The reach and impact of social marketing and reproductive health communication campaigns in Zambia

Background  

Like many sub-Saharan African countries, Zambia is dealing with major health issues, including HIV/AIDS, family planning, and reproductive health. To address reproductive health problems and the HIV/AIDS epidemic in Zambia, several social marketing and health communication programs focusing on reproductive and HIV/AIDS prevention programs are being implemented. This paper describes the reach of these programs and assesses their impact on condom use.     

Audience segmentation in worksite health promotion: a procedure using social marketing concepts

This study demonstrates how techniques of audience segmentationcan be combined with principles of social marketing to enhanceplanning for worksite health promotion (WHP). Using data froma mail survey of university employees, ‘future participation’was regressed on three blocks of (1) demographic, (2) behavioraland (3) psychosocial variables. Each block contributed significantlyto explaining variance in the dependent variables. All threeblocks together explained 40% of the variability in future participationand so all variables in the regression formed the basis forthe segmentation procedures. Six substantive clusters were identifiedthat differed along demographic, behavioral and psychosocialdimensions as well as work location. Analyses of variance demonstratedthat clusters were significantly related to differences on severalvariables important to planning and can be used to provide usefulinformation for program planning by associating group membershipwith specific preferences for different types of programs andchannels for delivery.     

Social marketing and communication in health promotion

Communication is a central aspect of health promotion and theopportunity for mass communication makes the ‘media’a popular option amongst health promoters. The media in thiscontext includes any non-personal channels of communication,from leaflets to television commercials to teaching packs. Thesechannels can be employed directly using deliberately designedmedia materials. Alternatively, they may be used indirectlyby stimulating editorial interest and comment on a particularissue. This paper will make some suggestions for improving theuse of the media in health promotion. In seeking guidance about how to make best use of the media,health promoters can turn to a number of disciplines, includingeducation, medicine, social psychology and communication theory.Another obvious source of insights is commercial marketing,where purposeful media communication, most apparent in the formof advertising, is in continuous use. it is this source of advicethat we want to examine here. In recent years much has been written about the applicationof commercial marketing approaches to social issues-so calledsocial marketing. This paper will begin by examining the originsof ‘social marketing’. it will then discuss itskey concepts and consider how these might help health promoterscommunicate more effectively. However, to interest active health promoters, the discussionneeds to progress beyond ideas and concepts, beyond theory anddemonstrate practical benefits that social marketing can providein real life situations. The paper will therefore continue byexamining the case histories of a number of media based healthpromotion campaigns and illustrate how the most basic of socialmarketing insights, consumer orientation, has contributed tothem.     

Account planning: applying an advertising discipline to health communication and social marketing

As health marketers seek new models to design campaigns, the advertising discipline of account planning offers an approach that can improve campaign development. The underlying principle of account planning is to bring the consumer perspective to all phases of campaign development, primarily through qualitative formative research. Account planners design the overall communication strategy and contribute to creative development of individual executions. The creative brief, a primary tool of account planning, is especially useful in conceptualizing campaigns. This report discusses the history and approach of account planning, followed by an example of account planning in the design of a social marketing campaign.     

An audience-channel-message-evaluation (ACME) framework for health communication campaigns

Recent reviews of the literature have indicated that a number of health communication campaigns continue to fail to adhere to principles of effective campaign design. The lack of an integrated, organizing framework for the design, implementation, and evaluation of health communication campaigns may contribute to this state of affairs. The current article introduces an audience-channel-message-evaluation (ACME) framework that organizes the major principles of health campaign design, implementation, and evaluation. ACME also explicates the relationships and linkages between the varying principles. Insights from ACME include the following: The choice of audience segment(s) to focus on in a campaign affects all other campaign design choices, including message strategy and channel/component options. Although channel selection influences options for message design, choice of message design also influences channel options. Evaluation should not be thought of as a separate activity, but rather should be infused and integrated throughout the campaign design and implementation process, including formative, process, and outcome evaluation activities. Overall, health communication campaigns that adhere to this integrated set of principles of effective campaign design will have a greater chance of success than those using principles idiosyncratically. These design, implementation, and evaluation principles are embodied in the ACME framework.     

Steps in planning and developing health communication campaigns: a comment on CDC's framework for health communication.

This reviews the efforts of the Centers for Disease Control and Prevention to integrate effective health communication into its programs that are designed to change behaviors. Although the 10-step framework for developing and implementing the Centers'' health communication programs is both practical and comprehensive, it is suggested that a reversal of steps 2 and 3 is a more logical sequence, is more consistent with the literature and, more importantly, could avoid misapplications of the framework by less experienced practitioners. Comment is also made on the dynamic nature of health communication planning and development, a point not made explicit in the Centers'' framework.     

Theory and practice in health communication campaigns: a critical interrogation

In recent reviews of the body of work on health campaigns, communication scholars discussed the importance of reflective thinking about the capacity of campaigns to effect change; this reflective thinking is especially important in the realm of the increasing gaps in society between the health rich and the health poor and the increasing marginalization of the poorer sections of society. This article critically reviews 3 central theories of health communication campaigns that represent the dominant cognitive approach: theory of reasoned action, health belief model, and the extended parallel process model. After articulating the limitations of these theoretical approaches, the article summarizes new directions in theory, methodology, and application of health communication campaigns targeting marginalized populations.     

Specification and misspecification of theoretical foundations and logic models for health communication campaigns

While increasingly widespread use of behavior change theory is an advance for communication campaigns and their evaluation, such theories provide a necessary but not sufficient condition for theory-based communication interventions. Such interventions and their evaluations need to incorporate theoretical thinking about plausible mechanisms of message effect on health-related attitudes and behavior. Otherwise, strategic errors in message design and dissemination, and misspecified campaign logic models, insensitive to campaign effects, are likely to result. Implications of the elaboration likelihood model, attitude accessibility, attitude to the ad theory, exemplification, and framing are explored, and implications for campaign strategy and evaluation designs are briefly discussed. Initial propositions are advanced regarding a theory of campaign affect generalization derived from attitude to ad theory, and regarding a theory of reframing targeted health behaviors in those difficult contexts in which intended audiences are resistant to the advocated behavior or message.     

The impact of mass communication campaigns in the health field

This article analyzes a series of health education projects that used the mass media to change behavior. First, the article describes how persuasion theories are used to maximize impact in mass communication campaigns. Second, this paper discusses theories of social psychology used in such campaigns. One such theory, cognitive dissonance, explains changes at the level of attitudes, beliefs and opinion. Another theory, social learning, defines strategies of behavior changes. A third theory, concerning diffusion of innovations, helps understand the network of interpersonal relationships essential for the adoption of any innovation. McGuire's inoculation theory suggests strategies to aid resistance to harmful environmental influences (e.g. smoking, excessive drinking, etc.). Third, this work reviews public health campaigns that have used one or more of these theories of social psychology. The first project, dealing with smoking behavior cessation and prevention, mainly used strategies of interpersonal communication for inoculating and modeling useful behavior in order to resist social pressures favorable to smoking. The second project, designed to prevent alcoholism, used the mass media primarily. The objective of this campaign was to obtain changes in knowledge, attitude and behavior in the public through modeling desirable behaviors over public service announcements. The third campaign, a heart disease prevention program, used a combination of mass media and interpersonal communication to achieve changes in lifestyle of the population. Finally, this article describes limitations in using mass media in behavior change health programs.     

Critiquing fetal alcohol syndrome health communication campaigns targeted to American Indians

It is widely recognized American Indians and Alaska Natives have suffered from far worse health status than that of other Americans. Health communication campaigns directed to American Indians and Alaska Natives and their outcomes must be grounded in an understanding of the historical and ongoing marginalization and cultural dislocation of these groups. The authors draw upon the specific case of health communication campaigns to reduce cases of fetal alcohol syndrome among American Indians and Alaska Natives. Counteracting stereotyping of American Indians and alcohol consumption by mainstream American popular culture and mediated discourses, coverage of fetal alcohol syndrome in the media is assessed. The study analyzes 429 American Indian news articles from 1990 to 2010. Mainstream American and American Indian media should cover health concerns such as fetal alcohol syndrome more extensively. Researchers, health communication campaign developers, health policy makers, and mainstream media must be knowledgeable about American Indian and Alaskan Native identity, cultures, and history, and diversity across Nations. Last, and most important, health communication strategists and health policy makers must welcome American Indians and Alaska Natives to take leadership roles in communicating culture- and Nation-specific health campaign strategies to eliminate health disparities.     

Overcoming methodological challenges in evaluating health communication campaigns: evidence from rural Bangladesh

In this study, we examine the effectiveness of the Smiling Sun multimedia health communication campaign in encouraging women to use family health services in rural Bangladesh. We control for endogenous program placement and address the potential endogeneity of self-reported campaign exposure in health-behavior equations by estimating a set of exposure, contraceptive-use, and antenatal-care equations by full information maximum likelihood (FIML). We find that evaluation methods that do not take into account these nonrandom characteristics of communication and program exposure may produce underestimates of program benefits. Relative to the exposure effect of 3.7 percentage points in the simple model of contraceptive use, the exposure effect in the FIML model is a larger 5.5 percentage points, corresponding to as many as 40,000 additional contraceptive users. We conclude that evaluations of health communication campaigns would benefit from methods such as estimation by FIML that address nonrandom exposure and program targeting.     

Evaluating MyPlate: an expanded framework using traditional and nontraditional metrics for assessing health communication campaigns

MyPlate, the icon and multimodal communication plan developed for the 2010 Dietary Guidelines for Americans (DGA), provides an opportunity to consider new approaches to evaluating the effectiveness of communication initiatives. A review of indicators used in assessments for previous DGA communication initiatives finds gaps in accounting for important intermediate and long-term outcomes. This evaluation framework for the MyPlate Communications Initiative builds on well-known and underused models and theories to propose a wide breadth of observations, outputs, and outcomes that can contribute to a fuller assessment of effectiveness. Two areas are suggested to focus evaluation efforts in order to advance understanding of the effectiveness of the MyPlate Communications Initiative: understanding the extent to which messages and products from the initiative are associated with positive changes in social norms toward the desired behaviors, and strategies to increase the effectiveness of communications about DGA in vulnerable populations.     

Evaluating the role of social marketing campaigns to prevent youth gambling problems: a qualitative study

BACKGROUND: Gambling among adolescents is a growing public health concern. To date, social marketing as a strategy to address problem gambling among youth has not been widely used. METHODS: A qualitative study through the use of focus groups was conducted to explore adolescents' exposure to existing prevention campaigns and their message content and communication strategy preferences for a youth gambling social marketing campaign. FINDINGS: Participants prefer that youth gambling ads depict real-life stories, use an emotional appeal and portray the negative consequences associated with gambling problems. They further recommend illustrating the basic facts of gambling using simple messages that raise awareness without making a judgement. Participants caution against the "don't do it" approach, suggesting it does not reflect the current youth gambling culture. CONCLUSION: This study should serve as a starting point for the development of a gambling prevention social marketing campaign. Targeting variables and campaign strategies highlighted should be considered in the early stages of development and tested along the way.     

Social marketing and communication: changing health behavior in the third world

Abstract Development communication, particularly within the health sector, is relatively new and still shrouded in mystique. Many health planners and policy-makers in developing countries and elsewhere do not yet fully appreciate the role communication plays in primary health care interventions. Nevertheless, communication theory, embracing diffusion of innovations and social marketing, can make a significant contribution in improving health status. This paper explores, through an examination of the literature and the experience of a worldwide research and development project, the synthesis of development communication, diffusion, social marketing, and primary health care. It attempts to demonstrate the value of integrating these paradigms within the context of a public health communication model. Focusing on the use of radio and interpersonal communication, the paper describes model projects in India and Honduras and reveals through their example the role of communication in changing health behavior in Third World settings.