resources imposed by perceptions of scarcity and suggest some ideas about how to address each of them in program design.

Scarcity of cognitive capacity - Cognitive resources available to people at any moment are limited and can be depleted by their being used for other activities. So increasing the cognitive demands of social change programs (cover more material, require more time spent in classes) may in fact be designing them to be less likely to succeed. The prescription: simplify choices people have to make and encourage rules-of-thumb (heuristics) for decision-making.

Scarcity of self-control - Think of our self-control as a psychic “commodity” of which we have a limited stock, so that using up some for one task (continuing to exercise when you really want to stop) depletes the amount available for other tasks (resisting the dessert at dinner after your workout).  The prescription: Defaults; Time Management skills; Making explicit commitments.

Scarcity of attention - Think of attention as another precious commodity – people do not have unlimited attention and might not pay attention to the ‘right’ things – they are busy paying attention to others. The prescription: Prompts and reminders; Incentives.

Scarcity of understanding – People’s mental models of how the world works may be incomplete; not all underlying causal relationships are correctly or accurately understood. The prescription: Framing and tailoring of messages to existing mental models; directly address underlying faulty assumptions.

“From our position of being reasonably well off and comfortable… we tend to be patronizing about the poor in a very specific sense, which is that we tend to think, “Why don’t they take more responsibility for their lives?” And what we are forgetting is that the richer you are the less responsibility you need to take for your own life because everything is taken care [of] for you. And the poorer you are the more you have to be responsible for everything about your life…. Stop berating people for not being responsible and start to think of ways instead of providing the poor with the luxury that we all have, which is that a lot of decisions are taken for us. If we do nothing, we are on the right track. For most of the poor, if they do nothing, they are on the wrong track. – Esther Duflo

Scarcity, tunneling and bandwidth. Good points to be reminding ourselves of as we talk with people among our priority groups and set out to design programs that will help them solve their real problems.

References

Datta, S. & Mullainathan, S. (2012). Behavioral Design: A New Approach to Development Policy. CGD Policy Paper 016. Washington DC: Center for Global Development.

Mullainathan, S. & Datta, S. (2013). Scarcity: Why having so little means so much. New York: Times Books.

Parker, S. (June 23, 2011).  Esther Duflo Explains Why She Believes Randomized Controlled Trials Are So Vital, Center for Effective Philanthropy Blog, June 23, 2011

 Image credit: Freddy Olsson.

 

Getting to the World Social Marketing Conference - 2015

The 3rd biannual World Social Marketing Conference is coming up 19-21 April 2015 in Sydney, Australia. Jeff French, the Conference Chair, has developed a Top 10 list for why you should be there:

    1.    Hear the most up-to-date evidence and thinking about how and why social marketing is being applied around the world.
    2.    Meet and talk with the world’s leading thinkers, researchers and practitioners.
    3.    Grow you professional network and set up joint projects and interventions.
    4.    Promote you own organization and what it’s doing, and find collaborators to work with you.
    5.    Share and showcase your work and learn from others around the world about cutting edge projects and innovation.
    6.    Discover hundreds of new social marketing projects and practitioners.
    7.    Take part in specialist seminars and training events that will enhance your professional practice.
    8.    Be inspired  by world class keynote speakers who will stimulate and challenge your thinking
    9.    Contribute to debates and Q&A sessions.
    10.    Chose from over 90 keynote sessions and seminars on all aspects of social marketing theory and practice.

The full conference program is now available and booking information is here.

I will be conducting a workshop ‘Exploring New Strategies and Tools for Social Marketing Research and Practice’ on the 19th and hope that some of you will join me. In the workshop we'll be talking about and working with innovative methods that, when combined, offer an entirely new approach to thinking about and planning social marketing programs.

Based on past conferences, I predict that you will leave (reluctantly) with enthusiasm for applying marketing principles to social problems; new knowledge, skills and professional relationships; and will be talking about your experiences there for years to come.

Asking the First Question for Change

I find that there are five fundamental approaches to how people approach solving wicked social problems and pursuing social change. They are distinguished by the first question each of them asks when thinking about possible solutions and approaches.

I was reading a profile of a Harwood Institute Public Innovator that crystallized this idea for me. It concerned a relatively circumscribed problem (not the scope or scale of reducing global HIV incidence or childhood obesity) where, even in those circumstances, the differences in approach become clear.

The problem was how to improve the narrow, gravel walking path near a church so that it was more accessible for people who used the path while pushing their spouses who had had a stroke in a wheelchair. When the college advisor who was leading the project was asked how he came up with the idea, he said it was a project to improve the lives of these caregivers.

The Harwood Institute teaches an idea of ‘turned outward’ - a straightforward approach that fits easily into a social marketing model. Turned outward techniques involve ‘working with your community to find out what people truly want – not just assuming or thinking you know what people and communities want.’ So far, so good.

So our public innovator asked the advisor how confident he was that a more accessible walking path was what caregivers wanted. Well, he had walked the path himself and had seen first-hand how difficult it would be for someone who was trying to push a wheelchair on it. But ‘No,’ he had not asked any caregivers about the idea.

The innovator’s suggestion was to hold a few small discussion groups with caregivers of people who had suffered a stroke and, as you might expect, the responses to his idea were a deafening ‘not interested.’ There were more important jobs-to-be-done in caring for a spouse who had had a stroke such as better transportation for stroke patients, training in one-on-one caregiving and accessing respite care facilities with short-term accommodations for people with special needs.

Even though the walking path project had already been funded, the advisor had the courage to shift course (or ‘pivot’ if you like). Instead, he and his students used the funding to set up free courses for issues the caregivers said they wanted help with: how to modify their homes to make them easier to navigate, ways of safely moving stroke victims into and out of their wheelchairs, fall prevention and self-care tips. Jobs that were much higher on their priority list. These courses have now become an ongoing program in that community.

The story illustrates how different change agents approach the same problem, and what can happen when the first question is changed. A technocratic ‘planner’ would take the plan selected by the advisor and ask the question: ‘I have identified a problem that I think is important and has a solution I can implement, what do I do next?’ And gone ahead with fixing the path.

Another more top-down, autocratic approach would be: 'I have identified a problem, how do I make people fix it (by, for example, threatening a lawsuit or fines against the church if the path isn’t made compliant with ADA Standards for Accessible Design)?'

A planner using a third method, let’s call it the ‘educational’ or ‘informational’ one, would be asking: ‘What can we do to inform caregivers of alternative paths to use when pushing a wheelchair to the church?’ Or warn them of the risks of using the path when pushing a wheelchair.

Another popular strategy, empowerment, poses the solution option a bit differently: ’How can we empower these caregivers to demand that the path be made wheelchair accessible?’ The corollary of this one is an advocacy model that asks: ‘How do we organize the community to seek justice for these patients and their families (justice in this case being equal access to the path)?’

Each of these solution types - technocratic, autocratic, informational or empowerment - have their merits in specific circumstances. But what each type of solution often ASSUMES is that the ‘fixers’ understand the problem and have the correct solution, whether it is based on theory, evidence-based practices (science) or ideology.

A ‘searcher,’ our turned outward public innovator (or people-focused social marketer), asks a different question: ‘I think I have identified a problem, I wonder what the people affected by it think about it and its possible solutions?’ It’s a position of both humility (we don’t presume to have the ‘right’ fix for, or even understanding of, the problem) and honor for the people affected by the problem (we value what they think and feel about a problem and possible solutions to it). And when we practice being a searcher what often times happens is that ‘our’ problem is not the ‘problem’ people want help solving. We pivot, and start providing value to people - not ‘solutions.’ Sometimes that value is through the questions we ask - not by instantly rolling out a 12-step protocol for change.

As I write in the first chapter of Social Marketing and Social Change:

Whatever your level of experience, this book is for …searchers: you want to understand what the reality is for people who experience a particular problem, find out what they demand rather than only what can be supplied, and discover things that work. You see adapting solutions to local conditions as more important than applying global blueprints, and you value people’s satisfaction with the offered solution, not how well crafted the plan was and whether it received all the necessary resources. Most of all, you have a bottom-line philosophy that you want to experience results that make you feel your life has been well lived. You have a hunger for doing something creative, amazing—something that will make a difference and perhaps change the world— and for being able to enjoy your work and someday look back and say, “Yes, I did that!”

Call it ‘turned outward’ or ‘people-focused,’ what matters in solving any type of social problem, gravel paths and supporting caregivers of people with strokes or screen time and preventing childhood obesity, is whether you ask the first question: is this the problem or job people really want my help with? And then whether you are ready to listen to their side of the story.

Image from http://www.ndspro.com/articles/water-blogged/

Asking Questions About Education Innovation and Reform

The reform of education - it’s products, policies, processes and people - poses all kinds of wicked problems, from what should (and should not be) in curricula, to how classes and schools are designed to achieve better outcomes for students and parents, how success is measured, and what the role of school personnel are in this most modern of ages. Innovations are widely touted, but few seem to be broadly adopted. Top-down approaches are rarely swapped out for more bottom-up processes (see these examples from the BIF Student Experience Lab for some exceptions). In over 4 decades of work in social marketing, I have seen few examples published in the literature that apply marketing ideas to solving some of these issues. And I wonder why?

I have many different hypotheses ranging from total indifference to ‘outside the box’ thinking to real or imagined concerns that introducing ‘marketing’ into education will somehow trivialize and contaminate the lofty aspirations (and ideologies) that educators and policy makers have of their calling. In work I have done with STEM education initiatives and school readiness, my involvement seems to start and end with the ‘planning’ meetings (“We’d like to have a social marketer’s POV”). And then…nothing seems to take shape. At one meeting a brand marketer also involved in STEM issues and I were pushing the idea to explore student-driven STEM communication and programming strategies. Our progress was summed up when he shouted out in exasperation near the end: “Doing it the way you’ve always done it (expert-driven directives and ‘messages’) is DOOMED!” [See The change we need: New ways of thinking about social issues]

The opportunities for me to insert a marketing perspective into education discussions and arguments are few and far in-between. So when I learned that a noted education reform specialist was coming to town to talk about initiatives underway in Sarasota and Manatee (Florida) county schools through the Annie E. Casey Foundation’s Campaign for Grade-Level Reading, I decided to drop in and listen.

Ralph Smith, the campaign’s managing director, had many encouraging things to say about what he experienced during his visit. We also heard from the principal of one exemplary grade school in Sarasota. You may have been in similar types of discussions. Philosophies and data are cited to make the case for “Why this problem [reading at grade level by 3rd grade]?” Emotional appeals to do what’s right for children and their parents. Exhortations that ‘we must all work together’ and that it ‘takes a community to educate a child.’ Glimmers of hope, such as offered by the school principal, into what might be working. Calls for ‘scaling up.’

What can a social marketer add to these discussions?

Near the end of the 90 minutes of the town hall meeting there was time for a Q+A session. I had several questions going through my mind:

• How do we focus people on an objective of children in the 3rd grade reading at that grade level when there are so other many competing concerns and issues that schools and communities face every day?
• How can nonprofits (not just the Casey Foundation, but local nonprofits who are supporting the program) who invest in these innovations design sustainability (or exit) strategies and not endanger the systems, people and processes they put into place to make the program work in the first place?
• How can local media continue to set and keep visible a public and policy agenda to support growth and long-term durability of attaining the objectives?
• What are the most important barriers that need to be addressed to make community action feasible - to cross the line between the schools’ and the community’s interests and bring them together?
• What are the most important elements of success (at least so far)?

Near the end of the Q+A I was able to ask ‘one question.’ So with three panelists (the local paper’s editorial page editor was the host), I wrapped up the last three into one. What I received in response was intriguing: the editor committed to a Sunday editorial on the issue and outlined his three main points, the principal pointed to the success of her schools efforts to bring community residents into her school to volunteer as reading tutors (something my wife already does with her), and Ralph Smith talked about the first and most important step being the building of trust between schools and communities. His central concern was that schools have to learn to not be afraid to share their data, regardless of the flaws and problems they expose. Communities, in turn, have to refrain from using those same data as a club to beat up the educators. Who is going to share their data when they fear the consequences [See The costs of fear]? And how can we have a meaningful conversation to address a problem without data? My take away was: until school and community leaders shift from being problem describers and blamers to solution seekers, with data driving their discussions, not ideology, bringing together the necessary community and school resources to improve education seems doomed (to quote a colleague). To start that process we need to earn trust from one another.

As social marketers we often talk about programs, policies and behaviors to improve society and the need for partnerships to make them happen. But rarely do we get down to the fundamentals of what makes any potential partnership work. It’s not the quality of the people and organizations at the table, the creative ideas that are expressed, or the evidence that supports a proposed strategy or intervention. It is the trust that exists, or is developed, among the participants. That is not a new idea for social marketers; trust is one of the pillars of the Value Space I proposed in Transformative Social Marketing [pdf]. As I said in that article (Lefebvre, 2013, p. 126):

“Trust is a larger idea than just a variable of interpersonal relationships or a characteristic of sources of messages. It also extends to organizations and companies that support and sponsor social marketing activities… We live in a world where trust is no longer a commodity that is acquired, but rather a value that we receive from the people we serve and our stakeholders. Without trust, social marketing risks slipping into coercion, liberal paternalism, propaganda and irrelevancy. Trust also underlies important concepts including social capital formation as well as the development of effective partnerships.”

The education system may not yet be ready to use social marketing as a tool to develop new products and services, promote innovative reforms and initiatives, or to build demand for more effective, efficient, equitable and sustainable programs. But could it be ready for trust? Is this an opportunity to bring new light to education about what life might be? To begin to contemplate the answers to some questions social marketers ask?

And for those of you who might go to similar types of meetings and stumble over what question to ask, here are ten suggestions I wrote about some time ago. Be sure to check #10.

Reference:

Lefebvre, R.C. Transformative social marketing: Co-creating the social marketing discipline and brand. Journal of Social Marketing, 2012; 2:118-129.

Webinar on Community-Based Prevention Marketing

Can social marketing be used in community settings? Involve real people from the community? Focus on more than just individual behavior change?

The International Social Marketing Asoscation's (iSMA) webinar series continues with several of my colleagues from the Florida Prevention Research Center (FPRC) at the University of South Florida College of Public Health talking about the evolution of community-based prevention marketing practice and research.

The dates and times are:

Time One: Thursday, January 29 at 10:00 am Pacific Standard Time/ 1:00 pm EST / 6:00 pm UTC+0 (GMT).

Time Two: Thursday, January 29 at 4:00 pm Pacific Standard Time/ 7:00 pm EST / 12:00 am UTC+0 (GMT) / Friday, January 30 at 11:00 am Australian Eastern Daylight Time.

"Community-Based Prevention Marketing (CBPM): Evolution from Programming to Policy Development to Systems Change" is based on over 15 years of work developing and testing CBPM. CBPM provides community coalitions with a marketing driven, systematic planning framework and toolkit for selecting, tailoring, implementing, and evaluating evidence-based interventions. Building on the achievements of CBPM for Program Development and its successor, CBPM for Policy Development, the FPRC is taking CBPM to the next level by bringing advances in systems science to the development of CBPM for Systems Change.

This webinar will provide an explanation of CBPM for Policy Development and its effectiveness. Participants will also be introduced to CBPM for Systems Change. By understanding the different levels of systems, and then designing social marketing strategies based on those insights, social marketers can have greater impact. Lessons learned from research and development of these frameworks will be shared to illustrate ‘upstream’ social marketing.

Presented by Carol A. Bryant, Distinguished USF Health Professor & Co-Director, FPRC; Alyssa B. Mayer & Mahmooda Khaliq Pasha, Doctoral Students (FPRC); Tali Schneider, Administrator (FPRC); and Brian J. Biroscak, Assistant Professor (Yale University) & Evaluation Lead (FPRC).

Space is limited to 150 participants per presentation. iSMA members receive early registration privileges.
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Also available at this link are the archives from the previous 10 webinars, including full recordings, handouts and slide presentations.

The Best of Social Marketing in 2014

Keeping up with the evolution of social marketing research and practice can be a tough problem. To help you out, this is my fourth annual review of papers that document in the peer-reviewed literature how the field is developing (here are the links to the 2011, 2012, and 2013 selections). I do not consider papers published in our two journals, the Journal of Social Marketing and Social Marketing Quarterly, as I presume that people are looking at them already. I am also interested in how social marketing is presented outside our immediate orbit.

One of my priorities in reviewing the work is how they help strengthen the evidence base for the discipline. Just collecting more stories, or case studies, about social marketing needs to end; we need a stronger focus on research with better descriptions of methods, collection and analysis of relevant data - not convenient ones, and the use of experimental designs. Pick up most textbooks on social marketing and read the references. I have, and was stunned by the lack of citations to research studies about the effectiveness of social marketing (my highest count was 10 - about as many as are in this post, and was something I deliberately set out to change with my book). I have heard from colleagues that they wouldn’t, or couldn’t, teach a course in social marketing in their department using available textbooks because there was a lack of ‘scientific rigor’ in them (or words to that effect). Practitioners can carry on about the ‘art’ of social marketing (I do it as well), but if social marketing is to be taken seriously by others (leading academic institutions and policy makers to name two) it needs data, not stories, to demonstrate its value.

Two controlled trials caught my attention. The article by Cates et al discusses their project to increase HPV vaccination rates among preteen boys in 13 counties in North Carolina, USA  and compares the outcomes with another 15 control counties in the same state. Randomization by organizational unit, in this instance churches, was an especially strong experimental approach employed by DiGuiseppi et al to investigate how social marketing can increase recruitment and retention of older adults into balance classes in order to reduce fall-related injuries. It is note worthy that these studies explore applications of social marketing to topics outside the mainstream of msot social marketing articles: vaccinations and injury prevention.

Other research studies that merit your attention are the work of Bhagwat et al and Firestone et al. Yes, the Bhagwat piece is two case studies, but I can take a story that is sprinkled with data and demonstrates a new application of social marketing - to food fortification programs in India. The Firestone et al study does not have a comparison group, but when you are involved in large-scale programming across five countries in Central America to reduce HIV risk, the correct decision, in my mind, is Go Big and leave the small stuff to other investigators. They present a wealth of data, and I was particularly impressed to see the attention to measures of program exposure - and that exposure was related to behavioral outcomes. Measuring the relevant, not convenient, variables is the lesson in this study.

One article that should be in the social marketing canon is the results of a comprehensive review of the literature by the US Community Preventive Services Task Force by Robinson et al. For those outside the US, this task force judges whether interventions have sufficient empirical evidence to justify their widespread use in public health programs. Combining low cost (or free) and easily accessible products with mass communication campaigns is now one of those recommended approaches. Also note the concluding sentence of their abstract - that methods are not usually described in enough detail to allow for conclusions to be drawn about other social marketing practices - and be sure to download the entire report. This is the type of evidence your departmental colleagues and chairs, senior managers and policy makers are looking for.

The other paper in this section by Wilhelm-Reichmann et al is a market analysis using a social marketing framework to assess how conservation plans can be integrated into land-use planning in South Africa. I liked their use of a marketing framework to approach the issue and that it also extends social marketing into the conservation and policy arena (and in full disclosure, I was an advisor in the early stages of their process).

The next section includes two papers that focus on improved cookstoves to address many health and environmental issues. While this sector has more frequently been the province of engineers and so-called marketing programs that were often little more than mass exhortation campaigns, as Shankar et al note, the problem is now being defined as how to create campaigns that are consumer-focused. Their seven considerations for future efforts are ones that any social marketing program, regardless of its topic or behavioral focus, would do well to adopt. The Bhojvaid et al consumer research piece is a logical next step in this progressive use of social marketing of a product that has been struggling for decades to find a consumer (rather than a health or environmental) problem to solve.

Shifting from a topical focus, the last three articles are concerned with Place - the piece of the marketing mix that too often ends up being how messages are distributed rather than focusing on 'where’ behaviors are engaged in. In all three of these studies, the authors approach the ‘where’ question from a critical perspective: how does the density of fast food outlets impact the prevalence of childhood obesity (Newman et al), how does the location of tobacco retailers affect adolescent smoking behaviors (Short et al), and the documentation of ‘pharmacy deserts’ that limit the accessibility to prescription medications in segregated minority neighborhoods (Qato et al). As social marketers, these results should remind us that we need to be thinking about larger ‘place’ questions and solutions to them.

The description of each article is drawn from its abstract and excerpts from the text. There is a link to the abstract, or more frequently, to the full paper. And for those who are interested in an even more extensive documentation of the social marketing literature, consider the Sage Library in Marketing Series on Social Marketing as an institutional investment.

Controlled Trials

Cates, J.R., Diehl, S.J., Crandellc, J.L. & Coyne-Beasley, T. (2014). Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys. Vaccine; 32:4171-4178.

Objectives: Adoption of human papillomavirus (HPV) vaccination in the US has been slow. In 2011, HPV vaccination of boys was recommended by CDC for routine use at ages 11–12. We conducted and evaluated a social marketing intervention with parents and providers to stimulate HPV vaccination among preteen boys.
Methods: We targeted parents and providers of 9–13 year old boys in a 13 county NC region. The 3- month intervention was based on four principles of social marketing: to promote (with radio public service announcements, posters, brochures, doctor’s recommendation) the product (HPV vaccine), while considering the price (cost, perception of safety and efficacy, and access), and place (healthcare providers’ office). Intervention counties were exposed to a campaign (Protect Him) with materials designed and pretested with racially and ethnically diverse parents of preteen boys, while control counties received no intervention. The campaign ran for 3 months before the school year started and when parents were most likely to seek vaccinations for their children. The intervention also included distribution of HPV vaccination posters and brochures to all county health departments plus 194 enrolled providers and an online CME training. A Cox proportional hazards model was fit using NC immunization registry data to examine whether vaccination rates in 9–13 year old boys increased during the intervention period in targeted counties (n=13) compared to control counties (n = 15) with similar demographics.
Results: The Cox model showed an intervention effect (B = 0.29, HR = 1.34, p = .0024), indicating that during the intervention the probability of vaccination increased by 34% in the intervention counties relative to the control counties. Comparisons with HPV vaccination in girls and Tdap and meningococcal vaccination in boys suggest a unique boost for HPV vaccination in boys during the intervention. Model covariates of age, race and VFC eligibility were all significantly associated with vaccination rates (p < .0001 for all).
Conclusions: This study is the first to use a social marketing intervention to boost HPV vaccination among preteen males. Social marketing techniques can encourage parents and health care providers to vaccinate preteen boys against HPV.

DiGuiseppi, C.G., Thoreson, S.R., Clark, L., Goss, C.W., Marosits, M.J., Currie, D.W., & Lezotte, D.C. (2014). Church-based social marketing to motivate older adults to take balance classes for fall prevention: Cluster randomized controlled trial. Preventive Medicine; 67:75-81.

Fifty-one churches (7101 total members aged ≥60) in Colorado, U.S.A. were randomized to receive no intervention or a social marketing program. The program highlighted benefits of class participation (staying independent, building relationships), reduced potential barriers (providing convenient, subsidized classes), and communicated marketing messages through church leaders, trained “messengers,” printed materials and church-based communication channels. Compared to 25 control churches, 26 churches receiving the social marketing program had a higher median proportion (9.8% vs. 0.3%; p < 0.001) and mean number (7.0 vs. 0.5; IRR = 11.2 [95%CI: 7.5, 16.8]) of older adult congregants who joined balance classes. Intervention church members were also more likely to recall information about preventing falls with balance classes (AOR=6.2; 95% CI: 2.6, 14.8) and availability of classes locally (AOR= 7.7; 95% CI: 2.6, 22.9).

The positive results of this RCT indicate that church-based social marketing that addresses product, price, place and promotion with more convenient, lower-cost classes and messages about staying independent and building social relationships, can successfully motivate older adults to enroll in balance and strength classes for fall prevention. These messages can be effectively disseminated through existing church communication channels. The involvement of church leaders and informal member-to-member contacts, rather than reliance on brochures and posters, appears important to marketing program success.


Other Research Studies

Bhagwat, S., Gulati, D., Sachdeva, R., & Sankar, R. (2014). Food fortification as a complementary strategy for the elimination of micronutrient deficiencies: Case studies of large scale food fortification in two Indian States. Asia Pacific Journal of Clinical Nutrition; 23 (Suppl):S4-S11. PDF

The burden of micronutrient malnutrition is very high in India. Food fortification is one of the most cost-effective and sustainable strategies to deliver micronutrients to large population groups.  Lack of industrial concentration and large segments of the population being outside the reach of commercial markets are the major challenges for food fortification. The Global Alliance for Improved Nutrition (GAIN) is supporting large-scale, voluntary, staple food fortification in Rajasthan and Madhya Pradesh because of the high burden of malnutrition, availability of industries capable of and willing to introduce fortified staples, consumption patterns of target foods and a conducive and enabling environment.

High extraction wheat flour from roller flour mills, edible soybean oil and milk from dairy cooperatives were chosen as the vehicles for fortification. Micronutrients and levels of fortification were selected based on vehicle characteristics and consumption levels. Industry recruitment was done after a careful assessment of capability and willingness. Production units were equipped with necessary equipment for fortification. Staffs were trained in fortification and quality control. Social marketing and communication activities were carried out as per the strategy developed. A state food fortification alliance was formed in Madhya Pradesh with all relevant stakeholders.
Over 260,000 MT of edible oil, 300,000 MT of wheat flour and 500,000 MT of milk are being fortified annually and marketed. Rajasthan is also distributing 840,000 MT of fortified wheat flour annually through its Public Distribution System and 1.1 million fortified Mid-day meals daily through the centralised kitchens. Concurrent monitoring in Rajasthan and Madhya has demonstrated high compliance with all quality standards in fortified foods.

Demand generation campaigns are important to create consumer awareness about the “added nutritional advantages” of consuming the fortified foods. This would lead to increased demand, and consequently an increased sale of the fortified food products, thus strengthening the commitment of the industry to continue and sustain fortification of their food products. Consumer awareness is needed to achieve the long-term goal of consumer-driven fortification, and systematic social marketing will play an important role to achieve this. An enabling environment that encourages voluntary fortification and increasing demand from well informed consumers is a prerequisite for success of voluntary fortification.

Firestone, R., Rivas, J., Lungo, S., Cabrera, A., Ruether, S., Wheeler, J. & Vu, L. (2014). Effectiveness of a combination prevention strategy for HIV risk reduction with men who have sex with men in Central America: a mid-term evaluation. BMC Public Health; 14:1244  doi:10.1186/1471-2458-14-1244

Despite over a decade of research and programming, little evidence is available on effective strategies to reduce HIV risks among Central American men who have sex with men (MSM). The Pan-American Social Marketing Organization (PASMO) and partners are implementing a HIV Combination Prevention Program to provide key populations with an essential package of prevention interventions and services: 1) behavioral, including interpersonal communications, and online outreach; 2) biomedical services including HIV testing and counseling and screening for STIs; and 3) complementary support, including legal support and treatment for substance abuse. Two years into implementation, we evaluated this program’s effectiveness for MSM by testing whether exposure to any or a combination of program components could reduce HIV risks.
Methods: PASMO surveyed MSM in 10 cities across Guatemala, El Salvador, Nicaragua, Costa Rica, and Panama in 2012 using respondent-driven sampling. We used coarsened exact matching to create statistically equivalent groups of men exposed and non-exposed to the program, matching on education, measures of social interaction, and exposure to other HIV prevention programs. We estimated average treatment effects of each component and all combined to assess HIV testing and condom use outcomes, using multivariable logistic regression. We also linked survey data to routine service data to assess program coverage.
Results: Exposure to any program component was 32% in the study area (n = 3531). Only 2.8% of men received all components. Men exposed to both behavioral and biomedical components were more likely to use condoms and lubricant at last sex (AOR 3.05, 95% CI 1.08, 8.64), and those exposed to behavioral interventions were more likely to have tested for HIV in the past year (AOR 1.76, 95% CI 1.01, 3.10).
Conclusions: PASMO’s strategies to reach MSM with HIV prevention programming are still achieving low levels of population coverage, and few men are receiving the complete essential package. However, those reached are able to practice HIV prevention. Combination prevention is a promising approach in Central America, requiring expansion in coverage and intensity.

Robinson, M.N., Tansil, K.A., Elder, R.W. et al;. (2014). Mass media health communication campaigns combined with health-related product distribution. American Journal of Preventive Medicine; 47:360-371.

Context: Health communication campaigns including mass media and health-related product distribution have been used to reduce mortality and morbidity through behavior change. The intervention is defined as having two core components reflecting two social marketing principles: (1) promoting behavior change through multiple communication channels, one being mass media, and (2) distributing a free or reduced-price product that facilitates adoption and maintenance of healthy behavior change, sustains cessation of harmful behaviors, or protects against behavior-related disease or injury.
Evidence acquisition: Using methods previously developed for the Community Guide, a systematic review (search period, January 1980–December 2009) was conducted to evaluate the effectiveness of health communication campaigns that use multiple channels, including mass media, and distribute health-related products. The primary outcome of interest was use of distributed health-related products.
Evidence synthesis: Twenty-two studies that met Community Guide quality criteria were analyzed in 2010. Most studies showed favorable behavior change effects on health-related product use (a median increase of 8.4 percentage points). By product category, median increases in desired behaviors ranged from 4.0 percentage points for condom promotion and distribution campaigns to 10.0 percentage points for smoking-cessation campaigns.
Conclusions: Health communication campaigns that combine mass media and other communication channels with distribution of free or reduced-price health-related products are effective in improving healthy behaviors. This intervention is expected to be applicable across U.S. demographic groups, with appropriate population targeting. The ability to draw more specific conclusions about other important social marketing practices is constrained by limited reporting of intervention components and characteristics.

Wilhelm-Rechmann, A., Cowling, R.M. & Difford, M. (2014). Using social marketing concepts to promote the integration of systematic conservation plans in land-use planning in South Africa. Oryx; 48:71-79.

Local land-use planning procedures are increasingly recognized as potentially crucial to ensure off-reserve biodiversity protection. Mainstreaming systematic conservation planning maps in these decision-making procedures has been proposed as a mechanism to achieve this. However, research is lacking on how to convince officials and politicians to change their behaviour and include the maps in their decision-making. Social marketing is a tool commonly used to effect behaviour change in many sectors but its application in conservation is limited. In the formative research phase of a social marketing study we interviewed locally elected politicians in four coastal municipalities in South Africa. We found that conservation and environmental issues play virtually no role in their work; however, they do attribute value to the natural environment. Land-use planning procedures are considered important but dysfunctional and the role of conservation is perceived negatively in their municipalities. Their information-seeking behaviour is clearly localized. We present a marketing analysis of these results and argue for improving the attractiveness of the product: the maps should be more option- than veto-based and should identify locally relevant ecosystem services. Locally significant information should be provided at a time and location convenient for politicians. We conclude that engagement with councillors should be proactive, refer to land-use planning and services from ‘nature’ rather than ‘biodiversity’ and use terminology and information that is locally oriented and meaningful from the politician's perspective. The analysis highlights the usefulness of the marketing approach for conservation.


Focus on Improved Cookstoves

Shankar, A. Johnson, M., Kay, E. et al. (2014). Maximizing the benefits of improved cookstoves: moving from acquisition to correct and consistent use. Global Health: Science and Practice; 2:268-274.

This paper reports on a meeting of the Working Group to Address Increasing Adoption of Improved Cookstoves. Marketing campaigns to promote cookstoves have yielded mixed results over the past decades, and generally adoption rates remain low. Marketing of improved cookstoves (ICS) must meet consumer needs and preferences if they are to lead to correct and consistent use and to successfully displace traditional stoves. This is also necessary for reducing household air pollution and fuel consumption, and therefore providing maximum health and environmental benefits. However, consumer needs and preferences are complex and are influenced by many contextual and social factors that require a deep understanding of culture, going beyond technology and economics.

Successful ICS business models will need to be sensitive to cultural practices in both the design of the product and marketing strategies. Key considerations that can aid in large-scale ICS adoption include:
1. Recognizing that stove adoption does not equate with stove acquisition and that long-term consistent and continuous use requires consumer buy-in and understanding of the value proposition that ICS can provide.
2. Designing marketing campaigns that engage the consumer by identifying key attributes of importance to the consumer, rather than long lists of attributes that do not necessarily influence the consumer’s decision.
3. Ensuring effective user engagement by including demonstrations, training, and post-sales support.
4. Addressing intra-household gender dynamics to enhance equity in purchasing decisions.
5. Including women more effectively through-out the cookstove value chain by improving both resources and agency-based support.
6. Identifying and respecting the cultural significance of cooking food.
7. Understanding the actual-use scenarios of the stove (for example, boiling water for tea versus frying flat breads).

Ultimately, protecting health and the environment will depend on whether the household energy sector can provide cookstoves with low-pollutant emissions while also meeting consumer needs. Thus, addressing those needs will be fundamental to achieving health and environmental goals.

Bhojvaid, V., Jeuland, M., Abhishek Kar, A., Lewis, J.L., Pattanayak, S.K., Ramanathan, N., Ramanathan, V. & Rehman, I. H. (2014). How do people in rural India perceive improved stoves and clean fuel? Evidence from Uttar Pradesh and Uttarakhand. International Journal of  Environmental Research and Public Health; 11:1341-1358.

Improved cook stoves (ICS) have been widely touted for their potential to deliver the triple benefits of improved household health and time savings, reduced deforestation and local environmental degradation, and reduced emissions of black carbon, a significant short-term contributor to global climate change. Yet diffusion of ICS technologies among potential users in many low-income settings, including India, remains slow, despite decades of promotion. This paper explores the variation in perceptions of and preferences for ICS in Uttar Pradesh and Uttarakhand, as revealed through a series of semi-structured focus groups and interviews from 11 rural villages or hamlets. We find cautious interest in new ICS technologies, and observe that preferences for ICS are positively related to perceptions of health and time savings. Other respondent and community characteristics, e.g., gender, education, prior experience with clean stoves and institutions promoting similar technologies, and social norms as perceived through the actions of neighbours, also appear important. Though they cannot be considered representative, our results suggest that efforts to increase adoption and use of ICS in rural India will likely require a combination of supply-chain improvements and carefully designed social marketing and promotion campaigns, and possibly incentives, to reduce the up-front cost of stoves. Given current efforts to increase promotion of ICS technologies in India and other less-developed countries, we believe that issues related to stove promotion and marketing, stove pricing and subsidies, and the nature of peer effects and how they relate to the visibility of stoves deserve additional study and rigorous testing.


Place-Based Research and Social Marketing Interventions

Newman, C.L., Howlett, E. & Burton, S. (2014). Implications of fast food restaurant concentration for preschool-aged childhood obesity. Journal of Business Research; 67:1573-1580.

Marketers and consumer health advocates have recently devoted considerable attention to built environments. One key aspect of built environments is the type and concentration of retail establishments available to consumers. Prior research on the relationship between retail type, concentration, and consumer health largely focuses on a lack of healthy retail establishments, rather than on the high concentration of unhealthy establishments. In this research, the authors examine the effects on preschool-aged childhood obesity rates associated with the direct and moderating influence of fast food restaurant density levels, consumer poverty, and urbanization. Results show that higher levels of fast food restaurant saturation are associated with increased levels of childhood obesity in both urban and poor areas, with the largest negative effect of fast food availability on obesity occurring in more economically disadvantaged, urban areas. Findings highlight why the societal impacts of targeting vulnerable populations through corporate location selection strategies should be fully considered in social marketing initiatives, especially given that unhealthy products with long term health risks are increasingly accessible.

The typical (short-lived) social marketing approach to obesity-related problems is to encourage individuals to exercise more or to eat more fruits and vegetables. Traditional social marketing messages such as these may quickly be dismissed in more urban and poorer communities though, as the realities of accessing and paying for more healthy foods or exercise facilities are realized. Therefore, the built environment plays an important, but often overlooked, role in the practicality and effectiveness of potential solutions to the childhood obesity epidemic. The present findings suggest that opportunities exist for social marketers to focus more heavily on community-specific environmental factors and their relationship with childhood obesity. More specifically, social marketing approaches that may be effective when convenient access to unhealthy fast food is high include: (1) social marketing efforts that specifically target parents of pre-school children in more urban, poorer areas, and (2) social marketing efforts that specifically focus on educating parents about potentially detrimental environmental factors specific to their communities, such as increased fast food availability, as opposed to traditional messages focused on individual behaviors.

Qato, D.M., Daviglus, M.L., Wilder, J., Lee, T., Qato, D. & Lambert, B. (2014). ‘Pharmacy deserts' are prevalent In Chicago's predominantly minority communities, raising medication access concerns. Health Affairs; 33:1958-1965. doi: 10.1377/hlthaff.2013.1397.

Attempts to explain and address disparities in the use of prescription medications have focused almost exclusively on their affordability. However, the segregation of residential neighborhoods by race or ethnicity also may influence access to the pharmacies that, in turn, provide access to prescription medications within a community. We examined whether trends in the availability of pharmacies varied across communities in Chicago with different racial or ethnic compositions. We also examined the geographic accessibility of pharmacies to determine whether “pharmacy deserts,” or low-access neighborhoods, were more common in segregated black and Hispanic communities than elsewhere. We found that throughout the period 2000–2012 the number of pharmacies was lower in segregated minority communities than in segregated white communities and integrated communities. In 2012 there were disproportionately more pharmacy deserts in segregated black communities, as well as in low-income communities and federally designated Medically Underserved Areas. Our findings suggest that public policies aimed at improving access to prescription medications may need to address factors beyond insurance coverage and medication affordability. Such policies could include financial incentives to locate pharmacies in pharmacy deserts or the incorporation of pharmacies into community health centers in Medically Underserved Areas.

Short, N.K., Tisch, C., Pearce, J., Richardson, E.A. & Mitchell, R. (2014). The  density of tobacco retailers in home and school environments and relationship with adolescent smoking behaviours in Scotland. Tobacco Control; Published Online First: 4 November 2014 doi:10.1136/tobaccocontrol-2013-051473

Background: Neighbourhood retailing of tobacco products has been implicated in affecting smoking prevalence rates. Long-term smoking usually begins in adolescence and tobacco control strategies have often focused on regulating ‘child spaces’, such as areas in proximity to schools. This cross-sectional study examines the association between adolescent smoking behaviour and tobacco retail outlet density around home and school environments in Scotland.
Methods: Data detailing the geographic location of every outlet registered to sell tobacco products in Scotland were acquired from the Scottish Tobacco Retailers Register and used to create a retail outlet density measure for every postcode. This measure was joined to individual responses of the Scottish Schools Adolescent Lifestyle and Substance Use Survey (n=20 446). Using logistic regression models, we explored the association between the density of retailers, around both home and school address, and smoking behaviours.
Results: Those living in the areas of highest density of retailers around the home environment had 53% higher odds of reporting having ever smoked (95% CI 1.27 to 1.85, p<0.001) and 47% higher odds of reporting current smoking (95% CI 1.13 to 1.91 p<0.01). Conversely, those attending schools in areas of highest retail density had lower odds of having ever smoked (OR 0.66, 95% CI 0.50 to 0.86 p<0.01) and lower odds of current smoking (OR 0.75, 95% CI 0.59 to 0.95, p<0.05).
Conclusions: The density of tobacco retail outlets in residential neighbourhoods is associated with increased odds of both ever smoked and current smoking among adolescents in Scotland. Policymakers may be advised to focus on reducing the overall density of tobacco outlets, rather than concentrating on ‘child spaces’.

Most Popular Articles of 2014: On Social Marketing and Social Change

Thank you to the over 35,500 people who have visited this blog over the past year. I am really delighted that you come from all over the world. In 2014, about ⅓ of unique visitors came from the US, followed in the top ten by Great Britain (UK), India, Australia, Canada, Philippines, Malaysia, Nigeria, South Africa and France (and then another 179 other countries).

What brings people to this blog? Searching for information or a solution to a problem has a lot to do with it. But whether you are an email subscriber, get a RSS feed, follow new posts on social media (Twitter and LinkedIn), or are one of the searchers, we all share a passion for understanding and learning how to do good better. And for many of us, that means how to apply marketing thinking and techniques to solve the wicked social problems we have chosen to seek answers to (social + marketing).

So what have been people searching for answers to in 2014 that brings them here? Here’s what your colleagues landed on in 2014.

EAST: A Method for Applying Insights in Social Marketing Programs 
EAST (Make behaviors Easy, Attractive, Social and Timely) is the most recent device created by the Behavioural Insights Team to help policy-makers incorporate behavior change principles into policy-making. While it does have some strengths in helping you become a better solution seeker, I also discuss some of its limitations.

How Social Marketing Can Improve the Effectiveness of Social Entrepreneurs 
Like me, you have probably seen or heard about some social entrepreneur who becomes the momentary darling of an organization, funder or social media meme. Once you get past the hype, or wait a year or two, that entrepreneur and their program prove to be less effective than their promotion suggests (if they have any data at all) or they have fallen off the radar (“sweet dreams and flying machines…”). I am continually amazed at how little attention social entrepreneurs seem to pay to basic marketing principles. In this post I review an article that demonstrates how a social marketing analysis and approach could strengthen a program that is designed to encourage environmentally sustainable behaviors.

Demarketing Obesity
I have had several posts on the use of demarketing strategies to reduce unhealthy behaviors. Indeed, a post on The 4Ps of Demarketing Tobacco Use was the overall most viewed post last year (first published in 2009). In Demarketing Obesity I look at how a proposed “nimble” approach to obesity prevention falls short of being effective. Proposed solutions to the obesity problem such as more calorie counting, more explicit nutrition labeling, and banning advertising of junk foods to children may be well intended, but off the mark. What if we applied marketing approaches, and not simply educational and communication ones, to changing the obesogenic environment?

Recharging Tobacco Control Efforts 
Tobacco control efforts headline global approaches to the wicked problem of the growing prevalence of noncommunicable diseases. In the US, tobacco control efforts are getting a boost from the FDA and the launch of its The Real Cost campaign. This post highlights the Persona for the campaign and other elements of its strategy along with links to campaign materials. However, a strong community teffort is also needed to complement these efforts, and I look at the latest evidence for best practices in community-based tobacco control programs.

The Future of Social Marketing: Craig's Happiness Talk 
This post and accompanying video are from the 2014 USF Social Marketing Conference. In them I pick up on the theme of how the deliberate use of social marketing could lead to positive changes in personal well being and national happiness indicators.

Guidelines for the Review of Social Marketing Papers 
Students, instructors, program managers, journal reviewers and editors will find a set of questions (or scoring criteria) that I use in guiding and grading student projects in my advanced social marketing class. It can also be a useful checklist for practitioners who want to benchmark themselves and their programs: “How well am I doing social marketing?”

The Purpose of Segmentation
The purpose of segmentation is to identify differences among groups that will drive how we approach and tailor our marketing solution. I also discuss and link to a study that found more potential harm from not segmenting; the "one size fits all" approach can actually deepen disparities among population groups.

Marketing that Improves the Practices of Health Care Professionals 
Providing information and behavior change programs through the “swamped channel” of health care professionals is the topic. What social marketing principles can be used to help improve health care practices?

Social Marketing and Social Change: A Review 
This is a review of my book Social Marketing and Social Change that appeared in Health Promotion Practice.
“[Craig] begins the book by connecting the purposes of social marketing and why people choose a profession in public health and health promotion: “How can I change the world? How can I make the world a better place?” He discusses how social marketing addresses these questions in 14 chapters, using theories, research, examples, case studies, and his extensive personal experience in social marketing for more than 25 years, both nationally and internationally.” 

Download a free first chapter of the book (pdf)

Academic Competencies for Social Marketing  
Following on the Consensus Definition of Social Marketing established in 2013 by the professional social marketing associations, academic competencies for social marketers were developed and approved by them in 2014. The competencies provide a set of participant-focused benchmarks for the development of course curricula and certificate completion requirements. A must read for students to assess the quality of courses and programs in social marketing and for the faculty who design and deliver them.

Once you refresh your memory, or catch up with these 10, stay tuned for more to come in 2015. Next up: the best social marketing papers of 2014.

Marketing that Improves the Practices of Health Care Professionals

Health care professionals (HCPs, that includes dentists, nurses, pharmacists, physicians and physician assistants among others) receive too little support in changing their practices, processes and policies to improve the health of their patients. In many cases they are simply given clinical recommendations to follow and are viewed as passive ‘channels’ to provide ‘authoritative and credible’ information to their patients.

I talked about this as a ‘swamped channel’ in Pediatricians Drowning in Advice and noted a study that documented 162 separate pieces of verbal advice pediatricians are recommended to provide their patients by policies established by their professional association. And then there are the hundreds (thousands?) of ‘tools’ that are distributed to HCPs to guide diagnosis and treatment decisions, counseling aids (including numerous ‘shared decision-making tools’ that include the patient and family in the process), and legal requirements such as for ‘meaningful use’ of electronic health records (EHRs).  Diffusing information, products and services to HCPs is a symptom of the producer orientation (or top-down perspective if you like): the expectation is that if HCPs are given these guidelines, tools and incentives, they will use them. Time and time again we see this is not the case. For example, estimates are that between 18-37% of US health spending is wasted. Wasted health care payments include those due to failures of care delivery - poor execution or lack of widespread adoption of best practices, such as effective preventive care practices or patient safety best practices; overtreatment, or care that is driven by providers' preferences, ignores scientific findings, and is motivated by something other than providing optimal care for a patient; and costs incurred while treating avoidable medical injuries, such as preventable infections in hospitals (Lallemand, 13 December 2012, “Reducing waste in health care,” Health Affairs). Better dissemination of ‘best practices’ is often called on to address these sources of ineffectiveness, inefficiency and waste in health care. In reality, adoption and sustained use of best practices is what is needed. How do we develop fewer expert-driven recommendations and more market and user-focused approaches to better practice? This is the type of puzzle that social marketing could be used more frequently to solve (see Chapter 13 - Social marketing for diffusion and program sustainability, Lefebvre, 2013, and Harris et al, 2012, A Framework for Disseminating Evidence-Based Health Promotion Practices in Preventing Chronic Disease).

It was from this perspective that I agreed to chair a session on “How to reach professional audiences,” knowing full well that ‘reach’ is not the problem. While each of the three presentations in the session provided useful information (you will find links to their abstracts through the last page link), they focused on conducting formative research and developing more toolkits for physicians. I had read these papers before the conference and was ready to exercise the chair’s perogative to make some comments at the end of their presentations. Here are some of the points I made and that you might consider when the subject of prioritizing HCPs or conducting outreach to them comes up in your program planning meetings.

Improving HCP Practices

No HCP group, whether it is physicians (even within a specialty area) or pharmacists, is monolithic. Segmenting them into more homogeneous groups is what allows you to tailor programs that are more relevant and useful for them. Segmentation might be done by practice setting, size of the practice, geographic location, HCP age, early adopter status and peer influencer role for starters.

HCPs have very few ‘needs;” they do, however have many problems to solve and jobs-to-be-done on a daily basis. Developing tools that help them solve these problems - not just the one we pick - is the next step.

How we help them integrate new practices into their existing work flow and office systems has been shown time-and-time again to be an important determinant of adoption. When adopting new practices require changes in work flow or office systems (adoption and meaningful use of EHRs is an example) we need to provide them with support products and services - and sometimes incentives - to divert their time and attention away from patients as briefly and efficiently as possible.

The immediate opportunity costs for adopting new practices (for example, fewer patients being seen) is a big issue for many HCPs I have worked with over the years. Stressing the longer-term benefits of adoption is not the answer. What are their most important jobs-to-be-done everyday and how do we help them get them done? That is the first question we need to be asking HCPs. What will be news to the neophytes to this world of HCPs: patient care is not usually at the top of these lists. The top of the list usually includes financial matters (especially in the US and in private sector practices) and satisfying bureaucratic demands.

Engaging some HCPs to be co-producers of products and services we want to offer to their peers is another step in the process that too few programs implement. And by this engagement, I don’t mean the convening of expert work groups who contrive ways to push guidelines and evidence-based practices onto their less expert peers. Rather, it is through attracting the real users, the HCPs who are in practice and have a much more informed perspective on the jobs-to-be-done in their everyday professional lives, that we can begin to design ways to adopt new practice behaviors, use decision-making tools and toolkits, and change their office systems and processes that also enhance their ability to get things done (or at least not get in the way of their getting done).

If you have done everything on this list so far, you may have developed some empathy for HCPs. Overcoming the stereotypes we have of different HCPs (What is a pharmacist’s daily job really like? How hard is it to be a physician’s assistant?) opens up the possibility that we can work with them to improve what they do - not just try and persuade them, or incentivize them, to do what we want them to. We can begin to imagine adoption experiences for them in which they find value. I  always think of the 162 pieces of advice pediatricians are already suppose to give their patients whenever I am in a meeting with people discussing HCP programs and someone suggests “Let’s get physicians (or any other HCP) to tell their patients about (or, do)…!” It sounds benign and simple, but is has become insidious strategy that reflects little empathy for the HCP.  Programs that employ that strategy simply add to the swamp.

Another tactical decision that reflects this lack of understanding and empathy is the one where program planners decide that one HCP group should be referring their patients to another one - usually this involves saying to general practice physicians to refer certain patients to specialists (for whatever expert-guided or evidence-based reasons). Referral in all of these instances isn’t a signal of better practice, it is a cue for the primary HCP to fear losing control over patient care - not something they find any value or benefit in doing.  For example, a recent analysis of barriers to referral for genetic services, a fast developing specialty area, found not only HCP knowledge and practice deficits, but the concern about ‘coordination of care.' If you were to address such a set of problems, where would you begin?

Finally, and most importantly, HCPs are people too: this is where the crowd at the session applauded. Applause is a funny way to respond to the obvious, but it is making the obvious a social norm that is important to people who work in this area. HCPs are not, as the experts might wish, automatons to be directed or functional units to be dissembled and reassembled to perform new tasks more effectively and efficiently.  Neither do they want to be cajoled into change or otherwise manipulated. Yes, there are the exceptions, but the majority of HCPs, whatever their title, are smart people, doing tough work under difficult circumstances. People who respect their intelligence and ability to make responsible decisions, and offer ways for them to do their jobs better, are met with open hearts and minds. The rest of you are just noise.

Further Reading on Diffusion and Health Care

Damschroeder, L.J., Aron, D.C., Keith, R.E., Kirsh, S.R.,  Alexander, J.A. & Lowery, J.C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science; 4:50 doi:10.1186/1748-5908-4-50

Abstract: We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect).

Greenhalgh, T., Robert, G., Macfarmane, F., Bate, P. & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly; 82:581-629.

Abstract: This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.

Keown, O.P., Parston, G., Patel, H., Rennie, F., Saoud, F., Al Kuwari, H. & Darzi, A. (2014). Lessons from eight countries on diffusing innovation in health care. Health Affairs; 33:1516-1522.

Abstract: This article describes the results of a qualitative and quantitative study to assess the factors and behaviors that foster the adoption of health care innovation in eight countries: Australia, Brazil, England, India, Qatar, South Africa, Spain, and the United States. It describes the front-line cultural dynamics that must be fostered to achieve cost-effective and high-impact transformation of health care, and it argues that there is a necessity for greater focus on vital, yet currently underused, organizational action to support the adoption of innovation. 

Image: https://www.flickr.com/photos/fdaphotos/8227787368

 

Can Soda Companies Engage in Social Marketing?

Coca-Cola, PepsiCo, and the Dr Pepper Snapple Group pledged yesterday to cut beverage calories in the American diet by 20% by 2025 through promoting bottled water, low-calorie drinks and smaller portions.

From The Wall Street Journal, “Under the voluntary agreement…the companies said they would market and distribute their drinks in a way that should help steer consumers to smaller portions and zero- or low-calorie drinks. They also have committed to providing calorie counts on more than 3 million vending machines, self-serve fountain dispensers and retail coolers in stores, restaurants and other points of sale.” E.J Schultz at AdAge added: “Marketing could play a key role in the effort, with the beverage companies saying in a statement that they will 'engage in consumer education and outreach efforts to increase consumer awareness of and interest in the wide array of no- and lower-calorie beverages and smaller portion sizes available.'"

AdAge reports that the companies would also put special emphasis on communities where there is less access to lower-calorie beverages. They may, for example, feature only reduced-calorie beverages at highly trafficked store areas such as checkout displays. Communities in Los Angeles and Little Rock, Ark., are expected to be the first places where these targeted efforts will occur.

The press release from the American Beverage Association also notes: “Each beverage company may undertake additional activities including: introducing and expanding new lower-calorie products and smaller-portion packages; product placement such as end aisle and checkout displays featuring only reduced-calorie beverages; merchandising efforts such as repositioning reduced-calorie beverages on shelves; providing coupons and other incentives promoting no/lower-calorie options; and taste tests/sampling programs in and out of store.” [Ed Note: I’ll underscore the ‘mays’ that are embedded in many of these promises.]

This news can be either welcomed or criticized. Who better than the marketers of these products to put their energies into ‘doing the right thing’ and making a contribution to reducing the obesogenic environment in the US? For example, in an analysis of the association of soft drink consumption, overweight, obesity and the prevalence of diabetes in 75 countries, it was found that a 1% rise in soft drink consumption was associated with an additional 4.8 overweight adults per 100, 2.3 obese adults per 100 and 0.3 adults with diabetes per 100. These findings were consistent across low- and middle-income countries as well.

Another perspective could be more cynical: are these companies trying to put a PR spin on what is already a losing cause for many of their products? Mike Esterl in the WSJ article highlights that soda's share of U.S. beverage consumption peaked at 29.6% in 1998 and stood at 23.1% last year.  "Consumption trends are moving in this direction already, so they might be promising something that will happen no matter what they do," said Kelly Brownell, dean of the Sanford School of Public Policy at Duke University, in USAToday.

Related to this point of corporate self-interest, not social responsibility, is the question of whether focusing consumers on choosing smaller containers will actually boost their bottom-line. There is some research to suggest this could be the case. In a behavioral simulation with undergraduate students using three different settings (fast food restaurant, movie theater and stadium), participants were offered in each simulated setting (1) 16 oz, 24 oz, or 32 oz drinks for sale, (2) 16 oz drinks, a bundle of two 12 oz drinks, or a bundle of two 16 oz drinks, and (3) only 16 oz drinks. The researchers found that participants bought significantly more ounces of soda with bundles than with varying-sized drinks. Total business revenue was also higher when bundles rather than only small-sized drinks were sold. They concluded that businesses have a strong incentive to offer bundles of soda when drink size is limited (remember those smaller portion sizes that are promised?).

The companies won't be penalized if they can't keep their promise, but the pledge's results will be tracked by an independent third party. Let's see just what outcomes this evaluation measures - and which ones are overlooked.

A couple of more points about this initiative. First, it’s better than the status quo - but by how much? I see little attention given to demarketing sugar sweetened beverages (SSBs). Rather, the corporate strategy is repositioning the ‘competition’ (options that each company also owns), engaging in point-of-choice education (calorie labeling on vending machines) that doesn't have evidence for its impact on choices or consumption of SSBs [and is something the FDA is already proposing requirements to do anyway], and even more communication and promotion.

Can these companies’ marketers actually change people’s behavior and help them make healthier choices - or will they stay in the corporate box of increasing the bottom-line? And at the end of the day, are they really accountable for anything but acknowledging that SSBs are a losing product category among more-and-more consumers?

And what would a social marketer be doing instead? Here are a few ideas:

Does marketing make us fat?
Obesity prevention: Getting it [food marketers lay out what is really necessary to make a dent in the obesity problem]

What are some of yours?

Academic Competencies for Social Marketing

What should be the minimal requirements for someone who wants to learn about and practice social marketing? That discussion has been bounced around the field for many years, and yes, everyone has an opinion. The good news is that with the emergence of the International Social Marketing Association, Australian Association of Social Marketing, and the European Social Marketing Association there are now platforms on which to develop consensus about these and other issues (such as the recently formulated Consensus Definition of Social Marketing). Yesterday, following similar actions by the AASM and EASM, the Board of the iSMA gave its final approval to what these basic competencies should be. The text of the document that was approved by all three Boards follows.

The academic competencies for social marketing outlined in this document are intended as guidance for instructors of academic courses and designers of academic and nonacademic certificate programs in social marketing. They provide a set of participant-focused benchmarks for the development of course curricula and certificate completion requirements. These competencies are not meant to prescribe or restrict the content of academic social marketing degree programs. It is anticipated that degree-granting programs in social marketing may have more competencies than are outlined here.

The development of these competencies was formally begun at a collaboratory held at the Social Marketing Conference in Clearwater Beach, FL, USA in June, 2012. Since then, the full list of competencies generated by that discussion have been reviewed and revised by the AASM, ESMA and iSMA Boards of Directors. The iSMA Board approved this version September 19, 2014. The ESMA and AASM approved them earlier in September 2014. 

It is planned that these competencies will be revisited in 2016 and potentially revised.

ACADEMIC COMPETENCIES IN SOCIAL MARKETING (September, 2014)

Upon completion of a social marketing certificate or academic course, a participant should be able to:

1. Describe social marketing to colleagues and other professionals and differentiate it from other approaches to influencing behaviors and social change.
2. Work with colleagues and stakeholders to identify community, state, province, national, regional, and/or international priorities, and identify those for which a social marketing approach may be appropriate.
3. Identify and segment populations and select appropriate, high priority segments.
4. Prioritize and select measurable behaviors (not just awareness or attitudes) of individuals, organizations and/or policy makers to influence.
5. Design and conduct situational analysis and formative research, employing mixed methodologies needed to understand current audience barriers and benefits, as well as competing behaviors and direct and indirect competition.
6. Select and apply relevant social marketing, behavioral, exchange and social science theories, models, frameworks and research to inform development of a social marketing strategic plan, one that meets the needs and wants of the intended audience.
7. Create an integrated social marketing mix strategy that extends beyond communications only campaigns, with consideration of all appropriate evidence-based tools and theory needed to influence a desired behavior.
8. Critically reflect and test the effectiveness, acceptability, and ethics of potential social marketing strategies with representatives of target audiences and stakeholders, and adapt as necessary.
9. Finalize an implementation plan, incorporating opportunities for scaling up and sustainability.
10. Design and implement an evaluation plan, including a monitoring system to assure programs are on track to achieve goals and meet agreed quality and efficiency standards.
11. Apply ethical principles to the conduct of research, developing, implementing and evaluating a social marketing plan.
12. Document and communicate the results of social marketing initiatives to colleagues, stakeholders, communities and other relevant organizations and groups.

Commentary: It is important to stress that these competencies should be used when designing a stand-alone social marketing course or certificate program - regardless of the discipline it is embedded in, for example, antrhopology, engineering, public health, sustainability, transportation, and social entrepreneurship. As noted in the introductory paragraph, they are not intended to prescribe or limit the content for a degree-granting program in Social Marketing that would hopefully extend beyond these basic elements. This list of competencies can also be used by students, and prospective students and sponsors, to analyze and understand whether the course they are taking or considering will provide them with the social marketing competencies these three associations believe comprise the core understandings and skills of the field.

Are three Boards want to hear your feedback, and you can certainly leave comments here as well. I will note that it is the first time we have agreement on some of the important characteristics of social marketing practice. For those of you who teach social marketing courses, or are interested in what the next level of skills could look like, you can check out my Guidelines for the Review of Social Marketing Papers that I use in my advanced social marketing class.