A recent attempt to redress the appalling oral health record of five-year-old children in west, central Scotland examined one immediate environmental influence on confectionery consumption – the availability of candy at supermarket checkouts.
Scotland is renowned for its sweet tooth and Scottish children consume 28 per cent more confectionery than their counterparts in the rest of the UK. Candy is frequently used to reward or pacify children, who come to associate comfort or praise with these sweet and familiar foodstuffs, thereby reinforcing their liking for them. Children often successfully ‘pester’ their parents for candy in supermarkets and shops. The strategic positioning of candy at the till-points greatly exacerbates this problem.
Research was conducted to inform a policy which would address the problem of confectionery at till-points. An audit of store policy and in-depth interviews with policy makers was conducted. This work identified the group of decision makers within each organization and the criteria for making space allocation decisions.
It was found that space planning decisions were rigorous and predictable: confectionery was placed at the point of sale to maximize profits from the available space. Three broad groups with an interest in confectionery policy were identified – marketers, space planners and buyers – and the barriers to adopting a confectionery policy reflected each party’s needs. The research concluded that any initiative must demonstrate customer loyalty (to satisfy marketers), be profitable (to satisfy space planners), and offer long-term profitability for the products and alternative merchandising arrangements (to satisfy buyers). As a result, possible initiatives to reduce confectionery from the immediate environment are being explored, including endorsement schemes, community partnerships and public opinion surveys.
Marketing staff Space planners Buyers
Exchange Customer loyalty Profitability Supply relationships Intervention Endorsement schemes Economic benefits Long-term profitability
Public opinion surveys Competitive advantage Alternative merchandising strategies
Need can be classified in a number of ways. Andreasen (1995) suggests that three factors should be considered: problem inci- dence (rates of need or problem per segment), problem severity (severity of need or problem per segment), and ‘population defencelessness’, ability per segment to cope with the problem or need (p. 177).
The social marketing mix
The marketing mix (see Chapter 11) also has to be adapted for use in social marketing. This section examines the relevance and application of each element of the mix (see Table 27.3).
Product
As described above, social marketing products are frequently intangible and complex behav- iours. This makes it difficult to formulate simple, meaningful product concepts (Bloom and Novelli, 1981). To take an example, ‘reduc- ing one’s fat intake’ is a complex behaviour in a number of ways: it involves a change in food choice, menu design, shopping behaviour, food preparation, personal habits, family routines, wider social norms and so on. Further, it is a behaviour which needs to be practised not just once, but repeated and sustained over a long period of time (Kotler and Roberto, 1989). As a first step towards formulating product con- cepts, social marketers need to identify and
Table 27.3 The social marketing mix
Tool Types
Product The offer made to target adopters Adoption of idea (belief, attitude, value) Adoption of behaviour (one-off, sustained) Desistence from current behaviour Non-adoption of future behaviour Price The costs that target adopters have to
bear
Psychological, emotional, cultural, social, behavioural, temporal, practical, physical, financial
Place The channels by which the change is promoted and places in which the change is supported and encouraged
Media channels Distribution channels Interpersonal channels Physical places
Non-physical places (e.g. social and cultural climate)
Promotion The means by which the change is promoted to the target
Advertising Public relations Media advocacy Direct mail Interpersonal Adapted from Kotler and Roberto (1989, p. 44).
clarify their product attributes. In commercial marketing, product attributes range on a con- tinuum from the tangible (colour, taste, shape, size, packaging, performance) to the intangible (brand, image, status). Social marketing prod- uct attributes are largely situated at the intan- gible end of this continuum. Some potential classifications of product attributes are sug- gested below:
䊉 Trialability– Can the behaviour be tried out beforehand before permanent or full adoption (e.g. wearing a cycling helmet)?
䊉 Ease– How easy or difficult is it to adopt the behaviour (wearing a seat belt versus giving up smoking)?
䊉 Risks– What are the risks of adopting the behaviour?
䊉 Image– Is the behaviour attractive or unattractive?
䊉 Acceptability– Is the behaviour socially acceptable?
䊉 Duration– Is the behaviour to be practised once or repeatedly? Is it to be sustained over the short or long term?
䊉 Cost– Does the behaviour have a financial cost or not (eating a healthier diet may involve more expense, drinking less alcohol does not)?
Analysing product attributes in this way helps social marketers to formulate meaningful and communicable product concepts. For example, in addressing teen smoking, research may suggest that image is a key issue, rather than the avoidance of health risks. The social mar- keter can then put particular emphasis on producing non-smoking options that are cool and trendy – such as freedom of choice – rather than ones that major on the health benefits of quitting.
A second major potential problem with the product for social marketers is flexibility. It is commonly argued that social marketers have less flexibility than commercial marketers in shaping their product offerings (Bloom and Novelli, 1981), for a number of reasons. First, the resources, technology and skills to develop
alternative products may not be as readily available to the social marketer as they are in commercial marketing, so the range of product innovation options is smaller. Fox and Kotler (1980) note that the anti-smoking social mar- keter seeking to develop the most attractive substitute product really should invent a safe cigarette, but is constrained by technological, financial and political factors. Second, product offerings may be constrained by political fac- tors outside the social marketer’s control. Gov- ernment policy or local public health strategy may dictate that only one behaviour or way of practising the behaviour should be endorsed.
For example, harm minimization, as opposed to abstention, solutions to the problem of drug abuse may be unacceptable in certain political climates.
Third, social marketing’s offerings often appear to be ‘absolutes’ in that the social or health benefit pertains only if the behaviour is adopted wholesale (so partial or temporary adoption is not possible) or is adopted in one particular form (so different forms of the behaviour cannot be marketed to different adopter groups). An example of such an abso- lute is smoking, where only total abstinence produces meaningful health benefits, as opposed to drinking, where different modera- tion messages can be promoted. Immunization and fluoridation of the public water supply are also examples of absolutes.
However, many other social marketing offerings are ‘relative’, in that a health or social benefit accrues even if the behaviour is adopted only in a moderate way. Exercise by elderly people is one example (Stead et al., 1997b).
Nutrition is another instance where social marketers can develop a wide range of product offerings for different target segments: the fruit and vegetable consumption programme out- lined in Case 4 above is one such example.
Furthermore, even in the case of absolute products, although social marketers may have limited control over the fundamental aspects of their offerings, they do, like commercial mar- keters, have potential control over how their
products are perceived and positioned. For example, in Case 2 above, different water fluoridation products were offered to local councils and water companies.
Price
Only a few of social marketing’s products have a monetary price (condoms are an obvious example: see Harvey (1997) and Dahl et al.
(1997) for discussion of pricing strategy in contraceptive social marketing.
However, there are almost always costs associated with behaviour change which act as obstacles to marketing social change; these may be financial, time, embarrassment, effort, iner- tia, pain, perceived social exclusion (e.g. Mar- teau, 1990). However, there should be benefits also. These may be tangible and personal benefits such as a longer life or intangible, societal benefits such as a better environment.
Rangun et al. (1996) argue that there are four broad types of social marketing initiatives according to this cost-benefit analysis:
1 Low cost and tangible, personal benefits, e.g.
cervical screening for women. In this case the target perceives clear, direct benefits to themselves. As change is easy, relative to the four other types of initiative, communication and information are key elements of the social marketing strategy.
2 Low cost and intangible, societal benefits, e.g.
recycling programmes. Here the behavioural change is relatively easy to adopt, but the benefits are not perceived to be as relevant to the individual. The authors argue that
convenience is the key to this type of programme, and the ultimate benefit to themselves and to society should be stressed.
3 High cost and tangible, personal benefits, e. g.
smoking cessation programmes. In this case there is a very clear personal benefit to adopting the suggested behaviour, but the costs associated with doing so are high. It is suggested that the social marketer adopts a strong ‘push marketing’ approach, supported by
communications campaigns and community level initiatives.
4 High cost and intangible, societal benefits, e.g.
CFCs in aerosols. This is clearly the hardest type of behaviour change to induce, as the costs are high and the benefits are hard to personalize and quantify. In this case, it may be necessary to adopt de-marketing approaches, use moral persuasion or social influence.
Place
Kotler and Zaltman (1971) suggest that place should be defined in social marketing as encompassing distribution and response chan- nels, and ‘clear action outlets for those moti- vated to acquire the product’ (p. 9). Where there is a communications element to a social market- ing initiative – for example, television advertis- ing, outdoor advertising, direct mail, health education leaflets – place applies to the media channels through which messages are to be delivered. Place can also apply to distribution channels where a social marketing programme has a tangible product base (e.g. condoms, needle exchanges). In these two instances and in social marketing programmes where a spe- cific service is being offered – for example, an antenatal class or workplace smoking cessation group – place variables such as channel, cov- erage, cost, timing (Kotler and Roberto, 1989), location, transport (Woodruffe, 1995) and acces- sibility (Cowell, 1994) are all relevant. For example, an initiative to increase uptake of cervical screening could reduce the costs of attending by manipulating the place variables of distance, time and convenience (offering screening at flexible times and in different locations).
In addition, many social marketing ini- tiatives depend on intermediaries such as health professionals, pharmacists, teachers and community workers to act as distribution chan- nels for media materials or as retailers for a particular behaviour change product – for example, GPs are often given responsibility for changing smoking and drinking behaviour
(Kotler and Roberto, 1989). Where intermedi- aries are to act primarily as distribution agents for media products, key variables such as accessibility and appropriateness should be considered. When these intermediaries have a more complex role (e.g. youth workers and teachers delivering a sex education curricu- lum), place variables such as source visibility, credibility, attractiveness and power (Percy, 1983; Hastings and Stead, 1999) should guide the selection of appropriate agents and inform the sort of support and training which is offered to them. For example, the drugs preven- tion literature has examined the relative merits of teachers, youth workers, police and peers as delivery channels for drugs prevention mes- sages (e.g. Bandy and President, 1983; Shiner and Newburn, 1996).
Social marketers are often dependent on the goodwill and co-operation of intermedi- aries for access to their end targets. This is particularly the case when dealing with sensi- tive health issues or with vulnerable groups such as young people, where there is usually a need to communicate not only with young people themselves, but also with key groups such as parents, teachers and politicians. These groups may act as ‘gatekeepers’, controlling or influencing the distribution of a message to a target group, or as ‘stakeholders’, taking an interest in and scrutinizing the activities of the prevention agency (McGrath, 1995). If an initia- tive is to be effective, it needs to satisfy the information and other needs of these two groups, and to maintain their support. Commu- nicating with gatekeepers and stakeholders is therefore just as important as communicating with the direct target group, and it should be approached in the same way in order to be effective (Hastings and Stead, 1999).
In Figure 27.2 above, one category of social marketing objectives is concerned with influ- encing policy and social norms. Here, ‘place’
becomes the centres of influence on public opinion and policy. In this context, media advocacy is likely to become particularly important (see below).
Promotion
Of the four marketing mix tools, promotion has received the most attention in social marketing.
Indeed, the prominence of social advertising in social marketing practice and literature has contributed to a tendency among non-market- ers to perceive the two as synonymous (Stead and Hastings, 1997; Sutton, 1991; Andreasen, 1994). In turn, this perception has given rise to criticisms of social marketing as ineffective because media interventions alone are deemed to be insufficient to change behaviour (Tones, 1994), expensive and difficult to do well (Bloom and Novelli, 1981; Stead and Hastings, 1997), and lacking new insights (Tones, 1994).
Three decades of mass media social adver- tising campaigns on smoking prevention, smoking cessation, exercise, nutrition, drug use, safer sex and other health issues have refined theoretical and practical understanding of how communication campaigns should be developed, designed, targeted, implemented and evaluated in order to have the best impact on public awareness, opinions and behaviour (e.g. Atkin and Freimuth, 1989; Backer et al., 1992; Flay, 1987; Hastings and Haywood, 1991;
Leathar and Hastings, 1987; Maibach and Cot- ton, 1995; Reid, 1996; Slater, 1995; Solomon, 1989; Worden et al., 1996). The conclusions are broadly in accord with mainstream marketing communication theory, so require no repetition here (see Chapter 17).
However, two aspects of social marketing communication do warrant further examina- tion: branding and media advocacy. The first because it is underdeveloped in the social sector and would benefit from further thought by mainstream marketers, and the second because it is well advanced in social marketing and therefore may provide some useful insights.
Branding
In commercial marketing, branding provides a crucial means of enhancing the product. Brands are deliberately designed to hone the emotional
benefits of the product, thereby adding value and encouraging consumption and loyalty (see Chapter 15).
Similar thinking can be applied in social marketing. For example, Lefebvre (1996) argues that all health communications have an emo- tional dimension – a ‘personality’ or ‘tonality’ – whether the health promoter intends it or not.
The message, channel and execution all contrib- ute to this. He cautions that health commu- nicators – just like their commercial counter- parts – must use research, design and careful targeting to ensure that the tonality matches the needs of their target audience.
Leathar (1980) and Monahan (1995) endorse the notion that health communicators should actively promote positive images about health.
For example, Monahan concludes her paper:
Positive affect can be used to stress the benefits of healthy behaviour, to give individuals a sense of control, and to reduce anxiety or fear.
All of these tactics are likely to enhance the success of a communication campaign.
On a more specific level, qualitative research conducted with pregnant women (Bolling and Owen, 1997) also emphasizes the importance of emotional communication, concluding that messages have to be sympathetic, supportive and non-judgemental. The primary need, the research suggested, is to establish a sense of trust.
Taking things a step further, social market- ers have also adopted the idea of branding.
Case 7 describes an attempt to brand positive health in Scotland during the 1980s. The brand was called ‘Be All You Can Be’.
Media advocacy
Another channel by which social marketers seek to influence public opinion and policy makers is via unpaid publicity in the mass media (Wallack et al., 1993; Chapman and Lupton, 1994). This involves negotiating with and satisfying media gatekeepers: newspaper editors and journalists, television and radio producers, advertising regulation authorities.