James H. Lindenberger

Adolescent Asthma Self-Management: Patient and Parent-Caregiver Perspectives on Using Social Media to Improve Care.

BACKGROUND Self-management of asthma can now leverage new media technologies. To optimize implementation they must employ a consumer-oriented developmental approach. This study explored benefits of and barriers to improved asthma self-management and identified key elements for the development of a digital media tool to enhance asthma control. METHODS Between August 2010 and January 2011, 18 teens with asthma and 18 parent-caregivers participated in semistructured in-depth interviews to identify mechanisms for improving asthma self-management and propose characteristics for developing a digital media tool to aid such efforts. RESULTS Teens and caregivers enumerated physician-recommended strategies for asthma management as well as currently employed strategies. Both groups thought of a potential digital media solution as positive, but indicated specific design requirements for such a solution to have utility. Whereas most participants perceived mobile platforms to be viable modes to improve asthma self-management, interest in having social networking capabilities was mixed. CONCLUSIONS A digital media product capable of tracking conditions, triggers, and related asthma activities can be a core element of improved asthma control for youth. Improved asthma control will help decrease school absenteeism.

Community-Based Prevention Marketing for Policy Development A New Planning Framework for Coalitions

Community-based prevention marketing (CBPM) is a community-driven framework for program planning, which applies social marketing concepts and techniques to the development of health behavior interventions. Whereas community members who comprise an action committee or coalition set the goals and make programmatic decisions, social marketing provides the planning framework to guide program design, implementation, and evaluation. CBPM has guided successful initiatives to promote physical activity in both youth and adults, to increase safety eyewear use in agricultural settings, and to delay alcohol and tobacco initiation among youth. However, the emergence of evidence-based policy has fostered renewed interest in “upstream” approaches to health behavior change that, in the United States, have included community partnerships as an important tool for policy development. Unfortunately, these community partnerships have had variable success because of the lack of a systematic framework for identifying, selecting, tailoring, and promoting evidence-based policies. We describe the adaptation and application of CBPM to improve community capacity for identifying and promoting evidence-based policies. The resulting framework, CBPM for Policy Development, is comprised of the following eight steps: (1) build a strong foundation for success; (2) review evidence-based policy options; (3) select a policy to promote; (4) identify priority audiences among beneficiaries, stakeholders, and policy makers; (5) conduct formative research with priority audiences; (6) develop a marketing plan for promoting the policy; (7) develop a plan for monitoring implementation and evaluating impact; and (8) advocate for policy change. We provide a description of each step and an examination of the experiences and lessons learned in applying it to youth obesity prevention.

Applying Systems Science to Evaluate a Community-Based Social Marketing Innovation A Case Study

In the United States, community coalitions are an important part of the public health milieu, and thus, subject to many of the same external pressures as other organizations—including changes in required strategic orientation. Many funding agencies have shifted their funding agenda from program development to policy change. Thus, the Florida Prevention Research Center created the Community-Based Prevention Marketing (CBPM) for Policy Development framework to teach community coalitions how to apply social marketing to policy change. The research reported here was designed to explicate the framework’s theory of change. We describe and demonstrate a hybrid evaluation approach: utilization-focused developmental evaluation. The research question was “What are the linkages and connections among CBPM inputs, activities, immediate outcomes, intermediate outcomes, and ultimate impacts?” We implemented a case study design, with the case being a normative community coalition. The study adhered to a well-developed series of steps for system dynamics modeling. Community coalition leaders may expect CBPM to provide immediate gains in coalition performance. Results from causal diagramming show how gains in performance are delayed and follow an initial decline in performance. We discuss the practical implications for CBPM’s developers—for example, importance of managing coalition expectations—and other social marketers—for example, expansion of the evaluation toolkit.

Coming of Age

The opinions expressed herein are those of the authors and the Development Training Institute, Inc. and not necessarily those of The Urban Institute, its trustees, or sponsors.

Physicians’ perceptions of mobile technology for enhancing asthma care for youth:

This study assessed physicians’ receptivity to using mobile technology as a strategy in patient care for adolescents with asthma. Understanding physicians’ perceived barriers and benefits of integrating mobile technology in adolescents’ asthma care and self-management is an initial step in enhancing overall patient and disease outcomes. We conducted in-depth interviews with second- and third-year pediatric residents and attending physicians who oversee pediatric residents in training (N = 27) at an academic medical center in the southeastern United States. We identified both benefits from and barriers to broader use of mobile technologies for improving asthma outcomes in adolescents. Resident physicians demonstrated greater readiness for integrating these technologies than did attending physicians. Prior to adoption of mobile technologies in the care of adolescent asthma patients, barriers to implementation should be understood. Prior to widespread adoption, such systems will need to be evaluated against traditional care for demonstration of patient outcomes that improve on the current situation.

Breast Cancer Screening: A Social Marketing Study

Breast cancer is one of the leading types of preventable cancer among women in the United States. Despite improvements in mammography and early detection techniques for breast cancer, special population groups within the United States continue to experience high incidence and mortality rates. This paper focuses on Kentuckys underserved populations. The research objectives were to: 1) identify the factors that motivate women at risk to be screened for breast cancer; and, 2) identify the factors that deter women at risk from being screened for breast cancer. A combination of quantitative (survey n=407) and qualitative (focus groups=19; in-depth interviews=58) research methods were used to examine factors that influence mammography use. Factors that motivate women to have mammograms include: physician referral; the belief that early detection will improve breast cancer outcomes; and, the belief that a mammogram is an effective test. Factors deterring women from having mammograms include: lack of physician referral; cost; and, the belief that mammography is dangerous. Research findings point to the need for a comprehensive, integrated approach to increasing utilization rates. This approach includes recommendations for increasing physician referrals, modifying service delivery, training staff, and development of client education materials and a public information campaign. These recommendations have been incorporated into a social marketing plan to increase utilization of mammography services in the state of Kentucky.

Social Marketing and Policy Making: Tools for Community-Based Policy Advocacy

The Florida Prevention Research Center (FPRC) at the University of South Florida has been funded by the U.S. Centers for Disease Control and Prevention (CDC) since 1998. In that time, its staff of researchers and practitioners have codeveloped with its community partners a wealth of tools for using social marketing to address local problems. Similar to the field of social marketing, the FPRC is evolving from exclusively developing ‘‘downstream’’ innovations to working farther ‘‘upstream,’’ which means we are frequently developing and testing new types of tools for those purposes. In this ‘‘Tools from the Field’’ paper, we share some tools and lessons learned for carrying out social marketing with community coalitions as well as preview forthcoming tools emanating from our latest CDC-funded research.

Leximancer Software as a Research Tool for Social Marketers: Application to a Content Analysis

The amount of human effort required to do content analysis research “by hand” is often time-consuming, and unreliability is a common concern. Our aim was to conduct a content analysis that traces the history of Social Marketing Quarterly (SMQ) articles by using Leximancer (version 4.5)—a software tool designed for analyzing natural-language text data. We adhered to Krippendorff’s network of steps to address two research questions: (1) “What are the prevailing conceptualizations of the application of social marketing?” and (2) “How have those conceptualizations changed over time?” We identified all SMQ volumes/issues published between May 1994 (inaugural issue) and September 2015. Our sampling units consisted of all SMQ “Application” articles published during that time (n = 162). Leximancer output includes a conceptual map representing the main concepts within the text and how they are related (themes). Based on conceptual and relational analyses, one would surmise that social marketing applications (e.g., campaigns) predominantly address health-related problems through behavioral influence strategies, informed by audience research and designed to include the elements of the marketing mix (e.g., messaging). The predominant health topic addressed by social marketing applications has been tobacco use and smoking. Leximancer has a number of desirable features including an ability to quickly handle large amounts of text in various formats and languages. However, those features are no substitute for a content analysis design that makes the research reproducible and available for critical examination—a shortcoming of previous content analyses of the social marketing field.