Social Marketing in Health Promotion - Literature review Example

Strategy Paper: Social Marketing in Health Promotion Social Marketing Defined Social marketing according to Healey & Zimmerman (2009) is the use of marketing techniques to achieve behavioural goals. In health promotion, marketing campaign is developed to solve health problems through marketing better attitudes and healthier lifestyle. Social marketing therefore is the application of marketing tools and techniques to get people change their health behaviours (p.75). Specifically, social marketing is about influencing a target population to voluntarily accept, reject, modify, or abandon a certain negative behaviour through communication and educational strategies (Green & Tones, 2010). In the United Kingdom, social marketing is a tool for social good making unhealthy behaviour less attractive while encouraging behaviour that builds health (ibid, 379). Pioneers of social marketing Kotler, Levy, and Zaltman defined it as a program designed and implemented to influence the acceptability of social ideas that include product planning, pricing, communication, distribution, and marketing research (Cheng et al, 2011). In 2007, the American Marketing Association or AMA define it as a marketing approach offering improvement in the welfare of individual and society where consumers are receptors and co-creator of values (Matei & Dinu, 2010). Social marketing is defined in different ways but there are three key aspects common in its definitions- adaptation of the technologies from commercial marketing, voluntary change in behaviour, and the improvement of social welfare (Goldberg et al, 1997). Similarly, social marketing has different elements and according to Kattapong (2007), social marketing definition developed by Lefebrvre & Flora (1988), Ling et al, 1992, Walsh et al. (1993), and Elliot (1995) contains different elements of social marketing campaigns while the Social Marketing Institute established six. These include behaviour change as benchmark, consistent use of audience research to better understand the target population, segmentation of target audiences to ensure efficiency in the use of scarce resources, creative, attractive, and motivating strategies, use traditional marketing mix – product, price, place, and promotion, and vigilance to competition faced by the desired behaviour (p.9). Although different emphasis were given to the different aspects of social marketing, it is still possible to identify their common ground that include social good, behaviour, harnessing power of marketing, and target audience defined value (French et al, 2010). It is important to not the aspects of social marketing often highlight two important social goals – influencing voluntary behaviour and understanding of specific target audience. For instance, social marketing in HIV/AIDS programs commonly use three main approaches to disease prevention – understanding mindsets, behaviour, and the disease. This is because mindset influences behaviour while knowledge of the disease enables easy identification of solutions (Kacou, 2010). Some critics of social marketing argues that its definition largely ignores the social, economic, and environmental factors that influence people’s health behaviours but according to Donovan & Henley (2010) it is not an inherent characteristics. This is because one fundamental aspects of marketing is awareness of the total environment in which the organization operates (p.9). Similarly, social marketing is more than just mass communication as it includes influences coming from economics, legal measures, and policy. It is adaptable and can be fully into interventions with full range of social marketing aspects including those that are associated with campaign design, target group identification, constraints, and factors influencing behaviour. For instance, the “Truth Campaign” launched in 2000 in the United States is aimed to build awareness and influence the public about tobacco industry’s intention to target young people through teen-orientated brands of cigarettes (Corcoran, 2007). The “Saskatchewan in Motion” or SIM campaign in Canada was developed in 2002 to increase physical activity by 10% by 2005. A province wide movement, SIM is not only increasing physical activity but to generate health, social, environmental, economic benefits, and embed understanding and behaviour changes into the culture of Saskatchewan communities (Cheng et al, 2011). In general, social marketing may be taken as a program oriented to health promotion with a set of principles and techniques that were derived from marketing theories and other disciplines. It is an approach to change people’s attitudes and behaviours through introduction and dissemination of new ideas and issues, and increased prevalence of positive health behaviours. It is consumer oriented and an approach to health promotion that creates win-win situations for all parties. It is not social control or simple mass media campaign but a method of empowering people and a problem-solving process that could suggest innovative ways of dealing with health and social problems (Bunton & MacDonald, 2002). Theoretical Context and Origins Social marketing for public health started way back in 1969 when Kotler and Levy article “Broadening the Concept of Marketing” was released. It was when marketing was considered beyond selling of consumer products and in 1971, social marketing was formally introduced as a controlled program intended to influence social ideas (Cheng et al, 2011). Social Marketing theory is generally an application marketing concepts and tools in order to increase acceptance of social ideas or practices thus often involve consumer orientation, target audience analysis and segmentation, and some aspects of exchange theory (Nnakwe, 2009). Like commercial marketing, social marketing is based on exchange theory, the basic theory in social marketing that involves there types of exchange – restricted, generalized, and complex (Takahashi, 2007). Restricted exchange holds that relationship between parties are the result of voluntary and mutually negotiated exchange of resources, benefits, or rewards that may come in the form of assistance, wealth, power, prestige, status, influence, information, access, sense of well-being, and so on. The relationship is governed by the rules of reciprocity or behavioural norms that require mutual exchange of benefits. The strength and duration of the relationship depends on the actions of both parties based on established expectations and moral norms. General exchange on the other hand include social network in order to incorporate different factors influencing behavioural change. The relationship in this type of exchange is reciprocal developed in three or more parties. Generalized exchange do not require any party to yield direct benefits as in restricted exchange but benefits that can be provided and received indirectly by parties involved. For instance, in general exchange relationship between parties A, B, and C, A may provide B with a direct benefit but this does not necessarily mean B should in return benefit A or A receiving compulsory direct benefit from B. Instead, such benefit can be pass on by B other party like C and C will be the one to benefit A. Complex exchange is a more multifaceted exchange between parties who establish a system of mutual relationships. For instance, parties in complex-exchange such as A, B, and C, may derive direct benefit from another even A and C are not involved in a direct relationship. This is because involvement with B entitle A and C to indirect benefit. In general, individual and organizations in social exchange theory are obligated to form social relationship using any of the three exchanges in order to satisfy human and societal needs (Braithwaite et al, 2009). There is no single theory in social marketing and as evidenced by different health interventions using social marketing approaches, a number of theoretical approaches are used. In the United States for instance, the Maryland WIC Food for Life Program, a peer-led educational and media intervention to increase fruit, vegetable, and fibre consumption use both Stages of Change and Social Learning Theory. PACE or Physical Activity and Nutrition Among Adolescent , an interactive computer program and practitioner-based intervention encouraging health nutrition and physical activity behaviours use both the above plus Relapse Prevention Model. Similarly, the San Diego Family Health Project incorporates Self-Management into Social Learning Theory to encourage healthy eating habits among those that are at risk of cardiovascular disease (Hastings, 2007). Social Learning Theory holds that learning occurs through reinforcement or the process where punishment act as deterrent. For instance, behaviours that are rewarded tend to be repeated while castigated behaviours are not repeated. In this theory, social reinforcement such as peer pressure, social norms, and so on play a vital role in influencing learned behaviours. For instance, new behaviours can be learned by observing reinforcements delivered to others such avoiding excessive speed while driving because such behaviour is punishable by law. Similarly, perceived self-efficacy derived from social norms reflects ability and self-confidence in pursuing acceptable social behaviour or avoiding the threat of social reinforcement (Donovan & Henley, 2010). Related to the above theory is the Theory of Reasoned Action being applied to health and environmental behaviours. In 1975, Fisbein and Ajzen suggested that volition or cognitive process by which an individual decides and commit to a certain course of action often occur when there is an intention to perform the behaviour as influenced by attitude and subjective norms concerning that behaviour. Since attitude is a function of beliefs and perceived outcome while subjective norms are a function of how others view the behaviour then a person in many occasions might not engage in that behaviour because the perceived outcome is not beneficial or people close to him are not comfortable with such behaviour. For instance, a person might have positive attitude to smoking but decided not to engage in that behaviour because his family and friends are not smoking because it is not good for their health (Donovan & Henley, 2010). Stages of Change There are a number of phases in the process of individual behavioural change and in the Stages of Change Model; these phases include pre-contemplation, contemplation, preparation, action, and maintenance. The pre-contemplation step is where an individual is not yet ready to change his or her behaviour thus requiring more effort from the social marketer. In the second phase, the individual is actively contemplating or thinking about the benefits and barriers to behavioural change thus some efforts focusing on short and immediate term gains may be helpful. In the preparation phase, the individual is already developing a plan of action, receptive and considering several strategies. The action phase is where change in behaviour actually occurs and therefore more outside support is needed to ensure maintenance and avoid setbacks. The fifth and final phase is maintaining the new behaviour that will eventually become a permanent part of individual lifestyle (Riegelman, 2009, p.61). Some interventions used Stages of Change approach is the Maryland WIC 5-a-day Promotion Program, which is a peer-led educational and media intervention to increase fruit and vegetable consumption. Another intervention with similar approach but in combination with Social Cognitive Theory and Relapse Prevention Model is PACE or Physical Activity and Nutrition Among Adolescents which is an interactive computer program and practitioner-based intervention to encourage healthy nutrition and physical activity behaviours (Hastings, 2007). In 1990 and 1991, Australia’s National Heart Foundation initiated two related mass media campaigns- “Exercise: Make it Part of Your Day” and Exercise: Take Another Step”. These campaigns are based on social cognitive theory and transtheoretical or Stages of Change model. Since the target population of these campaigns were inactive people, the expectation is for them to remain active after completing the first four stages (MacKinnon, 2003). Social Marketing in Practice Western Australia’s multi-strategy statewide youth smoking intervention was established in 1995 with a pilot social marketing intervention about youth smoking – “Smarter than Smoking campaign”. The main objective is to reduce the social acceptability of smoking and prevent the short-term and immediate negative effects of smoking. The main component of this social marketing intervention include mass media communications, school-based education programs, cessation support for smokers, and sending Smarter than Smoking messages through sports and arts events involving young people, publications, and the Internet. The campaign was funded for AUD $4.2 million from 1996 to 2005 and had raised awareness and created strong brand image. Similarly, to educate and change attitudes of indigenous Australians on the danger of sexually transmitted disease and reduce unplanned teenage pregnancies in the community, the “Snake Condom” campaign was promoted through social marketing approaches such as print, poster, television, and radio advertising (Thornley & Marsh, 2010). Findings of a systematic review of social marketing effectiveness in influencing individual behaviour particularly those that are involved in alcohol, tobacco, illicit drugs, and sedentary lifestyle reveals that social marketing can form an effective framework for behaviour change. For instance, Project Trust used media advocacy in their anti underage tobacco access campaign while the Quit for Life Programme in NSW Australia is a two-year mass media-based programme for smoking cessation. Overall, the result of the systematic review suggest that social marketing is a promising intervention approach in terms of physical activity, alcohol, tobacco, and drug use. More importantly, it can effective across range of behaviours, target groups, and settings (Ross et al, 2006). Applications of social marketing in health promotion began in the late 1980s. These include the “Quit” and “SunSmart” developed by the Victoria Cancer Council in 1988 against skin cancer. To reduce the social and human impact of workplace incidents, the Occupational Health and Safety organization in Australia used social marketing as driver for behavioural change. In 2006, a popular campaign using social marketing was adopted by New South Wales, Queensland and Western Australia. “WorkSafe Homecomings” was aimed to reduce the levels of fatality and injury rates across the state. Social marketing approaches and practice has been used in several countries like the US, Canada, Australia, New Zealand, United Kingdom, India, and so on. For instance, Health Challenge England used social marketing to improve health of the population while anti-rape posted and media supported rape prevention messages was a successful social marketing campaign in the United States (Universidad Jose Vasconcelos, 2012). In the study conducted by the Centre for Advance Studies in Nutrition and Social Marketing (2000) about current practices in health promotion and social marketing, those interventions pursuing reduction of dietary fat intake, obesity, increase physical activity, healthy eating and promotion of fruits and vegetable consumption are using one or combination of social-behavioural theories. Most common according to this study are theories and models in social learning, community organization, and socio-ecological model. Behaviour change efforts were focus on individual behaviours rather than family practices or community norms. However, the success of most interventions is often limited particularly in the area of social marketing since although it is commonly mentioned in the framework of most interventions; it is seldom applied in actual campaigns (p.10). Conclusion Social marketing is an effective tool in health promotion thus a number of interventions used such approach in raising awareness and encouraging positive behavioural change. In Australia and other countries, social marketing greatly contribute to the success of large public health campaigns particularly those aimed at altering individual behaviour and promoting healthy lifestyle. Systematic review of social marketing strategies suggests it is a promising intervention approach and an effective tool in influencing individual behaviour. However, this does not necessarily mean that all health interventions used social marketing approaches as one study of social marketing suggest. Social marketing is a valuable tool in influencing behaviour thus it should be in the centre of health promotion campaigns particularly in interventions aimed at improving nutrition and physical activity. 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