6503-1, 6503-2, 6503-3, 6503-4, 6503-5

Personality Variables

Dogmatism Fatalism Religiosity Self-monitoring Cultural values Try to figure out which personality variable is driving negative or positive health behaviors

Negative vs. Positive Framing

Some studies show negative framing greatly promotes: HIV testing Breast self-exams Some studies show positive framing greatly promotes: Regular exercise Sunscreen use Child safety seats

Formative Research

Sometimes called formative evaluation How do audiences respond to concepts and drafts of messages delivered through a specific channel? We'll discuss the uses and importance of formative research, audience segmentation, and methods for conducting formative research.

Formative Research Objective

To explore social networking website users' receptivity to receiving HIV prevention and testing messages Knowledge Networks survey (www.knowledgenetworks.com) Randomized experimental design

Why Formative Research?

To understand the target audience's needs, desires, and values before a health communication program is designed and implemented (Siegel and Lotenberg 2007) To understand how the audience might respond to a message delivered through a particular channel To test assumptions first

Traditional Model

Used demographics. Young/old, men/women, etc. Campaigns designed in this way produced small, if any, effects. Instead, we should think about what makes people truly unique.

Importance of Formative Research

"One reason for the success of campaigns is their use of formative research. Campaigns are often highly creative and professionally produced, but the messages or appeals used are inappropriate for the target audience; formative evaluation helps to shape the message content..." Vicki Freimuth "Formative evaluation is one of the most important elements of a campaign. Such evaluation is not always used as much as it should be. It is very important to know who a campaign is supposed to reach while the campaign is being designed." Marcy Kelly "Formative evaluation plays a crucial part in the success of any campaign. Not only does it provide a testing ground to make sure the messages used are appropriate for the target audience, it also offers a vehicle for getting the proposed target audience to 'buy into' the campaign in the first place." Jacqueline E. McDonald "Formative evaluation is absolutely imperative. 'Behind-the-desk' perceptions are not useful—the evaluation must get out to the public being served by the campaign." Patrick Coleman "Formative evaluation is critical to...a media campaign.... Mass media campaigns are often unsuccessful because their designers have little idea of the real characteristics of the target audience." Thomas Backer "Formative evaluation is critical to campaign success . . . With the help of formative evaluation the message can be tailored, the appropriate channels discovered, and the messages and channels directed to the audience at risk and not at the general population." Ronald E. Rice

Competitiveness

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AED Case Studies

Academy for Educational Development (AED), now known as FHI 360, presented these two research cases. Focus on how they went from problem to research to promotional tactic.

Presenting Facts and Statistics to Audiences

1980's public health ad campaigns employed emotionally neutral presentation of statistics. Facts and statistics presented alone are not as influential as once thought. Presenting facts and statistics can be effective under certain circumstances. Presenting numbers is often used to shock the audience into changing its behavior.

Important Considerations for Place

Available Easy to find and use (especially with websites) Appropriate Timely

What Is a Channel?

A medium through which to communicate a message Analog and digital Interpersonal, mass media, digital media, mobile devices, social media

Case 2: Tractor Safety

AED developed a tractor safety campaign to persuade New York State small crop and dairy farmers to install rollover protective structures (ROPS) on their older tractors. Issues: ROPS cost $700-$1400. Farmers didn't believe they'd get hurt (won't happen to me). Research indicated that farmers' primary value was their family. Instead of pointing finger at farmers, focus was on protection of children. Message uplifts and compliments farmer. Partnering with corporations, coupons were issued for ROPS. Essence of social marketing is working with others to develop best strategy to deter barriers and increase benefits of behavior.

Considerations in Picking Channels

Audience media habits Message features and framing Fact based? Inspirational? Complexity Budget What has been used in the past for this setting/population/ problem, etc.?

HIV Testing Example

Behavior being sold is getting tested. Service may be going to a testing center and speaking to a counselor. Product could be a tangible HIV quick test or gaining the knowledge of one's HIV status. Price may be discomfort, embarrassment, time, and/or money. Benefits are knowledge, peace of mind, responsibility to a partner, being a good person, etc.

Product

Behavior or a set of behaviors How can a behavior be a product? Any product is a collection of benefits (social and/or functional). Behaviors have benefits.

What's the Exchange?

Breast cancer prevention exchange: women, early testing can avoid leaving your husband behind to care for your child alone Anti-drug exchange: parents are most viable deterrent to their children's drug use Research showed that parents didn't believe they had much of an influence on their teens' drug use.

VALS

Come in eight segments Primary motivators

Connection Between Social and Commercial Marketing

Commercial marketing is all about sales and profits, and to achieve what they need: Repeat customers A share of the market Return on investment Social marketers: Don't have customers per se Don't typically offer products or services Don't charge money to people Don't have easily measurable outcomes

Willingness to Change

Committed to designing products consumers want Flexible to modify programs if research proves unsuccessful outcomes from current messaging Devoted to dynamic campaigns that are prepared to change when necessary Example: national campaign against drug abuse geared toward adolescents Flawed message basically said "give up marijuana and don't become a murderer" Revamped campaign, "Above the Influence," focused on teens' individual ability to be above drug use

Extended Parallel Process Model

Components: Fear Threat Severity Susceptibility Efficacy Response efficacy Self-efficacy

Are Benefits Worth the Price?

Current behavior may be due to novelty, excitement, ease of mind in pretending the problem doesn't exist. Social marketers have to communicate that their offering is better than current behavior. Offerings consist of services, behaviors, and tangible goods or commodities.

Message Framing

Defined as a set of concepts and theoretical perspectives on how individuals, groups, and societies organize, perceive, and communicate about reality. Framing is commonly used in media studies, psychology, sociology, and political science. News issues can be framed in various ways: Hero frame Feminist frame Individual responsibility frame 1960s economists began to study how framing risk affects people's ultimate decisions.

Choice of Emotional Appeal

Depends upon: Theory being used Target audience, age, psychographics Issue being communicated Appeal should always be appropriate to context.

Framing Theory

Developing messages Very important in health communication In media advocacy, can be used to create movements Change social environment through movements Can also be used in developing health campaigns Use news, expected and unexpected events to draw and frame media coverage ASSIST program

Need for Customization

Different users have different needs Some highly aware of HP, others not Access, timeliness, usability Need for multiple delivery channels Digital solution: online searchable database

Phases of Social Marketing

Each phase engages research and is evidence based. External research entails absorbing others' data and conducting expert interviews. Formative research is collected by you from the beginning.

Bedsider Social Game: Egona

Egona: A single cell striving to find the right match at the right time Mato matches: Not what Egona is looking for Egona's goal: With the help of her Symbiote friends, to fight off undesirable Matos, build up resources, and find the right match at the optimal time for the highest scoreqq

Environmental Health Example

Environmental health practitioners work hard at getting people to use reusable sacks as a solution. At first glance, product seems to be the reusable sack. It's also keeping the environment clean, saving wildlife, preserving bodies of water. Need to think about product on multiple layers. Is it beneficial, unique, competitive with current behavior?

Developing and Pretesting Messages and Materials

Environmental scan Formative research Develop and test message concepts Decide what materials to develop Develop materials Pretest materials Stages 2, 3, and 6 rarely happen, but all stages are important.

History

Established in the 1970s out of business and marketing schools. Health Canada established the first social marketing unit in 1981. U.S. Centers for Disease Control and Prevention established a center for marketing in 2004. National Health Service in the United Kingdom established the National Social Marketing Centre. Social marketing is a core strategy for promoting health at the population level.

Distinguishing Features of Social Marketing

Exchange theory Consumer orientation Data-based decision making Competition Willingness to change offer

History of Health Communication

Existed long before it was defined by academics Much recognition in past 20 years of its value to public health as a core competency Growing evidence of effectiveness in behavior change Healthy People 2010 first to include health communication objectives; Healthy People 2020 expanded its role and reach Institute of Medicine report (2003) Association of Schools of Public Health published a communication competencies for every MPH (2006) Growing recognition worldwide

How Does Fear Work?

Fear creates drive motivation: fight or flight Flight: controlling fear by defensive or avoidant behaviors Fight: controlling danger by engaging in less risky behaviors

Best Numerical Formats

For lengthy messages use consistent numeric format throughout. (Do not compare percentages with odds or frequencies.) Keep denominator consistent throughout entire message. Make it simple for audience to hear your message, comprehend the evidence, make their decision. Round numbers and avoid decimals. Expressing ratios as two smaller numbers (1 out of 10) leads to lower perception of risk than same ratio using larger numbers (10 out of 100). Present numbers visually to help audience make meaning out of numbers.

Core Functions of Communications Strategy

Forces us to be focused and clear Provides a tangible document for circulation throughout entire team Provides anchor against which all creative materials can be judged

Uses of Formative Research

Identify one or more target audiences Develop understanding of target audiences' needs, wants, values, and competing behaviors Determine what bundle of benefits is most compelling and how it can best be made available Develop and test messages, materials, and promotional strategies (Siegel and Lotenberg 2007) Select channels and design creative message delivery in the most effective way

What Is text4baby?

Free mobile information service of Healthy Mothers Healthy Babies Coalition (HMHB) In English and Spanish to promote maternal and child heath among low-income moms Provides pregnant women and new moms with motivation and information to help them care for their own and their baby's health Sign up by texting BABY (or BEBE) to 511411—receive three free messages a week timed to due date or date of birth Connects women to prenatal and infant care services and other resources

Audience Research

Goal: HP 2020 aims to meet key public information needs Readily accessible information, tailored to audience needs Develop relational, online database that users can search based on individual needs Think about audience needs, interests, abilities Conducted focus groups to identify information needs and interests Intro script: "Healthy People 2020, a national initiative of the U.S. Department of Healthy and Human Services, is being designed to serve as a mirror on the changing health of all Americans. It will also serve as an important initiative for communicating with individuals about their own health and how it can be improved. We want Healthy People 2020 to touch the lives of all Americans. You can play an important role in this."

Guilt

Guilt is caused when people believe they have not lived up to their own moral code. Moral codes are typically based on one's family, society, and culture. Historically research indicates guilt motivates altruistic behaviors. When humans feel guilty, they experience desire to stop the guilt and engage in helping behaviors. Social scientists and commercial advertisers have taken advantage of this human tendency. Designing messages to elicit guilt nonorganically has proven difficult to do. Guilt is effective when the topic is one the audience has control over. Guilt is effective when the issue at hand affects other people. Guilt can be effective depending on sex, age group, and emotional psychographics. Guilt appeals work in different ways depending upon the culture of the target audience. Don't overuse guilt appeal tactics as this may generate anger toward campaign.

Selecting Messages and Channels: Healthy People 2020

Healthy People (HP) sets agenda for healthy policy in United States. Policy priorities are set every 10 years. 2020 goals: Eliminate preventable disease, disability, injury and premature death Achieve health equity, eliminate disparities, improve health of all groups Create social and physical environments that promote good health for all Promote healthy development and behaviors across every stage of life www.healthypeople.gov/HP2020/

Bedsider: Using Multiple Channels

How different channels work together How they build relationships with participants

Broad Findings

Limited familiarity with/use of HP Identified needs to be addressed Ideas for increasing usage, improving awareness Create an online dissemination system

3 tenants of Integrative models

Make it look popular Humor

How Intensely Should Emotion Be Communicated?

Minimally, moderately or intensely? Emotion levels exist on a continuum. Intensity levels should differ depending on emotion being evoked.

Mobile Health (mHealth)

Mobile phones as a channel for health promotion and disease prevention To deliver health information, monitor patients' health, and remotely deliver health care Society for New Communication Research (http://sncr.org) mHealth Summit (http://www.mhealthsummit.org/program-details/ health-20) Mobile phones as research platform: data collection Text message surveys IVR: integrated voice response surveys Mobile phones for delivery and evaluation Text messaging or smartphone interventions Treatment adherence and monitoring

New Channels: Mobile and Social Media

Mobile phones offer powerful delivery channel Ubiquitous—text, video, Internet, etc. Social media connect large numbers of users Allows diffusion

Binge Drinking Mobile-Based Social Marketing Exercise

Mobile-based Social Mkting Breakout Exercise: Develop a mobile-phone-based social marketing campaign for undergraduate students at a large public university to help improve health condition BINGE DRINKING For your selected topic, outline: (a) situation analysis & audience profile: high rate of binge drinking in undergrad universities -- "One in four say their academic performance has suffered from drinking, all according to the National Institute on Alcohol Abuse and Alcoholism. The binge-drinking rate among college students has hovered above 40 percent for two decades, and signs are that partying is getting even harder." -- NY Times. (b) overall program goal; specific program objectives to decrease the rate of binge drinking amongs young college male students age 18-21years by 10% within 2years?? (c) utilization of the 4P's -promotion: The fantasy football app of drinking - fantasy drinking -price: Don't binge drink. You can still drink some, just don't overdo it. -product: Do better in school, get a better job, live a healthier life, don't get the freshman 15! -place: facebook, or mobile phone app (d) mobile health component: check in via mobile app and put down goal for the night, then record how many "red cups" you drank, compare with friends and if you go over your goal, you get fined a little $ and your friends/competitors get the money. Rate your drunkness on the vomit-o-meter

Creative Messaging

Motivational health messages need to be memorable and persuasive. Design elements to consider: Type of appeal Overall tone Spokesperson Think beyond a commercial advertisement.

Using Multiple Channels

Multiple digital channels Combinations of digital and analog channels (TV and radio)

Bedsider Builds Relationships

Multiple touch points Reminders Trusted resource for information Fun and entertaining Things to think about: What is the relationship about? What is the emotional identification? What are the core values?

Negative vs. Positive Framing (contd)

Negative framing tends to work with riskier issues. Positive framing works better with prevention. Negative framing works better with detection. Some studies show no framing effect at all.

mHealth Evidence

New and social media ubiquitous but slim evidence for health promotion Best evidence comes from mobile domain: can help modify health behaviors Most interventions rely on text messaging to guide behavior change Abroms et al. reviews evidence and research agenda including mobile behavioral theory Evans et al. describes evaluation strategies and presents text4baby evaluation Little published on theory or conceptual framework: need for studies to build mHealth theory

Presenting Numbers Graphically

One of the primary goals of risk and health communication is to make the data come alive. Study by Stone et al. (1997) showed that participants were more influenced by graphic displays than by numerical displays. Stone et al. replicated their study several times using several different graphics and numbers; results were consistent throughout. Graphic displays have been proven to be more effective than numerical displays at inciting change in people. Graphic displays make more sense to people.

Social Media as Engagement Tools

Opportunities for brands to engage consumers Public health social marketing as brands: more media impressions Makes it easy to engage: Just clicking a web link is engagement Can register for promotions, events Can play games, enter contests Enhances the exchange Promotes a conversation, opportunities for market research

Social Networking Site Use

Over 85% of U.S. adults use Internet 89% of 18- to 29-year-olds and 78% of 30- to 49-year-olds use social networking sites http://www.pewinternet.org/Reports/2013/social-networking-sites/Findings.aspx Focus on building online social networks or communities of people who share interests and activities and provide ways for users to interact "Weak ties" but wide reach

Factors Influencing Framing Efficacy

Personal motivation (Maheswaran and Meyers-Levy, 1990) Lowly motivated → superficial processing of the message → positive framing > negative framing Highly motivated → systematic processing of the message → negative framing > positive framing Targeted behavior (Banks, Salovey, Greener, Rothman, Moyer and Beauvais, 1995) Detection behavior → risk of negative outcome → negative framing > positive framing Prevention behavior → positive outcome targeted → positive framing > negative framing Expected message framing (Smith and Petty, 1996) Unexpected framing → detailed processing → negative framing > positive framing Expected framing → superficial processing → positive framing > negative framing

Egona Allegories

Preventing unplanned pregnancy and practicing safe sex Egona = egg; Matos = sperm Optimal sperm always on screen; must neutralize other sperm Birth control-themed Symbiotes = weapons Cappy, a jellyfish-like creature = condom Stalwart = the patch; protects Egona

4 P's

Product (or Service). Place. Price. Promotion.

Elements of Communications Strategy

Program goal Target audience Behavior or social/advocacy objective Communication objective Barriers to awareness or action Benefit promise Supporting reasons why Actions target audience should take Tone Planned executions

Types of Appeals

Rational arguments, e.g., facts, statistics, numerical displays Emotional appeals, e.g., fear appeals, pride appeals Social modeling, e.g., modeling targeted behaviors Aspirational images, e.g., runners achieving goals Slice of life, e.g., target audience in real world setting Expert appeals, e.g., expert in field, doctor All of these message strategies are informed by research and developed through the creative process

Environmental Scan

Research current campaigns addressing issue. What are they doing? Who are their spokespersons? How are they framing it? Who are they targeting? Are these campaigns effective? Situation analysis will provide some answers. Check other government agencies, non profits, and foundations that are also tackling issue. Environmental Scan (contd) Check history of your own organization. Has your organization dealt with similar issues in the past, and in what way? Were their efforts successful

Action Tendency

Research shows each human emotion encourages certain action. Every emotion is aligned with a different action tendency. Fear → fight or flight Sadness → amelioration Warmth → pride, calm Most emotional appeals ignite more than one emotion.

Developing and Pretesting

Review existing messages and materials. Develop and test message concepts. Decide what materials to develop. Develop messages and materials. Pretest those messages and materials. Develop and pretest delivery channels.

Do Numbers Work?

Smith et al. at Michigan State University conducted study on organ donation messages. Participants viewed either narrative or statistical messages about effects of organ donation. Researchers measured participants' emotions, thought processes, attitudes about organ donation and intentions to sign organ donor cards. Statistical messages, compared to the narrative messages, had a greater effect on thought processing. Statistical messages had higher overall credibility and overall effectiveness. Narrative messages were more likely to affect the participants' emotions. Numbers and narratives both important, but don't impact same outcomes. Consider your target outcome, and pick a message that will achieve that outcome.

Getting the Message Across

Submit editorials to local newspapers. Set up displays at malls or health fairs. Write press releases. Develop print materials. Train peer leaders.

Medicaid Module

To encourage uninsured moms to apply for coverage To remind current Medicaid/CHIP recipients to reapply for coverage To identify number of uninsured users who reported they applied for Medicaid/CHIP To reinforce text4baby moms to: Call Medicaid/CHIP, or to Visit www.insurekidsnow.gov/state

How to Promote a Message

The promotion "P" represents communication Channels of delivery Ad, social media, news coverage, message embedded in entertainment

Personality

Trait paradigm: We are born with "traits." May include self-esteem, sociability, etc. "Twin studies" have been done to assess trait theories. Phenomenological paradigm: Individuals' outlooks are shaped by experiences. Social/psychological paradigm: Personality and characteristics are shaped by relationships and interactions with others. Behavioral "Skinner's" paradigm: Behaviors that were reinforced are likely to persist. People debate whether we're born with personalities or they are formed; research suggests it's a little of both.

Consumer Orientation

Understand consumer perception and what benefits the consumer finds attractive. What barriers or costs will deter the consumer? With smoking cessation campaigns, you must understand the perceived benefits of smoking. Research shows that college students assume they'll quit at graduation. Benefit to quitting may be more money in your pocket. Someone else's benefit might be not smelling like smoke and not having yellow teeth. Target must be willing to give up those benefits for the advocated behavior. Respond to needs and wants of consumer by communicating recommended behavior through that lens.

Web Redesign for Healthy People

Vision: Create engaging, user-centered website that gives HP users a platform to learn, collaborate, plan, and implement strategies to reach the 2020 objectives Enable users to seek information based on their preferences/priorities Create other products to simplify HP Phased approach beginning December 2010

Need for Uniqueness

Want to be seen as different

General Public Focus Group Questions

What are the best ways to share health information with you? Local healthy agency? Short documents? E-mail? News and media reports? Leaders in your community?

Emotional Appeals

When, how, why, and for whom should emotional appeals be used? What is the purpose of the campaign? Increase exposure to this issue Increase attention to this issue Increase understanding of risk Increase acceptance of risk, encourage action Maintain desired behaviors In order for any campaign to be effective, we must know evidence base.

Demographics

description.' Demographics are the quantifiable statistics of a given population. Demographics are also used to identify the study of quantifiable subsets within a given population which characterize that population at a specific point in time. These types of data are used widely in public opinion polling and marketing Commonly examined demographics include: Gender (biological sex) Age Ethnicity, race Knowledge of languages Disabilities Mobility Homeownership Employment status And even location

What Is a Channel?

description.' For this class, a medium through which to communicate a message. Media include both analog and digital. Examples of channels: Video Radio Internet Social media Print

Formative Research

description.' Formative research is done before a health campaign is developed and launched. It asks and tries to answer "How do audiences respond to concepts and drafts of messages delivered in a specific channel such as a TV ad or text message?" Three basic types of formative research: Exploratory (understanding the audience) Concept testing (getting reactions to ideas for messages and channels) Pretesting (testing near-final drafts of messages and channels)

Messages and Channels

description.' In health communication, we deliver messages through a channel. We could promote a message encouraging smokers to quit through: Videos Radio ads Twitter feed Facebook page

Psychographics

description.' Psychographics is the study of: Personality Values Attitudes Interests Lifestyles Psychographic factors are also called IAO variables because this area of research focuses on: Interests Activities Opinions

Consumer Engagement

description.' Social media and mobile phones provide specific opportunities for campaigns to engage consumers. Campaigns are seen more often; more media impressions create ways consumers can benefit and be more connected. Promotes a conversation, opportunities for market research with consumers.

Social and Mobile Channels

description.' Social networks can both be channels to deliver health information in a "top-down" manner to an audience and: Networks can diffuse health information on a peer-to-peer basis Mobile phones can be used as platforms for health communication campaigns and for research purposes Mobile Health is the use of mobile phones to delivery health programs and campaigns

Communication Process

sender, message, medium, receiver, message

Definitions of Health Communications

"Health communication encompasses the study and use of communication strategies to inform and influence individual and community decisions that enhance health." (Freimuth, 2001) "The study and use of communication strategies to inform and influence individual and community decisions that enhance health." (CDC) The essence is the provision of information about health to individuals to persuade and motivate them to engage in healthier behaviors.

Definition of Media Advocacy

"The strategic use of news media and, when appropriate, paid advertising, to support community organizing to advance a public policy initiative." (Source: L. Wallack, News for a Change) You can think of media advocacy as strategies to position an issue in the mind of a target audience. Example: political campaigns

Familism

A social pattern in which the family assumes a position of ascendance over individual interests.

Individualism vs. Collectivism

A society's position on this dimension is reflected in whether people's self-image is defined in terms of "I" or "we." The high side of this dimension, called individualism, can be defined as a preference for a loosely knit social framework in which individuals are expected to take care of themselves and their immediate families only. Its opposite, collectivism, represents a preference for a tightly knit framework in society in which individuals can expect their relatives or members of a particular in-group to look after them in exchange for unquestioning loyalty.

Skills Needed for Health Literacy

Ability to follow public health alerts Understanding program offerings Understanding your rights and following informed consent Following a treatment regimen Ability to fill out forms and write letters of complaint Describe your symptoms and changes to your health status to a doctor Compare the risks and benefits of different treatment options Make sense out of charts and graphs Understand dosages

The Product

Actual product: primary behavior being advocated Environmental consciousness Augmented product: tangible objects/services The bag itself; many campaigns provide to promote use Benefits: positives outcomes occurring from product Pride, safety, a clean environment, and the knowledge that you're doing good Depend on target audience

Lifestyle and Income Grid

Allows marketers to design different campaign strategies for different segments of the population Can market different products, or market the same product, but in a different way

Association of Schools of Public Health Core Competencies

Communicates effectively both in writing and orally, or in other ways Solicits input from individuals and organizations Advocates for public health programs and resources Leads and participates in groups to address specific issues Uses the media, advanced technologies, and community networks to communicate information Effectively presents accurate demographic, statistical, programmatic, and scientific information for professional and lay audiences

Promotion

Communication Promoting the message Ad, social media, news coverage

Feasibility of Ideas

Developing a national, multimedia, strategic plan with advertisements placed all over major networks costs millions of dollars. Public health budgets are typically modest. For each segmented audience: How effectively can you reach the audience with the resources you have? How effectively can you influence its behaviors with the resources you have? Is it possible in the time frame you have since most public health work is funded by grants with set periods? Will the community (change agents) support your objectives? Decisions need to be thoughtful and evidence based before you begin.

Innumeracy

Difficulties that people have in understanding numerical risk Percentages, such as: 50% as a measure of whether something might or might not happen (50% of people who smoke get lung cancer) If the chance of getting a disease is 10%, how many people would be expected to get the disease out of 100? Orders of magnitude, such as: the riskier rate of something that kills 1,286 out of 10,000 compared to 24.14 out of 100 Personal discounting, as in: the risk of disease to others is always greater than the risk to yourself

Hofstede's Dimensions

Dimensions of culture: how one culture differs from another Individualism vs. collectivism Power distance Uncertainty avoidance Short- vs. long-term orientation

Major Components of U.S. Public Health Agenda

Disease prevention Health promotion Health care policy Business of health care Enhancing quality of life and the health of individuals within the community From "Healthy People 2010"

Why Does Literacy Matter?

Documented relation between socioeconomic status and health Literacy is related to those factors Understanding of medical treatments and illness management Performance of health-promoting behaviors Adherence to medical regimens (Iike glycemic control) Utilization of screenings and preventive care Self-reporting on health status

Types of Values

Global values: enduring and abstract Love, peace, freedom Terminal values: highly desired end states Instrumental values: a means to an end

Think Out of the Box

Go beyond the typical. Think about people's activities, where they go, what they read, watch, and peruse on the Internet. Reach them where they can be reached.

Place Where Decisions Are Made

Health care centers, hospitals, doctor/dentist offices. If person consults with family/friends, we want to reach those loved ones. Advertising reminders drive people to websites.

Campaign and Communication/Marketing Methods

In this course, a campaign is a program designed to achieve health objectives using a structured set of activities. Communication and marketing methods are used including: Messages Channels Efforts to modify the environment Consider activities designed to achieve specific objectives including: Promotions Advertising Placements Other activities Campaigns have communication objectives: If they see or hear the campaign, people should: Think about it Feel it Know it Believe in it Campaigns also have behavioral objectives: What people should do if they see or hear the campaign

Healthy People 2010 Objectives

Increase the proportion of households with access to the Internet at home Improve the health literacy of persons with inadequate or marginal literacy skills Increase the proportion of health communication activities that include research and evaluation Increase the proportion of health-related World Wide Web sites that disclose information that can be used to assess the quality of the site Increase the number of Centers of Excellence that seek to advance the research and practice of health communication Increase the proportion of persons who report that their health care providers have satisfactory communication skills

Framing in Terms of a Struggle

Institutional accountability City government corruption leading to food desert Personal responsibility Individuals have not been supportive enough of supermarkets News reflects U.S. culture's individual orientation Makes it hard to get a pure policy story in the news

Think Like a Marketer

Know your audience. Listen, listen, listen. Behavior is the bottom line. It's not enough to make people aware that there's a problem; they have to actually do something about it. Make behavior easy, fun, and irresistible. How do you make getting a prostate cancer exam fun? How do you make mammograms irresistible? How do you make HIV testing seem easy? Use the 4 Ps.

What Is Social Marketing? Kotler (founding father of social marketing)

Kotler and Roberto, 1989: "Social marketing is a program planning process that promotes the voluntary behavior of the target audience by offering benefits they want, reducing barriers they are concerned about, and using persuasion to motivate their participation in program activity." Andreasen, 1995: Social marketing is "the application of proven concepts and techniques drawn from the commercial sector to promote changes in diverse socially important behaviors." Marketing a product, service, or program, which is typically a behavior or an idea

Understanding Values

Learned processes that take place over time Can be societal/culture-wide or personal/family Traveling abroad can bring societal values to the fore After a while, your personal/family values might take precedence over cultural/societal values (becoming "acculturated") Example: children of immigrants A campaign designed for the children of immigrants might be designed differently from a campaign for the parents

Makers

Like experiencers, motivated by self-expression Work involves making and creating: food, buildings, etc. Have skills and experience Practical, value self-sufficiency Suspicious of new ideas, large institutions Respectful of governmental authority but resentful of governmental intrusion Unimpressed by material possessions, prefer basics To market to makers, focus on the creation of the product

Believers

Like thinkers, motivated by ideals Conservative, conventional, with established codes of belief Follow established routines organized around family and community As consumers, go for predictable, established brands Products for believers: familiar, known, rooted in conventional values

Exchange Theory

Long history in psychology and communication fields but social marketing employs it in a very straightforward manner. Exchange has to be a good deal. We ask people to exchange time, effort, and even emotions. Communicate alternative approaches for different audiences. Clearly demonstrate product's benefits. If quitting smoking means you lose all your friends, the exchange of whiter teeth may be a horrible deal. Better deal may focus on living a longer life. One-up the competition and explain in a truthful, ethical manner what the audience really gains.

Long- vs. Short-Term Orientation

Long-Term Orientation Short-Term Orientation Concern with society's search for virtue Strong concern with establishing the absolute truth Believe truth depends very much on situation, context, and time Normative in their thinking Show ability to adapt traditions to changed conditions Exhibit great respect for traditions Strong propensity for thriftiness; to save and invest Relatively small propensity to save for the future Perseverance in achieving results

Similarities to Commercial Marketing

Marketers want people to buy products, patronize services, and give to charities. Public health social marketers want people to: Start exercising Stop smoking Practice safe sex Go to the doctor Use Medicaid Give to charities

Masculinity vs. Femininity

Masculinity Dimension Feminity Dimension Preference in society for achievement Preference in society for cooperation Values heroism Values modesty Tendency for assertiveness Tendency to care for the weak Material reward for success Quality of life Society at large is more competitive Society at large is more consensus oriented

Where Media Advocacy Fits

Media Advocacy Health Comm./Soc. Mktg. Individual as advocate Individual as audience Advances health public policies Develops health messages and products Changes the environment Changes the individual

Strivers

Motivated by achievement Trendy, interested in the opinions of others Money defines success for them, but they don't have much Job rather than career; lack of skills and focus often slow them down Shopping is social; demonstrates ability to buy to peers Impulsive consumers Marketing should emphasize value by peers and upward mobility

Achievers

Motivated by desire for achievement Deep commitment to career and family Lead conventional lives and tend to be politically conservative Value consensus, predictability, and stability Active in the consumer marketplace Interested in established, prestige brands and devices that save them time Products for achievers: good for family, church; predictable, stable, and respected

Thinkers

Motivated by ideals Mature, satisfied, comfortable Value order, knowledge, responsibility Well educated, actively seek information Similar to high need for cognition Well informed about the world Marketing Canadian Club to thinkers would result in a different ad Might discuss quality of the taste, or liken product use to being cultured Moderate respect for status quo Have income to use but are conservative when making choices

Experiencers

Motivated by self-expression Young, enthusiastic, impulsive Seek variety and excitement Like to experience behaviors Avid consumers; spend a high proportion of their money on fashion, entertainment, socializing Apple often targets experiencers

What Leads to Behavior Change?

Motivation: Do people want to act? Opportunity: Can they act? Ability: Do they know how to act?

Need for Cognition

Not the same as intelligence level These are people who need to think everything through, do research, get advice, etc. *****TIME TO TRANSFORM. THIS IS YOU BECAUSE OF YOUR LOW CONFIDENCE. DON'T LET PEOPLE CLASSIFY YOU AS DUMB BC YOU ARE CAUTIOUS. TAKE RISKS AND IF YOU FALL, YOU KNOW WHERE NOT TO MAKE THE NEXT STEP. NO ONE CONTROLS YOU. NO ONE DICTATES YOUR DRIVE. YOU MAKE YOUR OWN PATH. IT'S YOUR STORY. AND IT'D BE A SHAME IF YOU LET ANYONE ELSE LIVE IT EXCEPT YOU.

Social Media

Now anyone can be an advocate. The meaning of journalism and source of agenda setting has changed. Major bloggers set the news agenda. We will focus on these trends.

Price

Often psychological or lifestyle related Bad behaviors can feel good. Have to change the cost/benefit equation for unhealthy behaviors and make the healthy alternative more appealing

Personality

Optimal stimulation level (OSL): Individuals' preferences for emotional arousal. When the actual level of stimulation is below/above optimum, an individual will attempt to increase/reduce stimulation respectively. Sensation seeking: Also called excitement seeking, is the tendency to pursue sensory pleasure and excitement. It's the trait of people who go after novelty, complexity, and intense sensations, who love experience for its own sake, and who may take risks in the pursuit of such experience. Sensation seekers are "easily bored without high levels of stimulation." Dogmatism: Arrogant, stubborn assertion of opinion or belief. Dogmatic assertion in matters of opinion. Need for uniqueness: Counterconformity motivations. Seeking to establish and maintain a sense of self-distinctiveness. Fatalism: Fatalists stress the subjugation of all events or actions to fate. This is the view that we are powerless to do anything other than what we actually do. Included in this is that man has no power to influence the future, or indeed, his own actions. Need for cognition (NFC): Is a personality variable reflecting the extent to which individuals are inclined toward effortful cognitive activities. It has been defined as "a need to understand and make reasonable the experiential world." Higher NFC is associated with increased appreciation of debate, idea evaluation, and problem solving. Religiosity: In its broadest sense, is a comprehensive sociological term used to refer to the numerous aspects of religious activity, dedication, and belief (religious doctrine). Another term that would work equally well, though less often used, is religiousness. Self-monitoring: Motivation to monitor your self-presentation in public. People who are strongly inclined to adjust their public presentation are called "high self-monitors."

Peeling the Onion

Outer layer: race, ethnicity, age, biological sex (demographics). Can be seen, but don't necessarily make us unique. Judgments based on a person's "outer layer" are generally stereotypes. When designing campaigns for communities, we must "peel away" the outer layer. Determine what motivates the target audience. To find out, we need to do research, get to the "core." To find out, we need to do research, get to the "core." The better you know your audience, the better you can design your campaign.

Price

People typically think about price in economic terms only. The exchange, or the price paid, is worth it for that product. We will discuss price and what it means in social marketing terms.

A Solution to the Problem

Product must have benefits, be unique, and be competitive in the marketplace. Define in terms of the target audience's beliefs, practices, and values.

Uniqueness of Social Marketing

Product: What are you offering the audience to satisfy its needs? Price: What must the audience give up to receive those benefits? Place: Have you identified places that maximize reach and receptivity? Promotion: What is the promotional strategy? (Policy)

Four Ps of Marketing

Product: What are you selling? Price: Can be valued monetarily or by difficulty Place: Where are you distributing the product? Promotion The Ps are the things you have some control over to increase an exchange of value with your customer.

Promotion

Promotion is what people think most about in marketing. Social marketing development is unique because it includes various elements. Not simply public-service announcements (PSAs). Social marketers think about how to promote a message. In colleges, liquor companies promote their product by handing out items like t-shirts, bags, and cups at bars.

Public Health vs. Clinical Health

Public Health: Clinical Health: Focuses on populations Focuses on individuals Monitor and diagnose health concerns of entire communities Diagnose and treat individual patients for disease or injury Concerned with health promotion and primary prevention Traditionally concerned with secondary and tertiary prevention

Framing to Get Access to the Media

Shape the story to get the journalist's attention. "Pitch" the story so the journalist is interested. Get the journalist more interested in the frame you are trying to promote. Staging events. The advocate can make the journalists more interested in covering their story. "Move the agenda." Use celebrities. Give the story a human interest angle to make it real. Give it a visual element that makes it interesting for television.

Data-Based Decision Making

Social marketers employ thoughtful, logical models for planning programs. They understand all factors that need addressing to get people to change behavior. They conduct systematic research to answer those questions.

What Are We Selling?

Social marketers sell behaviors, services, and products to a target audience in exchange for a price and benefit. Our product must compete successfully against the benefits of the target audience's current behavior.

Behavior Change

Social marketers want behavior change just like commercial marketers. Communicate to people that recommended behaviors make them better off. It makes society better off too.

Values and Value Systems

Specific values are abstract, enduring beliefs about what is right and wrong. Example: Fred, a middle-aged American male Values freedom Believes corporal punishment is inappropriate Believes in recycling, climate change Gathering this information, we start to get a better idea of who Fred is. We design campaigns for thousands of "Freds."

The Psychology of People

Specifically, the psychology that's relevant to the health behavior at hand Example: designing an exercise campaign for sedentary people Need to understand why they're sedentary in the first place

Innovators

Successful, sophisticated, take charge, high self-esteem Abundant resources Leaders, receptive to new ideas Active consumers Cultivated tastes Image is important, not for status but as an expression of high-end taste An ad tailored to them will not address power but rather taste and refinement

Marketing Example: X-Pack Smoking Cessation Kit

Target market: young adult smokers who are interested in quitting The offer Product: Smoking Cessation Kit (and e-mail counseling) Price: about the cost of a pack of cigarettes Place: web, quit lines, retail outlets Promotion: ads, point-of-purchase signage Effectiveness Nearly 15,000 packs distributed

Marketing Example: Preventing DUI in Rural Counties

Target market: young rural working men The offer: Product: a ride to the pub, between pubs, and home from the pub so that you can maximize your fun They also thought about price, place, and promotion Effectiveness: 17% reduction in DUI crashes after one year Nearly 20,000 rides given 70% brand awareness in community 80% support for the brand by community members

Survivors

Target of public health campaigns because they are most at-risk audience Value safety and security Focused on meeting needs Cautious consumers; they buy what they can afford Commercial marketers aren't generally trying to reach them, but public health practitioners are Loyal to brands, particularly if available at discount To communicate with them, emphasize that these are behaviors needed to survive with safety and security

Framing for Content

Tell the story from an advocacy perspective. Address the root causes. Deal with issues of social accountability. Who is to blame? Human interest angle Who is being harmed or helped?

Western Values

Tend toward materialism; value having things Owning a home is referred to as "the American dream" Work and play Individualism Family and children Health Authenticity The environment Technology

Introduction to Social Marketing

Term "social marketing" originated in 1970s, but only recently engaged lay public Does not refer to marketing via social media Uses marketing practices, theories, and strategies to influence behavior and achieve a social goal Researcher from 1970s once said, "Why can't we use the strategies used to sell soap to sell brotherhood?" Need to use same strategies that marketers use to sell products like Coca-Cola to sell prostate exams, HIV prevention, nutrition, and exercise

Terminal vs. Instrumental Values

Terminal Values Instrumental Values Prosperous life Ambitious Exciting life Broadminded Sense of accomplishment Capable A world at peace Cheerful Salvation Clean Self-respect Helpful Pleasure Honest Wisdom Obedient True friendship Loving Equality Responsible

Place

The location or distribution channel for getting messages or material out to target audiences

Acculturation

The process of adopting and internalizing at least some of the values of society and/or a smaller subculture.

Psychographics

The psychological and behavioral characteristics that describe message receivers Values and behaviors lead to lifestyle choices. An amalgamation of qualities that describe people

Media Advocacy

The strategic use of the media to raise the profile of an issue among the public and bring pressure to bear on policy makers How an issue gets framed An issue can be framed in different ways. The goal is legislative or policy development or change to enable a specific public health outcome. Example: ASSIST Used media advocacy to change media coverage Got the media to cover tobacco control as a public health issue

Social Ecology

The study of people in an environment and the influences on one another. Social ecological model (SEM) in public health (McLeroy et al., 1988; Stokols, 1996) posits that social and physical environment affects individuals. Effects are nested. The individual is at the core, surrounded by layers of more proximal and distal effects in the environment. It is within this context that health campaigns are another level of influence. All these factors must be considered to design an effective campaign.

Uncertainty Avoidance

The uncertainty avoidance dimension expresses the degree to which the members of a society feel uncomfortable with uncertainty and ambiguity. The fundamental issue here is how a society deals with the fact that the future can never be known: Should we try to control the future or just let it happen? Countries exhibiting strong UAI: Maintain rigid codes of belief and behavior Are intolerant of unorthodox behavior and ideas Weak UAI societies: Maintain a more relaxed attitude Practice counts more than principles

IOM Vision for a Health Literate Society

There are opportunities for adults to improve their health literacy. Information is reliable. Health content is part of K-12 curricula. Public health alerts are presented in everyday terms. Health practitioners communicate clearly with their patients, using everyday vocabulary. Rights and responsibilities are presented in clear terms.

Power Distance

This dimension expresses the degree to which the less powerful members of a society accept and expect that power is distributed unequally. The fundamental issue here is how a society handles inequalities among people. People in societies exhibiting high-power distance accept a hierarchical order in which everybody has a place and which needs no further justification. In societies with low-power distance, people strive to equalize the distribution of power and demand justification for inequalities of power

Important Marketing Concepts

Ultimate objective is to influence action. Intermediary objectives are: Create awareness of problem Increase comprehension of problem Change people's perception of problem Action happens when benefits are greater than costs. Programs are most effective when based on understanding of target audience's perception of proposed exchange. Target audiences are seldom uniform in perceptions. Must segment audience into units to speak to small collections of communities. These units have different values, personalities, beliefs and perceptions of exchange. Recommended behaviors always have competition that must be understood and addressed. Proposed action must be attractive enough to beat the alternative.

All About the Audience

Understanding the audience psychologically Understanding the audience's values Understanding what moves the audience All about behavioral influence

Values

Value system: Integrated set of specific values, some of which may conflict Specific values: Abstract, enduring beliefs about what is right or wrong Global values: Most enduring and abstract values Terminal values: Highly desired end states Instrumental values: Means to an end

Competition

What forces keep people from engaging in behaviors we want for them? Embarrassment, lack of knowledge, stress, they don't think it's important. Campaign to stop texting while driving: competition may seem clear. To beat the "now" mentality, you might show them what they could lose. Always position product relative to competition.

Sensation Seekers

What is the target audience's optimal sensation level? Younger adolescents tend to be higher-sensation seekers. More likely to try risky behaviors. High-sensation seekers pay attention to gritty, upsetting images.

Campaign Example: Where Do You Stand?

What type of personality would be motivated by this campaign? Someone who values others, peace, respect, and civility Someone who values women This campaign says "Be true to your values."

What You Can Control as an Advocate

What you say What materials you provide What sources you refer journalists, the public, and legislators to What facts you focus on What stories you tell

What Is Place?

Where are tangible products received or purchased? Where are services provided? What do you communicate if the audience is poor and without health insurance? Regarding media aspects, where will you deliver your message? What frame of mind will the audience be in when it receives the message? Example: Awareness campaigns regarding binge drinking and safe sex for college students Where do people act? When will people be in the right frame of mind to receive your message and take action?

What Is Social Marketing?

description.' "Social marketing is a program planning process that promotes the voluntary behavior of the target audience by offering benefits they want, reducing barriers they are concerned about, and using persuasion to motivate their participation in program activity." (Kotler and Roberto, 1989) "[Social marketing is] the application of proven concepts and techniques drawn from the commercial sector to promote changes in diverse socially important behaviors." (Andreasen, 1995) Social marketing uses marketing principles and practices to benefit the consumer and society rather than the marketer. (Evans, 2006)

What Is Media Advocacy?

description.' Strategic use of the media to raise the profile of an issue among the public and bring pressure to bear on policy makers. Goal of media advocacy is to "reframe" the way the public thinks about an issue (e.g., tobacco could be framed as a public health or as an economic issue). "The strategic use of news media and, when appropriate, paid advertising, to support community organizing to advance a public policy initiative." ( L. Wallack, 1993)