W. Douglas Evans

How social marketing works in health care

Social marketing applies commercial marketing strategies to promote public health. Social marketing is effective on a population level, and healthcare providers can contribute to its effectiveness. In the preface to Marketing Social Change , Andreasen defines social marketing as “the application of proven concepts and techniques drawn from the commercial sector to promote changes in diverse socially important behaviors such as drug use, smoking, sexual behavior… This marketing approach has an immense potential to affect major social problems if we can only learn how to harness its power.”1 By “proven techniques” Andreasen meant methods drawn from behavioural theory, persuasion psychology, and marketing science with regard to health behaviour, human reactions to messages and message delivery, and the “marketing mix” or “four Ps” of marketing (place, price, product, and promotion).2 These methods include using behavioural theory to influence behaviour that affects health; assessing factors that underlie the receptivity of audiences to messages, such as the credibility and likeability of the argument; and strategic marketing of messages that aim to change the behaviour of target audiences using the four Ps.3 Social marketing is widely used to influence health behaviour. Social marketers use a wide range of health communication strategies based on mass media; they also use mediated (for example, through a healthcare provider), interpersonal, and other modes of communication; and marketing methods such as message placement (for example, in clinics), promotion, dissemination, and community level outreach. Social marketing encompasses all of these strategies. Fig 1 Social marketing wheel Communication channels for health information have changed greatly in recent years. One-way dissemination of information has given way to a multimodal transactional model of communication. Social marketers face challenges such as increased numbers and types of health issues competing for the publics attention; limitations on peoples time; and increased numbers and types of …

Evaluating the truth® Brand

ABSTRACT The American Legacy Foundation developed the truth® campaign, an aspirational antismoking brand for adolescents. This study tested whether a multidimensional scale, brand equity in truth®, mediates the relationship between campaign exposure and youth smoking. We collected brand equity responses from 2,306 youth on a nationally representative telephone survey. Factor analysis indicates that the scale has excellent psychometric properties and effectively measures brand equity. We developed a structural equation model to test the mediation hypothesis. Results show that brand equity mediates the relationship between truth® and smoking. Analyses of potential confounders show this relationship is robust. Behavioral branding (brands about a behavior or a lifestyle) is an important public health strategy.

Conceptualizing Youth Empowerment within Tobacco Control

This article presents a conceptual framework that was developed to guide a national evaluation of the American Legacy Foundation’s (Legacy) Statewide Youth Movement Against Tobacco Use (SYMATU) program. This program was designed to develop youth-led, youth-directed initiatives within local communities. Two evaluation studies were designed and implemented from 2000 through 2003: a cross-site study that collected standard data elements across all 17 programs and a case study of five programs that collected formative data on variables thought to affect program implementation. In developing the youth empowerment (YE) conceptual framework, the authors started by reviewing literature to identify the concepts necessary for these types of initiatives and present a summary of their findings here. This article focuses on the development of the authors’overarching conceptual framework used to guide their evaluation studies. Other articles contained within this special issue present results from each of the SYMATU evaluation studies.

Mobile health evaluation methods: The Text4baby case study.

Mobile phones have been shown effective in several public health domains. However, there are few evaluations of the effectiveness of mobile health in health promotion. Also, although many studies have referenced behavioral theory, none appears to have explicitly tested theoretical assumptions or demonstrated mechanisms of change. More robust evaluation models that incorporate theory and measurement of behavioral mediators are needed. As in all public health programs, mobile health operates within a social ecological context. For example, organizational- and individual-level programs seek to influence health and health care practices and individual health behaviors. New programs such as Text4baby demonstrate how theory and explicit testing of mediators can be incorporated in evaluations. There are challenges and opportunities facing mHealth evaluations given the nature of the mobile channel. Mobile communication is ubiquitous, available at all times and places, and thus experimental control is often difficult. Natural experiments using variation in dosage of mHealth and place- or location-based designs may increase experimental control. Text4baby is a text messaging program that provides prenatal care messages to pregnant women and new mothers. It uses a partnership model with health care facilities often serving as local implementation partners. The authors review a case example of the evaluation of Text4baby at Madigan Army Medical Center. Participants were randomized to usual prenatal care plus text messaging or usual care alone. The evaluation has a theoretical model of behavior change and measures mediators as well as behavioral outcomes. Results will inform how behavioral theory works within mobile health programs.

Modeling Psychological Empowerment Among Youth Involved in Local Tobacco Control Efforts

The American Legacy Foundation funded 13 state health departments for their Statewide Youth Movement Against Tobacco Use in September 2000. Its goal was to create statewide tobacco control initiatives implemented with youth leadership. The underlying theory behind these initiatives was that tobacco control efforts can best be accomplished by empowering youth. To evaluate these initiatives, the authors developed a conceptual framework for youth empowerment that was used as a guide in developing standardized cross-site measures. This article describes the domains and attributes used to operationalize psychological empowerment as an outcome of youth involvement in these initiatives and presents results of our two-stage structural equation modeling. We conclude with a summary of lessons learned to date and recommendations for applying these findings to work in the field.

Perceptions of the food shopping environment are associated with greater consumption of fruits and vegetables.

OBJECTIVE The present study examined whether characteristics such as quality, selection and convenience are associated with dietary intake of fruits and vegetables independent of perceived costs in an inner-city, low-income population. DESIGN Secondary analysis of baseline data from a social marketing intervention designed to change household dietary practices among parents of 3- to 7-year-old children. SETTING A community sample drawn from six low-income, primarily minority neighbourhoods in Chicago, IL, USA. SUBJECTS From the parent study, 526 respondents completed the baseline survey and were eligible for inclusion. Of this number, 495 provided complete data on sociodemographic characteristics, fruit and vegetable consumption, perceptions of the shopping environment, perceived costs of fruits and vegetables, and food shopping habits. RESULTS Logistic regression analysis showed that more positive perceptions of the food shopping environment were associated with greater consumption of fruits and vegetables. There was an increase of approximately twofold in the likelihood of consuming three or more fruits and vegetables daily per level of satisfaction ascribed to the shopping environment. This association was independent of perceived cost, store type and sociodemographic characteristics. CONCLUSIONS Our data show that among a generally minority and low-income population, quality, selection and convenience are important determinants of fruit and vegetable consumption. Nutrition promotion campaigns that aim to alter the built environment by increasing access to fruits and vegetables should recognize that simply increasing availability may not yield beneficial change when characteristics of the shopping context are ignored.

Systematic Review of Public Health Branding

Brands build relationships between consumers and products, services, or lifestyles by providing beneficial exchanges and adding value to their objects. Brands can be measured through associations that consumers hold for products and services. Public health brands are the associations that individuals hold for health behaviors, or lifestyles that embody multiple health behaviors. We systematically reviewed the literature on public health brands; developed a methodology for describing branded health messages and campaigns; and examined specific branding strategies across a range of topic areas, campaigns, and global settings. We searched the literature for published studies on public health branding available through all relevant, major online publication databases. Public health branding was operationalized as any manuscripts in the health, social science, and business literature on branding or brands in health promotion marketing. We developed formalized decision rules and applied them in identifying articles for review. We initially identified 154 articles and reviewed a final set of 37, 10 from Africa, Australia, and Europe. Branded health campaigns spanned most of the major domains of public health and numerous communication strategies and evaluation methodologies. Most studies provided clear information on planning, development, and evaluation of the branding effort, while some provided minimal information. Branded health messages typically are theory based, and there is a body of evidence on their behavior change effectiveness, especially in nutrition, tobacco control, and HIV/AIDS. More rigorous research is needed, however, on how branded health messages impact specific populations and behaviors.

Social Marketing as a Childhood Obesity Prevention Strategy

In recent years, an ecological approach to nutrition and physical activity promotion has become widespread in community-based obesity prevention programs (1). One aspect of such approaches has been incorporation of social market-ing messages. The relationship between ecological approaches to obesity prevention and social marketing has not yet been systematically explored. In this commentary, we discuss this relationship and offer a model for research and action at the interface. Because our team works specifically on childhood obesity, this is our focus, but the perspective that we offer may be more broadly applicable.

Text4Baby: Using Text Messaging to Improve Maternal and Newborn Health

North America adopt new technologies and methods of communication, pregnant women and new mothers are no different. Text4baby, a free mobile information service of the National Healthy Mothers Healthy Babies Coalition, provides timely health information to women from early pregnancy throughout their baby’s fi rst year. The service sends important educational messages that are timed to the mother’s stage of pregnancy or to the baby’s age. <<

Mammography facilities are accessible, so why is utilization so low?

ObjectiveThis study examines new socio-ecological variables reflecting community context as predictors of mammography use.MethodsThe conceptual model is a hybrid of traditional health-behavioral and socio-ecological constructs with an emphasis on spatial interaction among women and their environments, differentiating between several levels of influence for community context. Multilevel probability models of mammography use are estimated. The study sample includes 70,129 women with traditional Medicare fee-for-service coverage for inpatient and outpatient services, drawn from the SEER–Medicare linked data. The study population lives in heterogeneous California, where mammography facilities are dense but utilization rates are low.ResultsSeveral contextual effects have large significant impacts on the probability of mammography use. Women living in areas with higher proportions of elderly in poverty are 33% less likely to use mammography. However, dually eligible women living in these poor areas are 2% more likely to use mammography than those without extra assistance living in these areas. Living in areas with higher commuter intensity, higher violent crime rates, greater land use mix (urbanicity), or more segregated Hispanic communities exhibit −14%, −1%, −6%, and −3% (lower) probability of use, respectively. Women living in segregated American Indian communities or in communities where more elderly women live alone exhibit 16% and 12% (higher) probability of use, respectively. Minority women living in more segregated communities by their minority are more likely to use mammography, suggesting social support, but this is significant for Native Americans only. Women with disability as their original reason for entitlement are found 40% more likely to use mammography when they reside in communities with high commuter intensity, suggesting greater ease of transportation for them in these environments.ConclusionsSocio-ecological variables reflecting community context are important predictors of mammography use in insured elderly populations, often with larger magnitudes of effect than personal characteristics such as race or ethnicity (−3% to −7%), age (−2%), recent address change (−7%), disability (−5%) or dual eligibility status (−1%). Better understanding of community factors can enhance cancer control efforts.