A government social marketing initiative in the north-east of England is seeking to reduce adolescent drug use and associated harm through a social cognitive schools and media programme (Home Office, 1998; MacKintosh et al., 2001). Drugs prevention literature indicates that current drug use status is an important variable which should be addressed in designing such programmes: the most effective interventions are those which, among other things, target users and non-users separately, with product offerings tailored to their current experiences and attitudes regarding drugs (Bandy and President, 1983;
Makkaiet al., 1991; Werch and DiClemente, 1994). However, had the programme developed a range of intervention components for young people already using drugs – who could in principle have been identified from extensive baseline data gathered on the target population before the programme began – it would never have secured the necessary co-operation of the schools, communities and parents who understandably would not have wanted their young people to be labelled as drug users (Stead et al., 1997a). Building and managing the relationship with these key gatekeepers and stakeholders was critical to the programme’s existence. The only option was to adopt a non-stigmatizing undifferentiated targeting strategy – offering the programme to all young people in all schools in the area.
Table 27.2 Major segmentation approaches
Characteristics Attributes Social marketing
Personal Demographic Age, Gender, Social class, Ethnicity, Family profile, Income, Employment
+ Health status
Psychographic Lifestyle, Personality + Health beliefs, motivation, locus of control
Geodemographic Geographical area, Neighbourhood type
+ Residence in disadvantaged area
Behavioural Usage, Loyalty, Response,
Attitudes
+ Health behaviour, Stage of Change
Benefits Benefits sought + Barriers
established. However, its relevance is clear.
Many of the major causes of mortality and morbidity in the developed world are lifestyle related, and health promoters have in the last 20 years or so reoriented their efforts from a focus on specific disease prevention to a focus on the lifestyle risk factors which impact on a wide range of disease – exercise, nutrition, smoking, drinking, safer sex. Knowing that middle aged C2DE men are at most risk of coronary heart disease is not sufficient: the social marketer needs to understand why some men in this group are motivated to engage in lifestyle behaviours which are protective of their health and why others are not, and to develop product offerings accordingly. Social marketers need to adopt segmentation approa- ches that acknowledge the complex psycho- social determinants of health behaviour (Slater, 1995).
Information which enables the social mar- keter to distinguish between targets on the basis of their values, beliefs and norms is also important. Various behaviour change theories, such as the theory of reasoned action (Fishbein and Ajzen, 1975), social learning theory (Ban- dura, 1977, 1986) and social cognitive theory (Maibach and Cotton, 1995) have posited that traits such as attitudes and norms influence adoption of health and risk behaviours (e.g.
Manstead, 1991; Fishbein et al., 1997). Increas- ingly, these theories are being adopted as the theoretical basis for segmented social market- ing interventions (e.g. Fishbein et al., 1997).
Geodemographics
This is the classification of people on the basis of where they live (Sleight, 1995). The geo- graphical distribution of much ill-health (e.g.
Whitehead, 1992; Smith, 1997a) and the cluster- ing of health and social problems in certain areas, particularly urban areas of deprivation (e.g. Glasgow City Council, 1998), suggest that this approach can contribute usefully to social marketing. Obvious applications of geodemo- graphics to social marketing are in selecting
channels for health advertising, identifying locations for health services, and direct mail.
A number of syndicated geodemographic information systems have been developed in the commercial marketing context (Sleight, 1995). While these are already proving to be useful to social marketers, public health is very often most concerned with geodemographic segments who are of least interest to many commercial marketers – the very poor. Classifi- cation systems such as ACORN and MOSAIC provide socio-economic indicators of small areas, and these can be combined with classifi- cation systems such as the Carstairs index for Scotland (McLoone, 1991) which provide a measure of affluence or deprivation within postcode sectors. Measures of deprivation, such as housing tenure, telephone and car owner- ship, and financial status, can also be incorp- orated to provide accurate targeting data for social marketers.
Behavioural characteristics
In commercial marketing, behavioural charac- teristics may include volume of product usage – heavy, medium, light users – transactional history (previous usage), readiness to use, responsiveness, and attitudes towards usage (Wilkie, 1994).
Again, these categories are of relevance to social marketing. Social marketers planning an initiative to encourage participation in a health promotion clinic could segment on the basis of current health behaviour, previous usage of health clinics, frequency of GP consultation and so on. Health service records held by GP practices and health authorities provide valu- able information on patients’ previous transac- tions with health services as well as on their current health behaviours (e.g. smoking, drink- ing, use of medicines).
A particularly important behavioural char- acteristic in social marketing is the concept of readiness to change. The transtheoretical model of behaviour change (Prochaska and DiCle- mente, 1983) posits that behaviour change is
not a discrete event, but a process that occurs through several stages: pre-contemplation, con- templation, preparation, action and mainte- nance. The model was initially developed to explain smoking cessation behaviour, but has since been applied to smoking, alcohol and drug addiction, weight control and eating disorders, safer sex behaviour, exercise partici- pation, mammography screening, sunscreen use, and other health behaviours (Prochaska et al., 1994). During pre-contemplation, individ- uals either do not want to change their behav- iour or are unaware of its consequences for themselves or others. During contemplation, they begin to think about the costs and benefits of changing their behaviour. In preparation, the individual is motivated to change, and makes initial mental and practical preparations. Dur- ing the action stage, the individual is in the process of changing, following which he or she may proceed to either maintenance or relapse to an earlier state.
The model is helpful in two ways. First, it emphasizes that behaviour change is complex and multi-staged, and that relapse may occur a number of times. Second, it provides a frame- work for designing appropriate messages and support interventions (see Figure 27.3). By understanding the target audience’s readiness to change, the social marketer can develop strategies appropriate to the group’s needs and wants (Werch and DiClemente, 1994). For exam- ple, Andreasen (1995) proposes a series of marketing tasks for each stage of change. During pre-contemplation, the marketer must create awareness and interest in the behaviour, and it may be necessary to try and shift value and belief systems. During contemplation, the mar- keter must persuade and motivate to enhance the benefits of the behaviour (e.g. mobilize social influence) and reduce the costs associated with change (time, effort or money). Andreasen deals with preparation and action stages simultane- ously, and proposes that marketers must focus on creating action by, for example, focusing on skills training exercises or confidence building.
Finally, to maintain change, social marketers
should consider reducing cognitive dissonance through reinforcement.
Benefit characteristics
Classification by benefit sought is specific to the particular product being marketed; for exam- ple, the market for cigarettes could be seg- mented on the basis of those who seek status (e.g. smokers of exclusive brands of cigarettes and cigars), those who need a cost-effective nicotine fix (e.g. established smokers), and those who seek reassuringly mainstream smokes (e.g. adolescents).
This type of segmentation analysis seems at first glance to have less relevance in social marketing than the preceding three types.
Social marketing targets very often do not welcome efforts to ameliorate their health and social circumstances (Levy and Zaltman, 1975), and if they are fundamentally resistant to changing behaviour may see no benefits in the messages and support being offered to them to facilitate this process. However, social market- ers still need to think in terms of consumers and the benefits they seek rather than products.
For example, Case 6 shows how benefit seg- mentation enhanced an attempt to influence oral health in Scotland. The target (retailers) was segmented on the basis of function (mar- keting staff, space planners and buyers) and different product benefits identified for each.
This case also illustrates how important seg- mentation is when targeting not only the final consumer, but those decision makers who can influence their operating environment.
Another example is exercise. A compar- ative study into younger and older people’s perceptions of exercise (Stead et al., 1997b) found that different subgroups perceived dif- ferent benefits in the product ‘physical activity’:
some, typically younger men, wanted to com- pete against an opponent, while others aimed to better their own personal targets – to run faster or swim further, for example. A third group was most concerned with body image, and a fourth enjoyed the prospect of meeting
new people, maintaining friendships and just
‘getting out’.
These benefit segments formed the basis of a targeted strategy to encourage physical activity.
The same research also examined per- ceived and actual barriers to participation in exercise. Again, it was possible to differentiate between segments whose lifestyle, health, health beliefs, personal circumstances and awareness prevented their involvement in exer- cise, to develop appropriate communication
and support strategies for each segment. Given the type of ‘negative demand’ social marketers often face (see ‘Departures from commercial marketing’ above), barrier segmentation is per- haps of particular value to social marketers.
It also suggests that social marketers should go one step further and, despite the potential philosophical problems noted above, segment their markets in terms of need. As well as bringing the standard segmentation benefits, this will ensure that limited resources are used most efficiently.