Health Communications and Social Marketing for IPP

Sureyya E. Hornston, PhD, MPHSureyya E. Hornston, PhD, MPH

Centers for Disease Control and Prevention (CDC), Centers for Disease Control and Prevention (CDC),

Division of STD Prevention, Division of STD Prevention,

Behavioral Interventions and Research Branch Behavioral Interventions and Research Branch Atlanta, GAAtlanta, GA

May 17, 2007May 17, 2007

Session Outline

How does mind work? Facts and How does mind work? Facts and RealitiesRealities

Effective Health Communication EffortsEffective Health Communication Efforts Incorporating Social Marketing PrinciplesIncorporating Social Marketing Principles ResourcesResources What’s next? Putting it all togetherWhat’s next? Putting it all together

My Objectives:

Introduce effective health Introduce effective health communications and social marketing communications and social marketing principles principles

Assist audience in starting to think like a Assist audience in starting to think like a “marketer” for future IPP initiatives“marketer” for future IPP initiatives

Newsweek and Discovery Channel Poll (2000)

83% of the respondents knew 83% of the respondents knew about the harmful effects of sugar about the harmful effects of sugar and fatty foodsand fatty foods

Only 42% were seriously trying to Only 42% were seriously trying to improve their diets.improve their diets.

Things to ponder about…

More information in the last 30 yrs. than More information in the last 30 yrs. than in the previous 5000 yrs.in the previous 5000 yrs.

More than 4000 books published More than 4000 books published around the world every day.around the world every day.

As volume increases, is any of the As volume increases, is any of the information getting into people’s information getting into people’s minds???minds???

“Positioning” AND “Re-positioning”

MIND: The ultimate marketing battlegroundMIND: The ultimate marketing battleground

The better understanding of how mind works The better understanding of how mind works = the better “positioning”= the better “positioning”

Positioning and re-positioning determine how Positioning and re-positioning determine how people will think about your “Product/process/ people will think about your “Product/process/ idea” – Appeal via the benefits idea” – Appeal via the benefits

Understanding the MIND

Minds are limited.Minds are limited.

Minds hate confusion and can lose Minds hate confusion and can lose focus easily.focus easily.

Minds are insecure.Minds are insecure.

Minds don’t change easily.Minds don’t change easily.

Minds are limited

First, get through the “volume control”First, get through the “volume control”

Second, the message is in short-term Second, the message is in short-term memory (Rule of Seven)memory (Rule of Seven)

Third, it must be transferred to long-term Third, it must be transferred to long-term memory (80% never gets transferred!) memory (80% never gets transferred!) WHY?? Because, minds have to be selective.WHY?? Because, minds have to be selective.

Message = Not interesting, not emotional. Message = Not interesting, not emotional.

Minds hate confusion and can lose focus easily.

Information and data Information and data More information = More confusionMore information = More confusion SolutionSolution: :

Bite size information that is easily Bite size information that is easily understood and KISSunderstood and KISS

Focus on a few powerful information Focus on a few powerful information and drive it into the mind.and drive it into the mind.

Minds are insecure

Most people tend to do what others doMost people tend to do what others do ““Principle of social proof”Principle of social proof”

Behavior is correct = others perform itBehavior is correct = others perform it

This can be a conduit to influencing This can be a conduit to influencing behaviors by:behaviors by:

TestimonialsTestimonialsCreating a “bandwagon” effectCreating a “bandwagon” effect

Minds don’t change easily

““Belief systems are important from the Belief systems are important from the perspective of information, because beliefs perspective of information, because beliefs are thought to provide the cognitive are thought to provide the cognitive foundation of an attitude. In order to change foundation of an attitude. In order to change an attitude, it is necessary to modify the an attitude, it is necessary to modify the information on which the attitude rests. It is information on which the attitude rests. It is therefore, necessary to change a person’s therefore, necessary to change a person’s beliefs, eliminate old beliefs, or introduce beliefs, eliminate old beliefs, or introduce new beliefs.”new beliefs.”

Attitudes & Perceptions by Drs. Petty and Attitudes & Perceptions by Drs. Petty and CacioppoCacioppo

What can we do?

Effective CommunicationEffective Communication

ANDAND

Social Marketing can help…Social Marketing can help…

Effective health Effective health communication effortscommunication efforts

Segment the general population Segment the general population

and and Target specific audiences with specific health Target specific audiences with specific health

messages (Audience segmentation)messages (Audience segmentation)

ONE SIZE ONE SIZE DOES NOTDOES NOT FIT ALL! FIT ALL!

Benefits of audience segmentation

Effective use of resourcesEffective use of resources

Culturally competent, customized strategiesCulturally competent, customized strategies

Appropriate channels of communicationAppropriate channels of communication

Providing pportunity to establish partnerships Providing pportunity to establish partnerships with audience focuswith audience focus

Identification of the “easier to change” Identification of the “easier to change” audiences (Diffusion of Innovations Theory)audiences (Diffusion of Innovations Theory)

Segmenting the general population

DemographicsDemographics

Physical/Medical historyPhysical/Medical history

Behavioral characteristics Behavioral characteristics

(“Do’ers” versus “Non-Do’ers”)(“Do’ers” versus “Non-Do’ers”)

Effective health communication efforts (Cont’d.)

Develop audience-centered Develop audience-centered messages with a “consumer messages with a “consumer perspective” perspective”

Capture and secure the attention of Capture and secure the attention of the “right audience”the “right audience”

Effective health communication efforts (Cont’d.) Make messages crystal clear, and include Make messages crystal clear, and include

easy action steps – appropriate for the easy action steps – appropriate for the audience’s stage of readinessaudience’s stage of readiness

ExampleExample:: Target audience at Pre-contemplation: No Target audience at Pre-contemplation: No

perceived risk/relevance - Increase perceived risk/relevance - Increase awarenessawareness

Target audience at Contemplation: Promote Target audience at Contemplation: Promote benefits, minimize perceived costsbenefits, minimize perceived costs

Effective health communication efforts (Cont’d.)

For message deliveryFor message delivery Involve a multi-pronged “systems Involve a multi-pronged “systems

approach” (Different modes and approach” (Different modes and channels)channels)

Plenty of repeat messaging (One-time Plenty of repeat messaging (One-time messaging does not work!)messaging does not work!)

Effective health communication efforts (Cont’d.)

Base communication interventions Base communication interventions on a behavioral theory or model on a behavioral theory or model

Consider using social marketing Consider using social marketing principles and techniquesprinciples and techniques

What is Social Marketing? Social marketing is...Social marketing is...“The application of “The application of commercial marketing techniques to the commercial marketing techniques to the analysis, planning, execution,and analysis, planning, execution,and evaluation of programs designed to evaluation of programs designed to influence the voluntary behavior of influence the voluntary behavior of target audiences in order to improve target audiences in order to improve their personal welfare and that of their their personal welfare and that of their society.” society.” Alan Andreason Alan Andreason

Social Marketing is…

““the design, implementation and control the design, implementation and control of programs aimed at increasing the of programs aimed at increasing the acceptability of a social idea or practice acceptability of a social idea or practice in one group of target adopters.”in one group of target adopters.”

Philip Kotler and Gerald ZaltmanPhilip Kotler and Gerald Zaltman

Social Marketing is not…

AdvertisingAdvertising

Public relationsPublic relations

Slick packaging of communication materialsSlick packaging of communication materials

Condom distributionCondom distribution

Health educationHealth education

Difference between Health Education/Promotion and Social Marketing? Health education/PromoHealth education/Promo: Relays information, : Relays information,

and educates individuals about a certain and educates individuals about a certain health issuehealth issue

END PRODUCT: Individuals who are educatedEND PRODUCT: Individuals who are educated SM’ingSM’ing: Focuses on “exchange of value,” : Focuses on “exchange of value,”

“competition,” and careful audience “competition,” and careful audience segmentationsegmentation

END PRODUCT: Behavior changeEND PRODUCT: Behavior change

Marketing

““Marketing is co-existent with life. I offer Marketing is co-existent with life. I offer something and you give me something something and you give me something back. Even in relationships, you are back. Even in relationships, you are marketing yourself, because you want marketing yourself, because you want the other person to accept you.”the other person to accept you.”

Dr. Sydney Levy - University of ArizonaDr. Sydney Levy - University of Arizona

Social Marketing:A Model for Interventions that Facilitate Change

What is the healthproblem?

What actions could reduce the problem

POLICY/RULES THAT INFLUENCE THE ACTIONPolicy, rules, legislation

WHO MUST ACT TO RESOLVE PROBLEM

Target audienceStakeholder,group,or

individual market research

WHAT ACTION MUST BE TAKEN

Product or Behavior

HOW YOU TELL THEM ABOUT THE WHAT, WHY, WHERE,

AND HOWPromotion or CommunicationPricing

Increasing knowledge Increasing benefits Decreasing barriers

Improving self-efficacyIncreasing social pressure

or norms

WHERE (HOW) THEY CAN DO BEHAVIOR

Place

community resourcespartnerships specific clinics product offering sites**may be where they learn how to do behavior (training)

classroom teachingmass media messagesmedia advocacysmall group discussionpatient/doctor interactionpoint of purchase displayscommunity meetingsworksite educationETC, ETC

describing the action in a way that is relevant to the target audience and helps fulfill some unmet need, but not contrary to science

Social Marketing as a Model for Interventions that Facilitate ChangeDr. Susan D. Kirby, 1995

Methods we can use to increase social pressure, provide protection for public, create action by third parties, andcreate incentives for health enhancing policies

WHY THEY WANT TO DO IT

Social Marketing Elements

WHOWHO needs to change needs to change WHATWHAT must they DO must they DO WHYWHY and and WHYWHY they might they might NOTNOT do do

this behaviorthis behavior

WHERE or WHENWHERE or WHEN they will get they will get

access, learn how, or see new access, learn how, or see new

behaviorbehavior

HOWHOW you will tell them about the you will tell them about the

WHO, WHAT, WHY, WHERE and WHO, WHAT, WHY, WHERE and

WHENWHEN

Intended AudienceIntended Audience Specific behavioral Specific behavioral

objectiveobjective Key factors influencing Key factors influencing

behavior in audiencebehavior in audience Interventions that address Interventions that address

the behavioral influencing the behavioral influencing factorsfactors

Communication component Communication component of intervention plansof intervention plans

Four P’s of Social Marketing

ProductProduct PricePrice PlacePlace PromotionPromotion

• Pull & Push

• Policy

Four P’s of Social Marketing (Cont’d.)Product:

Tangible (e.g. Condoms, medication)Tangible (e.g. Condoms, medication)

Intangible (Behavior change among Intangible (Behavior change among certain target audiences to do the certain target audiences to do the intended behavior)intended behavior)

Four P’s of Social Marketing (Cont’d.)

Price:Price:

Direct cost of the product in $$’sDirect cost of the product in $$’s

Indirect cost of the product Indirect cost of the product (psychological, social, situational) (psychological, social, situational)

Four P’s of Social Marketing (Cont’d.)

Place:Place: Message dissemination (via Message dissemination (via

electronic or print media, billboards, electronic or print media, billboards, etc.)etc.)

Product distributionProduct distribution Going where the “customer” is Going where the “customer” is

Four P’s of Social Marketing (Cont’d.)

Promotion:Promotion:

Communicate to the target audience(s) that the product is worth the price.

Other P’s of Social Marketing

Pull & Push:Pull & Push: Two strategies that work togetherTwo strategies that work together ““Push” is aimed at the “distributor”Push” is aimed at the “distributor” ““Pull” is aimed at the “consumer”Pull” is aimed at the “consumer” Reinforcing, synergistic effectReinforcing, synergistic effect

Other P’s of Social Marketing

Policy:Policy:

What can be done at organizational level or at government level to support the changes we are striving for?

Exercise One

What is the “Price?”What is the “Price?”

Everyone is tuned into…

…….WIIIFM.WIIIFM

Everyone is tuned into…

WhatWhatIs Is In In It It For For Me??Me??

WIIIFMWIIIFM

Everyone is tuned into…

WhatWhatIs Is In In It It For For Me??Me??

WIIIFMWIIIFM

WIIIFM in Social Marketing

If you do X you will get YIf you do X you will get Y X is a behaviorX is a behavior Y is something valued by Y is something valued by

audienceaudience tangibletangible intangibleintangible

Incorporating WIIIFM Think from audience perspectiveThink from audience perspective Address influencing factors from their Address influencing factors from their

perspectiveperspective Communicate from their perspectiveCommunicate from their perspective Finding a MATCH between the desired Finding a MATCH between the desired

program behavior and WHY the program behavior and WHY the audience might WANT to do itaudience might WANT to do it

Whose Payoff?Marketing Dept. of Marketing Dept. of

XYZ Company XYZ Company GOAL = $$GOAL = $$ Does Does notnot tell audience to tell audience to

buy products, so the buy products, so the company will make $$ company will make $$

Understands Understands audienceaudience

Fills an audience Fills an audience needneed

Tells audience howTells audience howproduct fills their product fills their

needneed

Us: Health Education or Us: Health Education or Communication Communication

programprogram GOAL = Decrease GOAL = Decrease

incidence/(-)behaviorincidence/(-)behavior Tells audience that Tells audience that

numbers are bad and numbers are bad and they need to be they need to be betterbetter Tells audiences Tells audiences

what to do without what to do without any audience viewany audience view

Not framed acc. to Not framed acc. to audience’s needsaudience’s needs

Health is not an end in itself… It is a means to a valued end

Our job is to translate the value of a Our job is to translate the value of a behavior into the audiences’ languagebehavior into the audiences’ language

Values vary greatly across peopleValues vary greatly across people a major reason to segment a major reason to segment

populationspopulations

Exercise Two

Whose Benefit? Whose Benefit?

WIIIFM? WIIIFM?

Resources

STD Communications DatabaseSTD Communications Database

Research - Syphilis Elimination Research - Syphilis Elimination Effort (SEE) ToolkitEffort (SEE) Toolkit

What is STD Communications Database?

A web-based tool that enhances formative A web-based tool that enhances formative research research

http://www.cdc.gov/std/commdata/http://www.cdc.gov/std/commdata/

Information on characteristics, knowledge, Information on characteristics, knowledge, attitudes, behaviors, and practices (KABPs) attitudes, behaviors, and practices (KABPs) of various target audiences and at-risk of various target audiences and at-risk populations on matters relating to STDspopulations on matters relating to STDs

What is “SEE Community Mobilization Toolkit?”

A toolkit containing A toolkit containing audience-specific audience-specific products products

PurposePurpose: Give state : Give state and local health and local health departments the departments the tools to reach out tools to reach out and build necessary and build necessary coalitions for syphilis coalitions for syphilis elimination workelimination work

WHO? - Selected target WHO? - Selected target audiencesaudiences

Policy Makers/Opinion Leaders Policy Makers/Opinion Leaders

Health Care ProvidersHealth Care Providers

Community RepresentativesCommunity Representatives

Methodology – How?

Literature review and “environmental scanning”Literature review and “environmental scanning”

Formative research Formative research

Recruitment via “snowball” sampling techniqueRecruitment via “snowball” sampling technique

Open-ended key informant interviews (238 Open-ended key informant interviews (238 interviews at nine sites)interviews at nine sites)

Data analysisData analysis

WHAT? - Research Questions

Perceived severity of syphilisPerceived severity of syphilis Barriers and overcoming these barriersBarriers and overcoming these barriers Suggested messages, tones, Suggested messages, tones,

spokespersonsspokespersons Preferred methods and channels of Preferred methods and channels of

receiving informationreceiving information Relationship between HIV and syphilisRelationship between HIV and syphilis

FindingsA)A)Barriers to recognition of syphilis as Barriers to recognition of syphilis as

an important PH issue and to an important PH issue and to garnering support:garnering support:Lack of awareness and knowledge Lack of awareness and knowledge

about syphilisabout syphilisCharacterization of syphilis as a Characterization of syphilis as a

“second class disease” – Stigma“second class disease” – StigmaLack of advocacy and spokespersonsLack of advocacy and spokespersons

Barriers to recognition of syphilis as an important PH issue and to

garnering support (Cont’d) Difficulty of talking about matters relating to Difficulty of talking about matters relating to

sex and STDssex and STDs Lack of funds and resourcesLack of funds and resources Distrust of gov’t institutionsDistrust of gov’t institutions Separate approaches for each STD and Separate approaches for each STD and

HIVHIV Competition from other issuesCompetition from other issues Issues relating to reimbursementIssues relating to reimbursement

Findings

B) Overcoming these barriersB) Overcoming these barriers

Increase knowledge and Increase knowledge and

awareness awareness about syphilis among TAabout syphilis among TA

Increase knowledge and awareness Increase knowledge and awareness

about syphilis in general publicabout syphilis in general public

Increase fundingIncrease funding

FindingsC) Suggested messages, tones, C) Suggested messages, tones,

spokespersonsspokespersons

General theme: Fact-filled, serious tone General theme: Fact-filled, serious tone emphasizing syphilis rates and emphasizing syphilis rates and consequences of syphilisconsequences of syphilis

““Get the facts out;educate people. You have to Get the facts out;educate people. You have to be blunt with them and correct the idea that be blunt with them and correct the idea that syphilis is gone.”syphilis is gone.”

““There is nothing funny about syphilis”There is nothing funny about syphilis”

Suggested messages, tones, spokespersons (Cont’d.)

Elected Officials preferred local Elected Officials preferred local community leaders community leaders

Opinion Leaders: Local and nat’l Opinion Leaders: Local and nat’l celebrities, political leaders as celebrities, political leaders as spokespersonsspokespersons

CBOs emphasized the importance of CBOs emphasized the importance of clergy’s role, and culturally sensitive clergy’s role, and culturally sensitive messagesmessages

Suggested messages, tones, spokespersons (Cont’d.)

HCP:HCP: Medical authority (Surgeon General, CDC, Medical authority (Surgeon General, CDC, professional organizations) professional organizations)

Need for clarification of what syphilis Need for clarification of what syphilis elimination meanselimination means

Simple treatment protocols and guidelinesSimple treatment protocols and guidelines Info. on prevalence, signs, symptomsInfo. on prevalence, signs, symptoms Relevance of syphilis to one’s practiceRelevance of syphilis to one’s practice Guidance on sexual history takingGuidance on sexual history taking

Findings

D) Preferred method/channels of D) Preferred method/channels of receiving informationreceiving information

CBOs and community leadersCBOs and community leaders: Internet : Internet and mass media, newslettersand mass media, newsletters

HC providersHC providers: Professional literature and : Professional literature and meetings, newsletters, other HCPsmeetings, newsletters, other HCPs

Elected OfficialsElected Officials: Internet, mass media, : Internet, mass media, newsletters from authoritative sourcesnewsletters from authoritative sources

Summary of FindingsSummary of Findings

Main Gaps in Knowledge and AwarenessMain Gaps in Knowledge and Awareness

Signs and symptoms of syphilis

“Syphilis is a disease of yesterday”

National Syphilis Elimination Plan

What to do with these findings?

Increase knowledge and awareness Increase knowledge and awareness about syphilis among selected target about syphilis among selected target audiences and in general public audiences and in general public

BY:BY:

Developing fact-filled, culturally sensitive Developing fact-filled, culturally sensitive

communication materials with a serious communication materials with a serious

tone for all target audiences tone for all target audiences

AND AND

facilitate community mobilizationfacilitate community mobilization

A Sampling of SEE Toolkit Materials Community Mobilization GuideCommunity Mobilization Guide Various brochuresVarious brochures Camera-ready print adsCamera-ready print ads

Syphilis pocket guide and sexual history taking pamphlet for health care providers (HCPs)

A Sampling of SEE Toolkit Materials (cont.)

Tip sheetsTip sheets

Contact lists (Local CBOs and Policy Contact lists (Local CBOs and Policy Makers)Makers)

MSM-specific materialsMSM-specific materials

Availability of SEE Toolkit Materials (Cont’d.)

On the web:On the web:

CDC Warehouse (Order by phone or via CDC Warehouse (Order by phone or via the order form online)the order form online)

http://www.cdc.gov/std/see/

In summary…For each target audience segmentFor each target audience segment

Identify benefits that matter to the target audienceIdentify benefits that matter to the target audience

Consider ALL costs and barriers to the suggested behaviorsConsider ALL costs and barriers to the suggested behaviors

Also consider the WIIIFMAlso consider the WIIIFM

Make the suggested behavior easy to do or break it down to Make the suggested behavior easy to do or break it down to

easy action steps based on the stage of readinesseasy action steps based on the stage of readiness

Deliver messages in a clear, uncluttered and uniform mannerDeliver messages in a clear, uncluttered and uniform manner

For message delivery, involve a multi-pronged “systems For message delivery, involve a multi-pronged “systems approach” with plenty of repeat messagingapproach” with plenty of repeat messaging

CDC’s Commitment to You

TrainingTraining

Technical assistanceTechnical assistance

Wrap up & Questions

THANK YOU!

Exercise Three

What’s next?What’s next?