Understanding Social Marketing for Improved Public Health

1. Dr Viral DaveAssistant ProfessorCommunity Medicine GCS Medical College, Ahmedabad Social Marketing

2. What is Social Marketing? • One well-known definition of social marketing is "the application of commercial marketing technologies to the analysis, planning, execution, and evaluation of programmes designed to influence voluntary behavior of target audiences in order to improve their personal welfare and that of society." Key points in this definition: Social marketing • Uses commercial marketing strategies. • Involves influencing voluntary (not forced or coerced) behavior change (not just increased awareness or increased knowledge). • Promotes an end goal of improved personal welfare and improved welfare of society.

3. Social Marketing Vs Social franchising • Social franchising is defined as using authorization granted by a government, company or organization to an individual or group enabling them to carry out specified activities directed towards social gain. • Social franchising was described as applying successful business principles to the provision and supply of health care services for social gain, usually in which a provider or group of providers is contracted to offer a standardized set of services (quality, fixed cost, branded), that may be used by and benefit public or private providers and clients. Social franchising therefore may or may not incorporate marketing techniques to promote supplies of specific products.   • While social marketing has been used extensively in programmes for young people, there is very little experience of social franchising of health services for young people, although there is clearly overlap between the two.

4. Introduction • There is also growing interest and experience of using these same marketing techniques to market “lifestyles” or “behaviours” • Social marketing facilitates the acceptance, rejection, modification, abandonment, or maintenance of particular behaviors by groups of individuals, often referred to as the target audience. • It uses marketing techniques to promote and distribute specific health-related supplies, commodities and services using (e.g. condoms, pre-packed treatment kits for STIs, FP supplies, bed nets, oral rehydration solutions). • Internationally, it has been used to improve access to potable water, eliminate leprosy in Sri Lanka, increase tuberculosis medicine adherence, and promote immunizations and universal iodization legislation, among other applications.

5. Current scenario in India • In Indiathe NPP 2000 stressed the need to implement Social Marketing scheme for advocating “products and services”. • The objectives were • To increase the number of outlets of services or products like : condoms, oc pills, ORS, MTP, Cu T. • To improve the quality of services and products • To involve or enhance partnership between Government and private sector. • To improve access to family welfare services.

6. Current scenario in India • Seventy-one percent of modern contraceptive users obtained their method from a public sector source. However, the source of contraception varies greatly by method. • Eighty-four percent of sterilized women had the operation in a government facility, usually in a government or municipal hospital. • By contrast, just over half of IUD users utilized the private medical sector for their IUD insertion. Almost two-thirds of pill users got their most recent supply from the private medical sector, which is also the most common source for condoms.

7. Achievements of SMP in India • The social marketing of condom increased from 16 million pieces in 1968 to 755.89 million in 2006. condoms marketed under SMP represents one-third of total condoms distributed in India. • The social marketing of OC Pills increased from 7.24 lakh cycles in 2005 to 406.93 lakh cycles in 2006. • Awareness regarding condoms and OC Pills has substantially increased, and is reflected in declining total fertility rates and increased contraceptive prevalence rate from 10.4% to 56% . • Help to change option and choice within each product ( condom and OCP ) for consumers.

8. What is Social Marketing? Social marketing can be thought about as a • Systematic and strategic planning process. • Social or behavior change strategy. • Mindset for addressing problems. • Total package of strategies carefully chosen based on characteristics of the target audience. Social marketing is NOT • Just advertising or communication. • A media campaign. • Reaching everyone. • A fast process. • A theory.

9. When Should You Use Social Marketing? • Social marketing should be used when voluntary behavior change is your goal and you desire an audience-focused program. Also, you must have the time and skills to adhere to the process. • You would not use social marketing if you were only trying to educate or raise awareness. Although, if the hope is that education or awareness will lead to behavior change, then social marketing would be appropriate.

10. When Should You Use Social Marketing? • Many people assume that social marketing is a resource intensive process and that you must have a large budget and many people. • This can be true, but it is also possible to use social marketing with limited resources. There are certain modifications that can be made when you have limited resources. • If you have limited resources or are working with a very small group of people, you can still use the social marketing mindset (thinking about problems and issues from the standpoint of the person who needs to change) for no cost, even if you are not able to complete the steps in the social marketing planning process.

11. When Should You Use Social Marketing? • The concepts of social marketing can also be used to make "upstream" changes, such as environmental or policy changes. • The end beneficiary of a particular environmental or policy change isn't always the person who needs to make the behavior change. • For example, you could be trying to get a school board to adopt a specific policy. The beneficiary of such a policy would be the children in the school system. In this case, the school board is the target audience and the behavior change is adopting the policy. • Environmental and policy changes can be the primary goal of your program, or they can be used with activities designed for the end user. If your program includes environmental/policy level changes and individual level changes, you will likely have two separate target audiences and two different behavior changes.

12. some drawbacks Although there is good evidence that social marketing works to make products more acceptable and desirable, it is less clear how far the techniques lead to effective use of the products (e.g. condoms or pre-packed STI treatments), or how effective they are for increasing access to commodities for the most vulnerable groups, who are usually in greatest need. Although the product may be purchased, it is important that the product is used, and used correctly, and more data are needed on the balance between supply, purchase and the preventive measures and messages that need to accompany the products if consistent behaviours are to be sustained. Distribution and sales data do not necessarily reflect these prevention components, and ensuring that this aspect of the services is monitored is very important, but resource consuming.

13. Definitions of Key Terms • Primary target audience : also called target audiences, a group of individuals whose behavior needs to change to positively impact the problem. They could be directly affected by the problem themselves, or those who can make policy or environmental changes (i.e., voting behavior, approval of policies). • Secondary audience:A group of individuals who exert influence on the primary target audience's behavior.

14. Definitions of Key Terms • Formative research: Research conducted during the development of your program to help you choose and describe a target audience, understand the factors which influence their behavior, and determine best ways to reach them. Also called formative assessment, market research, consumer research, or audience research. • Behavioral objective:A written description of the aim or goal you have for the specific behavior you want the target audience to take. It should be a clear, specific, measurable, and feasible action.

15. Definitions of Key Terms Intervention strategy:A guiding plan of action for the social marketing program. The intervention strategy (also called market strategy) encompasses • Specific target audience segment(s). • Specific behavior change goal. • Benefits of the desired behavior to promote. • Costs and barriers to behavior change that will be minimized. • The marketing mix (product, price, place, and promotion). • Activities that will influence or support behavior change.

16. Primary vs. Secondary Audiences • The important point is to determine whose behavior change will be your central focus, and, therefore, who you will need to conduct formative research with to understand potential intervention components and strategies. • For example, if you wanted children to get more physical activity by walking to school each day, children would be your primary audience. They need to change their behavior to impact the problem (lack of physical activity). But, the majority of program activities may be designed to intervene with parents who play a significant role in influencing the behavior of their children.

17. Primary vs. Secondary Audiences • Even though, in this situation, parents are a secondary audience due to their influence on children, you may need to think of them as another primary audience because their behavior needs to change to support behavior change in their children. • Regardless of how you choose to categorize them, you'd need to conduct formative research with parents because they will require unique strategies in your intervention design.

18. What Makes Social Marketing Different? Several elements of social marketing are borrowed from the field of commercial marketing but the unique are: • Audience orientation. • Audience segmentation. • Influencing behavior. • Competition. • Exchange. • Marketing mix. Addressing these elements collectively is what makes social marketing different from other public health planning approaches.

19. Audience Orientation • Social marketing planners take time to learn what the target audience currently knows, believes, and does. All decisions are made with the audience's perspective in mind. The program is designed to fulfill the audience's needs and wants. • You may already know a lot about audience and have some ideas about the program's activities. It can be tempting to start planning based on these ideas, but social marketing requires that you test those assumptions with the target audience first. You may be right, but you may also be surprised at what your audience thinks and says. • example

20. Audience Segmentation • Audience segmentation is the process of dividing a broad target audience into more homogeneous subgroups, called audience segments. • Example • Social marketers are more likely to divide populations into distinct segments on the basis of current behavior (e.g., heavy versus light smoking), future intentions, readiness to change, product loyalty, and/or psychographics (e.g., lifestyle, values, personality characteristics).

21. Audience Segmentation • Purpose: To make your program more effective and to use your resources wisely. • A program developed for the "general public" will likely not be really effective for any one person or group. • But, by tailoring efforts to a particular segment, you can greatly improve your effectiveness because you can use the programming, communication channels, and messages that are most relevant to your segment. • This way, they are more likely to be reached and more likely to pay attention, creating a more effective program.

22. Influencing Behavior • Influencing behavior (not just awareness or knowledge) is the bottom line of any social marketing program. • Therefore, your program's goals should be designed to influence behavior instead of only increasing knowledge or awareness of a problem. • You may want your target audience to adopt a new behavior, stop a current behavior, or refrain from starting a new behavior.

23. Influencing Behavior To do this, you need to understand • Current behaviors of your audience. • Ideal behaviors. • Reasonable steps to move the audience from the current behavior towards the ideal behavior. • What determines their behavior. The initial behavior change you ask for may not be to adopt the ideal behavior. The audience may need to start with smaller changes that move them towards the ideal behavior. The end point is always action. Ask yourself: What do we want the target audience to do as a result of our intervention? • example

24. Competition Social marketing, like commercial marketing, takes place in a competitive environment. • In social marketing, Competition is defined as the "behaviors and related benefits that the target audience is accustomed to—or may prefer—to the behavior you are promoting." • The marketing mindset asks, what products (behaviors, services) compete with those we are promoting, and how do the benefits compare to those offered by competing behaviors? Answers to these questions enable social marketers to offer benefits that best distinguish healthy behaviors from the competition and develop a sustainable competitive advantage that maximizes their products’ attractiveness to consumers.

25. Competition • example : behavioral options that compete with public health recommendations and services, e.g., bottle-feeding versus breastfeeding. • The target audience is doing something instead of the behavior you want them to do. Why does the audience prefer the competing behavior over the behavior you want to promote? Does the environment support your behavior or the competition? In social marketing programs, competition should be acknowledged, explored, and addressed by the strategies of the program.

26. Exchange For every choice we make, there is an exchange that occurs: • we give one thing up in return for something else. In the commercial marketing world, this exchange can be tangible (pay an extra quarter and get more fries), or it can be intangible (buy a brand-name pair of shoes and get the image that goes with the brand). • While the exchange can be tangible in social marketing but, the exchange is often intangible, such as giving up a TV show to go for a walk to improve one's health.

27. Exchange • The target audience will compare the costs and benefits of performing a behavior before choosing to adopt it. • You must determine what your target audience values and what costs they perceive to create an exchange that persuades them to adopt your behavior over the competition. • The exchange should increase the perceived benefits of the target behavior and minimize its costs. Or it could increase the perceived costs of the competing behaviors and minimize their benefits. • example

28. Marketing Mix The marketing mix, also known as the "4 P's," is made up of four parts that, together, create the exchange offered to the target audience • Product: What the audience gets or what you offer; can be tangible items, intangible benefits, or the behavior itself. • Price: What the audience gives up to get a tangible product; also the costs or barriers to making the desired behavior change. • Place: Where the audience is located or gathers, performs the desired behavior, accesses. products/services, or is thinking or hearing about the health issue. • Promotion: Messages, materials, channels (path used to reach the target audience), and activities to promote behavior change and describe the product, price, and place features of the program.

29. Marketing Mix-Product • In social marketing, the product usually refers to the desired behavior and all of the benefits, services, and tangible items that lead the target audience to adopt the desired behavior. • To be successful, social marketers believe the product must provide a solution to problems that consumers consider important and/or offer them a benefit they truly value. • The marketing objective is to discover which benefits have the greatest appeal to the target audience and design a product that provides those benefits.

30. Marketing Mix-Product • Kotler and Lee speak of three levels of a social marketing product. The "core product" or innermost level is made up of the benefits of the desired behavior. • The "actual product" is the behavior itself, and • The "augmented product" contains any objects or services created to support behavior change. • For example, the behavior of eating fruits and vegetables would be the actual product, the fruits and vegetables themselves and a new farmer's market that sells fruits and vegetables would be augmented products. • Whatever the product, you will use formative research to learn from the audience what will make it appealing to them.

31. Marketing Mix -Price • Pricerefers to the cost or sacrifice exchanged for the promised benefits. This cost is always considered from the consumer’s point of view. • The price for social marketing products is not always monetary, but can include barriers such as loss of time, decrease in pleasure, loss of self-esteem, loss of respect from peers, lack of access, or embarrassment and the psychological hassle that often accompanies change, especially when modifying ingrained habits. • Once the costs or barriers of the desired behavior are identified, social marketing attempts to minimize or reduce them.

32. Marketing Mix -Price • If that's not possible, you may be able to increase the costs of the competing behavior by making it more difficult or less appealing. • In setting the right price, it is important to know if consumers prefer to pay more to obtain “value added” benefits and if they think that products given away or priced low are inferior to more expensive ones. • Consumer research conducted by Population Services International, for instance, revealed that many teens did not trust condoms that were given by public health agencies. But even a small, affordable monetary price (25 cents) was sufficient to reassure them that the condoms were trustworthy.

33. Marketing Mix- Place The concept of "place" includes both where and when the audience • Performs the desired behavior. • Is located or gathers. • Accesses products or services. • Thinks or hears about the health issue or behavior. • Place includes the actual physical location of these outlets, operating hours, general attractiveness and comfort, and accessibility, e.g., parking and availability by public transportation.

34. Marketing Mix- Place • Placement strategies can include offering services or materials in locations that are convenient and pleasant, or placing information where and when your audience is already thinking about the behavior (or about the competing behaviors). • Other placement strategies could make the behavior more accessible, such as increasing the number of clean, safe parks in a neighborhood or opening up school sports facilities to the community after school hours.

35. Marketing Mix- Promotion • Promotion includes communication or education that describes the program's • Benefits. • Product • Price. • Place. • It includes • Messages. • Materials. • Channels. • Incentives. • Activities.

36. Marketing Mix- Promotion • Promotional activities may encompass advertising, public relations, printed materials, promotional items, signage, special events and displays, face-to-face selling, and entertainment media. • You may also use media advocacy techniques like writing letters to the editor, or developing relationships with the press to promote your messages. Consider • Where and when your audience will attend to the message. • What incentives you might offer to participants. • Who should deliver the message.

37. Ethical Considerations The marketing of social products, services, and ideas is particularly prone to ethical dilemmas. Unlike most commercial marketing, social marketing involves some of our most deeply held beliefs and moral judgments. Recent work on ethics highlights unique issues about the moral justification of social marketing’s • Aims (e.g., individual or social welfare versus individual satisfaction), • Procedures (e.g. , how much disclosure is necessary in the promotion of a contraceptive about product side effects) and • Outcomes (e.g., moral changes in a community, especially when the social marketers are not members of that community)

38. Ethical Considerations • Efforts to change health behaviors can impact a variety of contextual factors; therefore, it also is important to anticipate any unintended effects social marketing activities may have on target audiences and others. • Media messages should not reinforce stereotypes or stigmatize population segments [e.g., by presenting smokers as nasty or parents as unfit ]

39. Social Marketing Planning Process • The social marketing planning process is a structured approach to developing and implementing a program or intervention for voluntary behavior change. The planning process is consists of six phases. • Six Phases1. Problem description.2. Formative research.3. Strategy development.4. Intervention design. 5. Evaluation.6. Implementation.

40. Phase 1: Problem Description Checklist for problem description • Statement of the problem. • A list or description of the factors that contribute to the problem. • List of broad potential target audiences, secondary audiences, and behavior changes (with rationale for each). • Summary of any existing data about the problem, audience, and behavior. • Models of behavior change that may apply. • Best practices or lessons learned from other programs that may be similar. • List of your strategy team members and summary of how decisions will be made. • SWOT (strengths, weaknesses, opportunities, and threats) analysis. • Identify Information Gaps

41. Phase 2: Formative Research • in phase 2, you will make sure you've identified all information gaps, and then learn how to use formative research to fill those gaps, thereby informing decisions made in phase 3, strategy development. • The information you collect during the formative research phase should help you to • Narrow and describe the target audience. • Select a specific behavior for the audience to change. • Identify the factors which influence the audience's behavior. • Develop a preliminary marketing mix (product, price, place, and promotion) for the intervention.

42. Formative Research Process The formative research process can be broken into seven main steps:Step 1: Analyze Information GapsStep 2: Write Research QuestionsStep 3: Choose Data Collection Method • Common Formative Research Methods • Focus groups • In-depth interviews/intercept interviews • Observations/environmental scans • Surveys

43. Formative Research Process Step 4: Develop Instrument(s) The answers that you get are only as good as the questions you ask. Step 5: Recruit ParticipantsStep 6: Collect DataStep 7: Analyze and Report Findings At this point, you should know quite a bit more about your audience and their behavior than you did at the beginning of your project. Final decisions about audience segments and behavioral objectives will be made in the next phase.

44. Phase 3: Strategy Development Take all of the information you've collected, analyzed, and summarized in the first two phases and use it to make strategy decisions, such as • A final target audience segment. • Secondary audiences. • Specific behavior change and behavioral objectives. • Strategies based on the 4 P's. Campaign strategies and materials are then developed, pretested, piloted, and revised prior to program implementation. Monitoring and evaluation activities continue throughout the program implementation to identify any necessary program revisions, and to understand program effectiveness and make midcourse corrections as needed.

45. Phase 4: Intervention Design • This is the phase where planners choose and develop activities, products, messages, materials, distribution channels, supporting services, and so forth to put the marketing strategy designed in phase 3 to work. • Develop a detailed intervention design based on chosen strategies and audience research. • Identify partners needed to implement program and discuss how to work with them. • Analyze and list details that need to be accomplished to complete intervention activities. • Revise a logic model to include intervention activities and desired outcomes. • Define process and outcome objectives. • Discuss planning issues including budgets and program timeline. • Describe importance of pre-testing and appropriate times to use it.

46. References • Modules on social marketing-Website of CDC. • SOCIAL-MARKETING IN PUBLIC HEALTH : Sonya Grier and Carol A. Bryant. An article from Annual Review in Public Health,2005, volume 26:319–39 • Text-book of community medicine: Sunder Lal

47. Thank you