Health Communications and

Social Marketing for IPP

Sureyya E. Hornston, PhD, MPH

Centers for Disease Control and Prevention (CDC),

Division of STD Prevention,
Behavioral Interventions and Research Branch
Atlanta, GA

May 17, 2007

Session Outline
 How does mind work? Facts and
Realities
 Effective Health Communication Efforts
 Incorporating Social Marketing Principles
 Resources
 What’s next? Putting it all together
My Objectives:
 Introduce effective health
communications and social marketing
principles

 Assist audience in starting to think like a

“marketer” for future IPP initiatives
Newsweek and Discovery
Channel Poll (2000)

 83% of the respondents knew about

the harmful effects of sugar and fatty
foods

 Only 42% were seriously trying to

improve their diets.
Things to ponder about…
 More information in the last 30 yrs. than
in the previous 5000 yrs.
 More than 4000 books published
around the world every day.
 As volume increases, is any of the
information getting into people’s
minds???
“Positioning” AND “Re-positioning”
 MIND: The ultimate marketing battleground

 The better understanding of how mind works

= the better “positioning”

 Positioning and re-positioning determine how

people will think about your “Product/process/
idea” – Appeal via the benefits
Understanding the MIND
 Minds are limited.

 Minds hate confusion and can lose

focus easily.

 Minds are insecure.

 Minds don’t change easily.

Minds are limited

 First, get through the “volume control”

 Second, the message is in short-term

memory (Rule of Seven)

 Third, it must be transferred to long-term

memory (80% never gets transferred!)
WHY?? Because, minds have to be selective.

 Message = Not interesting, not emotional.

Minds hate confusion and can
lose focus easily.
 Information and data
 More information = More confusion
 Solution:
 Bite size information that is easily
understood and KISS
 Focus on a few powerful information
and drive it into the mind.
Minds are insecure

 Most people tend to do what others do

 “Principle of social proof”
Behavior is correct = others perform it
This can be a conduit to influencing
behaviors by:
 Testimonials

 Creating a “bandwagon” effect

Minds don’t change easily
“Belief systems are important from the
perspective of information, because beliefs
are thought to provide the cognitive
foundation of an attitude. In order to change
an attitude, it is necessary to modify the
information on which the attitude rests. It is
therefore, necessary to change a person’s
beliefs, eliminate old beliefs, or introduce
new beliefs.”

Attitudes & Perceptions by Drs. Petty and

Cacioppo
What can we do?

 Effective Communication

AND

 Social Marketing can help…

 Effective health
communication efforts
 Segment the general population
and
 Target specific audiences with specific health
messages (Audience segmentation)

ONE SIZE DOES NOT FIT ALL!

Benefits of audience segmentation
 Effective use of resources

 Culturally competent, customized strategies

 Appropriate channels of communication

 Providing pportunity to establish partnerships

with audience focus

 Identification of the “easier to change”

audiences (Diffusion of Innovations Theory)
Segmenting the general
population
 Demographics

 Physical/Medical history

 Behavioral characteristics
(“Do’ers” versus “Non-Do’ers”)
 Effective health communication
efforts (Cont’d.)
 Develop audience-centered
messages with a “consumer
perspective”

 Capture and secure the attention of

the “right audience”
Effective health communication
efforts (Cont’d.)
 Make messages crystal clear, and include
easy action steps – appropriate for the
audience’s stage of readiness
Example:
 Target audience at Pre-contemplation: No
perceived risk/relevance - Increase
awareness
 Target audience at Contemplation: Promote
benefits, minimize perceived costs
Effective health communication
efforts (Cont’d.)

For message delivery

 Involve a multi-pronged “systems
approach” (Different modes and
channels)

 Plenty of repeat messaging (One-time

messaging does not work!)
Effective health communication
efforts (Cont’d.)

 Base communication interventions

on a behavioral theory or model

 Consider using social marketing

principles and techniques
What is Social Marketing?
Social marketing is...“The application of
commercial marketing techniques to the
analysis, planning, execution,and
evaluation of programs designed to
influence the voluntary behavior of
target audiences in order to improve
their personal welfare and that of their
society.” Alan Andreason
Social Marketing is…
“the design, implementation and control
of programs aimed at increasing the
acceptability of a social idea or practice
in one group of target adopters.”

Philip Kotler and Gerald Zaltman

Social Marketing is not…
 Advertising

 Public relations

 Slick packaging of communication materials

 Condom distribution

 Health education
Difference between Health
Education/Promotion and Social
Marketing?
 Health education/Promo: Relays information,
and educates individuals about a certain
health issue
END PRODUCT: Individuals who are educated
 SM’ing: Focuses on “exchange of value,”
“competition,” and careful audience
segmentation
END PRODUCT: Behavior change
Marketing
“Marketing is co-existent with life. I offer
something and you give me something
back. Even in relationships, you are
marketing yourself, because you want
the other person to accept you.”

Dr. Sydney Levy - University of Arizona

 Social Marketing:
A Model for Interventions that
Facilitate Change
HOW YOU TELL THEM ABOUT
WHY THEY THE WHAT, WHY, WHERE,
WANT TO DO IT AND HOW
Pricing Promotion or Communication
Increasing knowledge
Increasing benefits classroom teaching
Decreasing barriers mass media messages
Improving self-efficacy media advocacy
Increasing social pressure small group discussion
or norms patient/doctor interaction
point of purchase displays
What is the health WHO MUST ACT TO community meetings
WHERE (HOW) THEY CAN worksite education
problem? RESOLVE PROBLEM DO BEHAVIOR ETC, ETC
What actions could Target audience
Stakeholder,group,or
Place
reduce the problem
individual market community resources
research partnerships
specific clinics
product offering sites
**may be where they learn how
to do behavior (training)
POLICY/RULES THAT
WHAT ACTION MUST BE INFLUENCE THE ACTION
TAKEN Policy, rules, legislation
Methods we can use to increase
Product or Behavior social pressure, provide
describing the action in a way protection for public,
that is relevant to the target create action by third parties, and
audience and helps fulfill some create incentives for health
unmet need, but not contrary enhancing policies
to science

Social Marketing as a Model for Interventions that Facilitate Change

Dr. Susan D. Kirby, 1995
 Social Marketing Elements
 WHO needs to change
 WHAT must they DO
 WHY and WHY they might NOT do
this behavior
 WHERE or WHEN they will get
access, learn how, or see new
behavior
 HOW you will tell them about the
WHO, WHAT, WHY, WHERE and
WHEN
 Intended Audience
 Specific behavioral
objective
 Key factors influencing
behavior in audience
 Interventions that address
the behavioral influencing
factors
 Communication component
of intervention plans
Four P’s of Social Marketing

 Product
 Price
 Place
 Promotion
• Pull & Push
• Policy
Four P’s of Social Marketing
(Cont’d.)
Product:

 Tangible (e.g. Condoms, medication)

 Intangible (Behavior change among

certain target audiences to do the
intended behavior)
Four P’s of Social Marketing
(Cont’d.)
Price:

 Direct cost of the product in $$’s

 Indirect cost of the product (psychological,

social, situational)
Four P’s of Social Marketing
(Cont’d.)
Place:

 Message dissemination (via electronic

or print media, billboards, etc.)
 Product distribution
 Going where the “customer” is
Four P’s of Social Marketing
(Cont’d.)
Promotion:

Communicate to the target

audience(s) that the product is
worth the price.
Other P’s of Social Marketing

Pull & Push:

 Two strategies that work together
 “Push” is aimed at the “distributor”
 “Pull” is aimed at the “consumer”
 Reinforcing, synergistic effect
Other P’s of Social Marketing

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?”

Everyone is tuned into…

….WIIIFM
Everyone is tuned into…
What
Is
In WIIIFM
It
For
Me??
Everyone is tuned into…
What
Is
In WIIIFM
It
For
Me??
 WIIIFM in Social Marketing
 If you do X you will get Y
 X is a behavior
 Y is something valued by
audience
 tangible

 intangible
Incorporating WIIIFM
 Think from audience perspective
 Address influencing factors from their
perspective
 Communicate from their perspective
 Finding a MATCH between the desired
program behavior and WHY the
audience might WANT to do it
Whose Payoff?
Marketing Dept. of Us: Health Education or
Communication
XYZ Company program
 GOAL = $$  GOAL = Decrease
 Does not tell audience to incidence/(-)behavior
buy products, so the  Tells audience that
company will make $$ numbers are bad and
Understands they need to be better
audience  Tells audiences
Fills an audience what to do without
any audience view
need  Not framed acc. to
Tells audience how
product fills their audience’s needs
need
 Health is not an end in itself…
It is a means to a valued end

 Our job is to translate the value of a

behavior into the audiences’ language

 Values vary greatly across people

 a major reason to segment
populations
Exercise Two

Whose Benefit?
WIIIFM?
 Resources

 STD Communications Database

Research - Syphilis Elimination

Effort (SEE) Toolkit
What is STD Communications
Database?
 A web-based tool that enhances formative
research
http://www.cdc.gov/std/commdata/

 Information on characteristics, knowledge,

attitudes, behaviors, and practices (KABPs) of
various target audiences and at-risk
populations on matters relating to STDs
What is “SEE Community
Mobilization Toolkit?”
 A toolkit containing
audience-specific
products
 Purpose: Give state
and local health
departments the
tools to reach out
and build necessary
coalitions for syphilis
elimination work
WHO? - Selected target
audiences

 Policy Makers/Opinion Leaders

 Health Care Providers
 Community Representatives
Methodology – How?

 Literature review and “environmental scanning”

 Formative research
 Recruitment via “snowball” sampling technique

 Open-ended key informant interviews (238

interviews at nine sites)

 Data analysis
 WHAT? - Research Questions

 Perceived severity of syphilis

 Barriers and overcoming these barriers
 Suggested messages, tones,
spokespersons
 Preferred methods and channels of
receiving information
 Relationship between HIV and syphilis
Findings
A)Barriers to recognition of syphilis as
an important PH issue and to garnering
support:
 Lack of awareness and knowledge
about syphilis
 Characterization of syphilis as a
“second class disease” – Stigma
 Lack 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
sex and STDs
 Lack of funds and resources
 Distrust of gov’t institutions
 Separate approaches for each STD and HIV
 Competition from other issues
 Issues relating to reimbursement
Findings
B) Overcoming these barriers
 Increase knowledge and awareness
about syphilis among TA
 Increase knowledge and awareness
about syphilis in general public
 Increase funding
Findings
C) Suggested messages, tones,
spokespersons
General theme: Fact-filled, serious tone
emphasizing syphilis rates and consequences
of syphilis
“Get the facts out;educate people. You have to
be blunt with them and correct the idea that
syphilis is gone.”
“There is nothing funny about syphilis”
Suggested messages, tones,
spokespersons (Cont’d.)
 Elected Officials preferred local
community leaders
 Opinion Leaders: Local and nat’l
celebrities, political leaders as
spokespersons
 CBOs emphasized the importance of
clergy’s role, and culturally sensitive
messages
 Suggested messages, tones,
spokespersons (Cont’d.)
HCP: Medical authority (Surgeon General, CDC,
professional organizations)
 Need for clarification of what syphilis

elimination means
 Simple treatment protocols and guidelines

 Info. on prevalence, signs, symptoms

 Relevance of syphilis to one’s practice

 Guidance on sexual history taking

Findings
D) Preferred method/channels of
receiving information
 CBOs and community leaders: Internet
and mass media, newsletters
 HC providers: Professional literature and
meetings, newsletters, other HCPs
 Elected Officials: Internet, mass media,
newsletters from authoritative sources
Summary of Findings

Main 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
about syphilis among selected target
audiences and in general public
BY:
Developing fact-filled, culturally sensitive
communication materials with a serious
tone for all target audiences
AND
facilitate community mobilization
A Sampling of SEE Toolkit
Materials
 Community Mobilization Guide
 Various brochures
 Camera-ready print ads

 Syphilis pocket guide and sexual

history taking pamphlet for health
care providers (HCPs)
 A Sampling of SEE Toolkit
Materials (cont.)

 Tip sheets

 Contact lists (Local CBOs and Policy

Makers)

 MSM-specific materials
 Availability of SEE Toolkit
Materials (Cont’d.)
 On the web:

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

 CDC Warehouse (Order by phone or via

the order form online)
 In summary…
For each target audience segment

 Identify benefits that matter to the target audience

 Consider ALL costs and barriers to the suggested behaviors

 Also consider the WIIIFM

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

easy action steps based on the stage of readiness

 Deliver messages in a clear, uncluttered and uniform manner

 For message delivery, involve a multi-pronged “systems

approach” with plenty of repeat messaging
CDC’s Commitment to You

 Training

 Technical assistance
 THANK
YOU!

Wrap up & Questions

Exercise Three

What’s next?