Upstream Social Marketing

ASU Wellness and Health PromotionMay 13, 2008

Karen Moses, MS, RD, CHES and Jim Grizzell, MBA, MA, CHES, HFI

Policies and Laws

Living ConditionsDiscrimination Social Capital

Culture

Social Networks

Social Gradients

ViolenceSocial Support

Income

Transportation

Education

Individual and Community Health

Learning Objectives

• Explain importance of moving upstream– Social determinants of health

– Policy makers, decision makers, implementers, regulators, funders, police, other influencers

• Describe upstream social marketing approaches

• Apply upstream social marketing to ASU health problems

Why Move Upstream

• It is unfair to expect individuals to use healthy behaviors– Even if motivated because barriers make it

difficult

• Social environment in which we live has a marked impact on our choices

• Our behavior is only partially under our own control

Why Use Upstream Social Marketing

• A social determinant may seem– Too big to tackle– Out of bounds because it is not specifically health-

related

• Can’t understand many health problems without acknowledging predisposing causal factors

Why Use Upstream Social Marketing

• Social marketing is appropriate– whenever you have a behavior to influence– for motivating a bureaucrat to implement

new or existing laws or regulations that would contribute to increase social welfare

• Customer orientation

• Behavior• Theory• Insight• Exchanges• Competition

• Audience segmentation and targeting

• Marketing mix

– Continuous and strategic formative & process research, monitoring and evaluating

Benchmarks

Green text are common tasks left out of social marketing programs.

Alan Andreasen’s Approach

• Process– Listening– Planning– Pretesting– Implementing– Monitoring– Revising

• Concepts and tools– Stages of change– BCOS

• Benefits, Costs, Others, Self-assurance

– Competition

• Others concepts– Segmentation, 4Ps,

Branding

CDCynergy Social Marketing Edition

• CDCynergy's Competitive Advantage– Extremely pre/post tested – Distills comprehensive best

practices – Vetted by major players in

social marketing – Over 700 resources – CDC originated – Use CDCynergy for funding

requests • Looked on very favorably!!

– Recognized nationally and internationally

• Phases1. Problem description2. Market research3. Market strategy4. Interventions5. Evaluation6. Implementation

Green text are common tasks left out of social marketing programs.

Logic Model

Phase 1: Problem Description

1. Write a problem statement2. List and map the causes of the health

problem3. Identify potential audiences*4. Identify the models of behavior change and

best practices*5. Form your strategy team6. Conduct a SWOT analysis

* These are Logic Model items

Phase 2: Market Research

1. Define your research questions2. Develop a market research plan3. Conduct and analyze market research4. Summarize research results

Phase 3: Market Strategy

1. Select your target audience segments*2. Define current and desired behaviors for

each audience segment*3. Describe the benefits you will offer*4. Write your behavior change goal(s)*5. Select the intervention(s) you will develop for

your program6. Write the goal for each intervention

Phase 4: Interventions

1. Select members and assign roles for your planning team

2. Write specific, measurable objectives for each intervention activity*

3. Write a program plan, including timeline and budget, for each intervention

4. Pretest, pilot test, and revise as needed5. Summarize your program plan and review the factors

that can affect it6. Confirm plans with stakeholders

Phase 5: Evaluation

1. Identify program elements to monitor2. Select the key evaluation questions3. Determine how the information will be

gathered4. Develop a data analysis and reporting plan

Phase 6: Implementation

1. Prepare for launch2. Execute and manage intervention

components3. Execute and manage the monitoring and

evaluation plans4. Modify intervention activities, as feedback

indicates

Learning Objectives

• Explain importance of moving upstream– Social determinants of health

– Policy makers, decision makers, implementers, regulators, funders, other influencers

• Describe upstream social marketing approaches

• Apply upstream social marketing to ASU health problems

Extra Slides

Resources

Resources

Moving to a Health Agenda 20

Positive outcomes and ROI

Reduced utilization

Reinforcement Management: Finding intrinsic and extrinsic rewards for new ways of working;

Environmental Reevaluation: Appreciating that the change will have a positive impact on the social and work environment;

Self-Liberation: Believing that a change can succeed and making a firm commitment to the change

Self-Reevaluation: Appreciating that the change is important to one’s identity, happiness, and success

Dramatic Relief: Emotional arousal, such as fear about failures to

change and inspiration for successful change

Consciousness Raising: Becoming more aware of a problem and potential solutions

Processes of Change

Customer Orientation• Customer in the round’ Develops a robust understanding of

the audience, based on good market and consumer research, combining data from different sources– A broad and robust understanding of the customer is

developed, which focuses on understanding their lives in the round, avoiding potential to only focus on a single aspect or features

– Formative consumer / market research used to identify audience characteristics and needs, incorporating key stakeholder understanding

– Range of different research analysis, combining data (using synthesis and fusion approaches) and where possible drawing from public and commercial sector sources, to inform understanding of people’s everyday lives

Insight

• Based on developing a deeper ‘insight’ approach – focusing on what ‘moves and motivates’– Focus is clearly on gaining a deep understanding and

insight into what moves and motivates the customer– Drills down from a wider understanding of the customer to

focus on identifying key factors and issues relevant to positively influencing particular behaviour

– Approach based on identifying and developing ‘actionable insights’ using considered judgement, rather than just generating data and intelligence

23

Health in Higher Education

• Health in higher education supports 18 million students in 4,200 IHEs

• Many college and university professionals work in higher education to promote health– 250 professionally prepared ACHA HEs - 1:72,000*– 19,000 faculty and staff – 1:947

• Health problems– Campus wide– Specific to college or major

• Influences quality and productivity

* See notes section

24

Traditional Health Programs

• Use the Medical Model– Health services has primary responsibility– Staff trained in clinical practice

• Health care agenda focus is on the physical– Healing sickness/injury– Wellness for physical health

• Methods focus on the individual– Awareness activities, written information, didactic

presentations

25

The Traditional Approach

• Limits our understanding of health – Physical health is what counts most– Ignores role of environment/community on health– Lacks prevention focus

• Financially costly and ineffective– Lacks cost-effectiveness, positive ROI, reach, impact

• Removes responsibility for health outcomes by non-health entities– Gives medical systems a lot of power

26

Traditional Health Programs

• Based on tradition, convention, belief, anecdotal evidence

• Pressure to be seen as acting• Desire to help• Poorly developed skills and understanding of

population behaviour change• Short term policy planning, budgeting and

review

27

Evolution of College Wellness & Health

1850s 1970s 1980s ~1995 2010

Instruction, Treatment, Exercise Health Education/Promotion EB/CE-HP*

1st Generation 2nd Generation 3rd Generation

* Evidence-based / Cost Effective Health Promotion

HealthyCampus

Objectives

Moving to a Health Agenda 28

Evolution of College Wellness & Health

Results / Outcome Oriented

Evidence-Based & Cost-

Effective Health

Promotion

* Health Cost Management

Focus on student learningStrong risk reductionStrong high risk focusSome required activitySite and virtualEnvironmental changesStrongly personalMajor incentivesSig. others servedRigorous assess/eval

Traditional Medical and

Health Promotion

Traditional Medical Model

and Health Education

Mostly health focusSome risk reductionLittle risk reductionLimited HCM orientedAll voluntarySite-based onlyWeak personalizationModest incentivesFew sig. others servedWeak assess/eval

Fun activity focusNo risk reductionNo high risk focusNot HCM* orientedAll voluntarySite-based onlyNo personalizationMinimal incentivesNo sig. others servedNo assessment/eval

Activity OrientedMorale Oriented

Name of Model

Main Features

Primary Focus

Social MarketingCommercial vs. Social

• Marketing is about behavior change– The bottom line– ROI and CEA

• If your intervention won’t change behavior– Don’t do it!!!!

• Theory– Distillation of previous work– Simplify complex phenomena

Some Questions to Guide Theory Selection

• Where are people in relation to a particular behavior?

• What factors cause this position?• How can they be moved in the desired

direction?

32

Keys to Effective Use of the Ecological Perspective

• Expand the focus beyond health information and programming

• Integrate responsibility for health across student affairs and academic units

• Provide supportive environments and reduce barriers to optimal outcomes

• Promote leadership and involvement by multiple partners

33

Intervention Pyramid

High

Low

Cost

High

Low

Reach

Policies

Health Communication, SocialEcological Model & Social Marketing

Activities no feedbackHealth Systems

Activities w/ Health Education

SpecialtyCare

Community &Neighborhood Collaboration

Primary Care

Moving to a Health Agenda 34

Business Case

Levels of Interventions & Wellness Program ROIs

Program Levels

Intervention Levels

Quality of Life

TraditionalHealth &

Productivity

I. Awareness Information, no feedback

<1:1

IIa. Behavior Change Health education w follow-up

3:1

IIb. Behavior Change Targeted priority health

issues with Social Marketing

6:1 to >15:1

III. Supportive Environment Ecological Approach, Policies

>15:1

35

Continuum of Services

Intensive

Early Intervention

Universal Prevention

For students at highest risk of engaging in high

behaviors or already having a health problem

For students at risk of engaging in high

behaviors or already having the health

problemFor all

students, regardless of

risk to delay or prevent health

problems

From Dept of Education Safe Schools / Healthy Students Grant Guidelines

36

Health in Higher Education

Karen S. Moses, MS, RD, CHES*Director, Wellness and Health PromotionArizona State University

Chair, NASPA Health in Higher Education Knowledge CommunityMember at Large, ACHA Board of Directors Deputy Coordinator, Coalition of National Health Education Organizations

* Certified Health Education Specialist

37

The Ecological Perspective

The science and art of helping people change their lifestyle to move toward a state of optimal health….Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behavior, and create environments that support good health practices. Of the three, supportive environments will probably have the greatest impact in producing lasting changes.

• M. P. O’Donnell, American Journal of Health Promotion (1986)

38

A New Paradigm: The Ecological Approach to Campus Health

• Views the connections among health, learning, and the campus structure

• Explores relationships between and among individuals and the learning communities that comprise the campus environment

39

Using the Ecological Perspective on Campus

• Establish a Working Group• Identify Campus Values• Assess Student Health Data• Analyze Campus Health Concerns

Through an Ecological Lens• Environmental influences• Individual influences

• Develop a Plan

40

Influencing Factors

Individual

People

Community

Characteristics of the:

Place

Organization

41

Environmental Influences

Behavior settings: Rituals,student organizationsCultural Influences: Customs, traditions, valuesEconomic Forces: Student financial stability, budgetInhabitants: Diversity, Athletics,Greek, campus communities, etc.

The location of the campusThe weatherThe constructed designsLandscapes

Organizational StructurePoliciesOrganizational Climate

Political ClimateConservative/liberal Pro education?Reinforcement and RewardsFor healthy org & indiv behaviors

Place People

Organization Community

42

Stress: Environmental Influences

Financial concernsISO – global troubles

Relationships w/friendsLack of friends/commuters

Irresponsible drinkersUninvolved students

Warm climateLack of parking

High trafficCampus size—distances

Crowding—long lines

Services--lack of info Depts disconnected

Too many stepsWeak policy enforcement

Inconsistent messages

State budget crisisIncrease in tuition/fees

Rewards for over commitment

Culture of stress

Place People

Institution Community

Social Marketing in Health Promotion 43

Policies

Health Communication,Ecological / Environmental Approach

Activities no feedback

Health SystemsActivities w/ Health Education

SpecialtyCare

Community &Neighborhood Collaboration

Primary Care

Social Marketing’s FitIntervention Pyramid

Moving to a Health Agenda 44

Historical Snapshot: Think Health Agenda & Business Case

Corporate & College Health & Wellness

1850s 1970s 1980s ~1995 2010

Recreation Fitness Health Education > Promotion HPM*

1st Generation 2nd Generation 3rd Generation 4th Generation

Instruction, Treatment, Exercise Health Education > Promotion HAPM*

1st Generation 2nd Generation 3rd Generation

* Health & Productivity Management, Health & Academic Performance Management