On Social Marketing and Social Change

Piggy-Back to Success

Jumping off of my principles for success in social marketing programs post, Katya at Non-Profit Marketing has a set of questions to ask yourselves; Before you start from scratch on anything, spend an hour seeing what’s already there, what can help you and what stands in your way.

She expands on the core question: what already works in the marketplace?

Global Tobacco War Enters New Phase

Phillip Morris is back. After taking partial cover with a new corporate identity, The Wall Street Journal reports that Phillip Morris International is about to be spun out as a separate company by Altria Group. It will be the world's largest nongovernmental tobacco company. The move would free the tobacco giant's international operations of legal and public-relations headaches in the U.S. that have hindered its growth.

The article focuses on the 'good news.'

The separate entity...would be exempt from U.S. tobacco regulations and out of reach of American litigators. Importantly, its practices would no longer be constrained by American public opinion, paving the way for broad product experimentation.

So welcome world to Marlboro Intense (and talk about buzz marketing); Heatbar and PMI-owned stores to introduce the device to smokers; Marlboro Wides; the Tobacco Block System; Marlboro Mix 9 - sweet smelling cigarettes with tobacco, cloves and flavorings - and twice the tar and nicotine of a typical US cigarette; Marlboro Filter Plus; and Chinese cigarette brands marketed in Central Europe, Eastern Europe and Latin America. With market share of 5.2 trillion smokes a year at stake, product innovation has been unleashed.

China, with 350 million smokers, Pakistan, Ukraine, Argentina, Australia, New Zealand, the UK and Germany all get special mention in the article as being in PMI's marketing cross hairs.

Future products in the PMI pipeline will feature unusual packaging, a response to limits on cigarette advertising imposed by the WHO antitobacco treaty...Fancier packs are intended to lure smokers into paying a premium for the company's brands.

The losers? American suppliers of tobacco to PMI. And the 1 in 10 adults worldwide who die of a tobacco-related disease each year.*

* about 5 million/year and counting... Looks like the Bloomberg Global Initiative on Tobacco may need reinforcements.

Creating Collaborative Space: The PAHO Paper Clinic

The enthusiasm over social media often overlooks the important professional side of the street. Social marketers and health communicators are quick to explore social media for 'the audience,' but my impression is they are less inclined to adopt it for themselves. I have noted before how US intelligence agencies have rapidly shifted to blogs and wikis for information gathering and sharing; there are also open source epidemiology sites available; and the CDC has been actively been engaging with social media and blogging in particular. I just received this announcement that the Pan American Health Organization has designed and launched a virtual collaborative space to provide review and guidance for people and organizations in that region who want to submit abstracts to the XVII International AIDS Conference. The space features are described as including:

• Toolkit: links that would enable users to learn about the techniques and art of writing scientific proposals and papers.
• Tutorship: will be provided – at a limited scale initially - to improve the quality of some promising papers and to sharpen the capacities of investigators and writers.
• Virtual tools for exchange of information and experiences – forum, blog, wikis.

The site states that PAHO cannot assure that abstracts reviewed in this space will be accepted to the conference. It may go a long way, though, in providing access to tools and expertise for people and organizations whose experiences deserve to be shared with a broader audience, but whose limited knowledge and capabilities place them at a disadvantage for submitting abstracts for peer review at a scientific meeting. Excellent idea!

My blog doesn't see many visitors from the Latin America, so if you know people in that region who may be interested in the resource, pass the word. And be sure to check the Director's blog.

Principles for Success in Social Marketing

The 2008 version of my social marketing class is ready to begin. Among the changes is adapting Phil Kotler and Nancy Lee's 3rd edition of Social Marketing - subtitled now as influencing behaviors for good. In it, they list 15 principles for success. Here they are with some commentary.

Take advantage of prior and existing successful campaigns. They are referring to an environmental scan of campaigns,and applying lessons from them to your own. Unfortunately, few accessible descriptions of successful campaigns tell the real story about how they got to that point; that's usually where the lessons are. When you are doing this, focus on campaigns that are focused on your priority audiences, NOT the health issue. That's when you learn and possibly get some audience insights.

Start with target markets most ready for action. Almost every behavior change approach will echo this sentiment, and it is a correct one. Yet you also need to focus on the audience critical to the success of your program. And please stop referring them to targets. If you respect their dignity and ability to make choices they might be less inclined to try and dodge your messages. 

Promote single, simple, doable behaviors - one at a time. Again, a basic principle of any effort to change the behavior of an individual. But what model do you use when you are trying to change the behavior or hundreds, thousands or millions of people [pdf file]?  And be sure to avoid preaching the public healthy behavior and focus on what's relevant to them [pdf file].

Identify and remove barriers to behavior change. This approach to social marketing may have it's time and place, but it less frequent than advice like this should lead you to practice. I'll quote myself here: Addressing deficits and moaning about barriers seems to be in the DNA of too many public health programs; practice some positive deviancy and test whether building on aspirations and assets doesn’t suggest different strategies and approaches. If nothing else, you’ll have a more diverse collection of concepts to test with your audiences and partners.

Bring real benefits into the present. Another well-known principle of behavior change dating back to at least B.F. Skinner and operant conditioning - though the authors prefer to attribute it to economic theory. Also realize that the benefits don't have to be shouted out for the audience to understand and respond to them.

Highlight costs of competing behaviors. See also operant conditioning where the size of the consequence (or vicarious exposure to, or expectations of, positive consequences if you want to flip to social cognitive theory) is a major determinant of whether a behavior is acquired. I wonder how many people practicing social marketing really understand the essentials of behavior change rather than making it so complicated? My impression is that they get too wrapped up in cognitive activities (intentions, beliefs, attitudes) and economists' guesses (and Freakonomics may not explain things that well either) when the basics might be easier. And some behaviors may be more determined by social factors than they first appear.

Promote a tangible good or service to help target audiences perform the behavior. For international readers, this might seem to flip social marketing as generally understood on its head. For the social marketers in the developed world, a reminder that products are not just the 4Ps of pamphlets, posters, PSAs and publicity. Strive for products and services that help people change and not merely be channels to inform or expose them to messages.

Consider nonmonetary incentives in the form of recognition and appreciation. I completely agree that monetary incentives are too often a default position for many change agents. Learning a little more about what motivates people is worth looking into.

Make access easy. For services and products, I agree. But social marketers also need to insure that their audiences have the opportunities to try new behaviors, practice them and then be able to sustain them. Otherwise, behavior change is just an idea. This is where thinking about and targeting  (things, not people) environmental, structural and policy barriers makes sense.

Have a little fun with messages. They do point out that for some types of organizations even a little bit of fun might be out-of-bounds. But be careful not to make it a joke or have the fun overshadow the intent of the message ('I laughed so hard I didn't pay attention to what they were saying').

Use media channels at the point of decision making. Always a good strategy, though I prefer to think of this as just one of several openings (the right time, place and frame-of-mind) that we need to be present in. Research notes a person living in the US makes more than 200 decisions about food a day. Plenty to aim at for the obesity prevention folks.

Try for popular/entertainment media. Back to the 'make it fun idea' and entertainment education certainly can play a role in communication efforts - if you can get your audience to come and pay attention. But for scalable behavior change, I want to use media to reach an audience where ever they are and then worry about tone.

Get commitments and pledges. Another classic behavior management tool for individual behavior change that finds many applications as behavior contracts. A little more difficult to do for populations, but not impossible. And a nice way to begin to introduce price as incentives into the social marketing program.

Use prompts for sustainability. They are referring here to sustaining behavior, not the sustainability of social marketing programs (unfortunately). Their relentless focus on individual behavior change leaves a lot out of what concerns practitioners and policy makers.

Track results and make adjustments. Just be sure you are monitoring and evaluating the important things, not simply what is easy and measurable. Will you be able to answer the questions: So what? Who cares?

Here are five suggestions I have for successful programs.

What we will continue to grapple with throughout the course, and indeed in the profession (or discipline), is how to use social marketing for scalable impact on health issues and not be bound by theories and approaches that try and do it one person at a time. Been there, done that.

Problem Solving with the Web

When confronted with some of life's common problems, more people rely on the internet for information and support than they do on experts or family members.

The report from the Pew Internet and American Life Project finds that 76% of US adults have access to the internet, a figure that has shown little change over the past 2 years. Likewise, broadband access (reported by 77% of all users or 55% of all American adults) remains a major determinant for how often people access the internet, the variety of reasons they do so, and the richness of the experience while they are on it. Persons with only dial-up access to the internet at home (what they refer to as low access) were more likely to have household incomes < $40K, have a high school diploma or less and be age 62 years or older.

In the study, 45% (n=756) of the sample reported they had dealt with a serious illness or other health condition experienced by either themselves or someone close to them in the past two years - the most common of the ten problems asked about. In coping with health problems, the sources of information were quite different from the overall picture. People looking for information and support for a health problem were most likely to consult a health professional (86%) followed by family or friends (51%), the internet (46%), print sources (37%), TV or radio (17%) and government agencies (16%).

These data need to put into context with other research by the Pew Internet Project that has found, for example, that 80% of all US adult internet users have searched for health information on the web. While searching for health information may be an activity that engages a majority of people at some point in time, when a health situation arises health information seeking becomes a high involvement behavior that may be aimed at reducing social distance and facilitating social support. However, it is also the case that the internet has surpassed all other media - other than interpersonal - as the  preferred channel for health information for adults who have access to it.

Another Pew report noted the importance of the internet for those who provide care to a loved one who is sick:

• 36% said the internet helped them find advice or support from other people.
• 34% said the internet helped them find professional or expert services.
• 26% said the internet helped them find information or compare options.

Whether casually searching for health information, seeking it because of a health problem, or coping with the illness of someone, the internet has become a dominant part of the communication network people prefer to access. Equity of access, especially among people with no or low access, must continue to be an on-going policy concern as more Americans look to the internet for understanding and addressing their health care needs.

People Sound Asleep

Nearly half of all PSAs aired on US television stations in 2005 ran between midnight and 6AM, reinforcing the true meaning of the acronym. The finding is from the Kaiser Family Foundation report released today: Shouting To Be Heard (2): Public Service Advertising in a Changing Television World. Perhaps more sobering for the true believers in PSAs is that this figure has not significantly changed since 2000 and is part of the total of 0.5% of airtime given to communications for the public good.

Further evidence of the deterioration of Public Service Advertising is that the report now distinguishes between 'donated' PSAs and 'paid' ones (only 27% of those run after midnight and 51% are by for-profit companies).

Some other sobering facts for those with visions of using television in their campaigns:

• One in five donated PSAs (20%) specifically addressed a local issue, cause or event, while 80% were national in scope.
• English-language broadcast stations assessed by the study (ABC, CBS, Fox, and NBC) donated an average of 18 seconds an hour to PSAs.
• The cable stations (CNN, ESPN, MTV, Nickelodeon, and TNT) donated an average of 15 seconds an hour. The Spanish language network (Univision) donated an average of 29 seconds per hour to PSAs. (The overall average across all types of stations was 17 seconds an hour).
• Health was the most common PSA topic, accounting for 26% of all donated PSAs.  A wide variety of health issues were addressed, with the most frequent being fitness (6% of all donated PSAs), cancer (4%), HIV/AIDS (3%), and overall wellness (3%).
• Fund-raising was a close second at 23%.
• Environmental issues accounted for 4% of all donated PSAs.
• Eight percent of all donated PSAs specifically targeted children or teens. Two percent specifically targeted seniors.
• The proportion featuring a Web address increased from 32 percent in 2000 to 75 percent in 2005, while the proportion with a toll-free telephone number decreased from 49 percent to 38 percent over the same period.
• Nonprofits were the most common sponsors of donated PSAs (71% were sponsored or co-sponsored by a nonprofit). More than a third (38%) of all spots listed a media company as a sponsor or cosponsor. Government agencies sponsored or co-sponsored 15 percent of all donated spots, with for-profit companies co-sponsoring eight percent of all donated spots.

The report notes that while the debate has raged for years over requiring broadcasters to dedicate a certain amount of time to communications for the public good in return for their access to public airwaves (say 1min/hour compared to the current 17 seconds), one might expect this issue to spillover into new media and mobile phones in the next few years.

The conclusion:

A viewer would have to watch more than 200 hours of television before they’d see even a single hour of donated PSAs; and during that time, they’d see more than 50 hours of ads and promos...This report offers a sobering reminder to national and local nonprofits that relying solely on donated PSAs on television may provide neither the reach nor the frequency that public education campaigns need.

And the Ad Council, the industry-supported and largest producer and distributor of PSAs reported revenues in 2007 of $38.7 million. Not bad for a questionable approach to affect positive social change.

Social Marketing and HIV/HepC Prevention among IDUs

Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China. [Abstract]

 AIDS. 2007 Dec;21 Suppl 8:S115-22

Authors: Wu Z, Luo W, Sullivan SG, Rou K, Lin P, Liu W, Ming Z

OBJECTIVE: To evaluate the effectiveness of a needle social marketing strategy to reduce needle sharing and hepatitis C Virus (HCV)/HIV transmission among injecting drug users (IDU) in China.

DESIGN: Two-armed, prospective, community-randomized prevention trial.

SETTING: Four counties/townships in Guangxi and Guangdong provinces; one randomized to intervention the other to control in each province.

PARTICIPANTS: Injecting drug users: 823 (443 intervention, 382 control) at baseline and 852 (415 intervention, 407 control) at the second cross-sectional survey 12 months later.

INTERVENTION: A needle social marketing programme, including promotion of safe injection norms and increased access to clean needles over a 12 month period.

MAIN OUTCOME MEASURES: Cross sectional surveys at baseline and follow-up compared changes in drug using behaviours and HIV and HCV rates in the intervention and control communities.

RESULTS: Needle sharing behaviours were similar in the two groups at baseline (68.4 vs. 67.8%), and dropped significantly to 35.3% in the intervention community and remained relatively stable in the control community (62.3%; P < 0.001). In a subset of cohort of new injectors, the incidence of HCV was significant lower in intervention than in control in both provinces (P < 0.001, P = 0.014) and overall (P < 0.001) but HIV was only significantly lower in intervention in Guangdong (P = 0.011).

CONCLUSION: Needle social marketing can reduce risky injecting behaviour and HIV/HCV transmission among injecting drug users in China and should be expanded.

Myths and Truth About HIV Epidemics

We recently had Jim Shelton in to talk with us about some of the new work we are undertaking in HIV prevention. Jim is the author of a recent paper in The Lancet (a free subscription) that takes aim at some of the mythologies and misconceptions about the nature of generalized HIV epidemics in light of recent research findings. For social marketers, here are a few of the more salient ones that might influence how you think about segmentation and priority audiences.

HIV spreads like wildfire — Typically it does not. HIV is very infectious in the first weeks when virus levels are high, but not in the subsequent many-year quiescent phase.

Sex work is the problem — Formal sex work is uncommon in these generalised epidemics.

Men are the problem — The importance of women in generalised epidemics is evidenced by the high proportion (sometimes the majority) of discordant couples in which the woman, not the man, is HIV positive.

Adolescents are the problem — Although adolescent women are affected through sex with older men, HIV incidence increases in women in their 20s and later in life. Men are infected at even older ages. Thus interventions in young people, including abstinence, although important, have limited usefulness.

And for the nay-sayers who believe that behavior change efforts are fruitless he adds another point.

Actually, facing the prospect of deadly illness, many people will change. Homosexual men in the USA radically changed behaviour in the 1980s. And the reductions in HIV incidence in Kenya and eastern Zimbabwe were accompanied by large drops in multiple partners, probably largely as a spontaneous reaction to fear.

As for his truth -

...our priority must be on the key driver of generalised epidemics — concurrent partnerships.

Separating facts from myths, ideologies and values can be difficult. But getting the science right must be a first step to developing effective social marketing interventions. Educating policy-makers is another.

And if this list intrigues you, read his Confessions of a condom lover, also in The Lancet.

PSI on YouTube

Well, regular readers knew it had to happen sooner or later... Population Services International (PSI) is on YouTube.

PSI, a nonprofit organization based in Washington, D.C., combines the power of markets with the dignity of choice to make healthy behaviors available to low-income and vulnerable populations in more than 60 developing countries with programs in malaria, reproductive health, child survival and HIV. PSI and its overseas affiliates have almost 40 years of experience in producing television spots promoting healthy behavior that are developed for the countries where they are used and pre-tested on the target audiences. PSI's YouTube page features a sampling of some of those spots from around the world in all four of PSI's health areas. This page will be updated regularly so come back again soon to see new spots.

Thanks to Noelle, Leif and all the contributors! It's beginning to feel very...social.

Viewing the Conversations Sessions

The powerpoint presentations from the Conversations on Social Marketing Fall 2007 series are now available at the  PSI web site. They include Katya Andresen's essential ingredients of social marketing in which she includes the atypical times you need to be thinking like a marketer and three core ideas to be a successful social marketer.

Richard Pollard describes the Total Market Approach where all sectors (public, private and NGO or donor-financed social marketing) are integrated within one “market” that is segmented by willingness to pay. While the TMA idea was originally developed for products and services, I see expanding this concept to include behaviors using 'opportunities and readiness to engage in behaviors' (in addition to willingness to pay) as one of our next frontiers for thinking through intersectoral, integrated social marketing programs (some ideas for obesity prevention folks!).

Doug Evans develops the idea of public health branding, how to measure the impact of brand equity in behavior change programs and a review of empirical evidence to support the usefulness of brand logic (as I have called it) in designing social marketing interventions. This is an area every social marketer needs to get comfortable with to develop and position their strategies for product, service AND behavior adoption and use.

Greg Cowal presents innovative methods for improving point-of-choice programs aimed at poorer populations that rely on ethnographic research, tailored detailing and merchandising strategies, retailer education and the use of GPS systems for program management. The intense interest, and the insights generated, by the commercial sector on the next 4 billion need to quickly seep into the practice of social marketing practitioners everywhere if they want to improve their ability to serve the needs of poor and vulnerable populations.

Enjoy the presentations. I am beginning to think about the Spring 2008 Conversations - eyewitnesses to the development of social marketing?

Adjusting to Kids' New Reality

I have been talking about virtual worlds for kids for a while now, including a post about an Atlanta Constitution article 11 months ago that looked at sites Nedra and I have chronicled in some detail and where the CDC has gotten involved. What started off as experiments for creating virtual worlds for kids (my focus) is turning into a full-fledged movement according to the NYT. [Image from Club Penguin.]

Second Life and other virtual worlds for grown-ups have enjoyed intense media attention in the last year but fallen far short of breathless expectations. The children’s versions are proving much more popular, to the dismay of some parents and child advocacy groups. Now the likes of the Walt Disney Company, which owns Club Penguin, are working at warp speed to pump out sister sites.

“Get ready for total inundation” said Debra Aho Williamson.

Doing health promotion and social marketing projects in schools is getting to be so...quaint. Debra estimates 20 million kids will be on virtual world sites in 3 years (8.2 million are there now).