Case 3 Cervical screening: barriers to segmentation in social marketing
A public health department wishes to encourage women within a certain age range in the health authority area to attend for cervical screening. There are a number of possible ways in which this population can be segmented, including:
䊉 socio-demographic (social class, education, income, employment);
䊉 psychographic (beliefs regarding preventive health, fatalism, attitudes towards health services);
䊉 health behaviour (smokers/non-smokers etc.);
䊉 previous usage behaviour (attendance for screening); and so on.
From available secondary research into the characteristics of attenders and non-attenders for cervical and other screening (e.g. Thorogood et al., 1993; Austoker et al., 1997; Sugg Skinner et al., 1994), the public health department could make certain assumptions about the women most likely to respond positively to the programme: ABC1, well educated, in work, positive beliefs about ability to protect oneself from cancer, favourable attitudes towards health service and so on. If the screening programme were to be run as a profit-making service, this would be the segment to target. The screening agency could develop messages consonant with these women’s beliefs, deliver them through workplaces at which the women are most likely to be employed, utilize media most likely to be consumed by them, and so forth. However, the health authority’s objective is not to run the most profitable screening service possible, but to make the biggest possible impact on public health by reducing incidence of cervical cancer. To do this, the screening programme needs to reach those groups with the highest risk of cancer – the groups who, the same research shows, are the least likely to attend for screening.
infrequently, risky and highly self-expressive’
(Kotler, 1994), and the latter comprising items such as confectionery or cigarettes which are much more habitual. High involvement prod- ucts typically command careful consideration by the consumer (‘central processing’) and demand detailed factual information from the marketer. Low involvement products are con- sumed much more passively, with very limited (or no) search and evaluation (‘peripheral processing’), and simple advertising emphasiz- ing ‘visual symbols and imagery’ (Kotler, 1994) is called for.
Or, as Petty et al. (1988) expressed it, for high involvement products consumers are attracted by the tangible attributes of the products, the ‘steak’, but for low involvement purchases, consumers are more attracted by the intangible qualities or the ‘sizzle’.
Both the categorization scheme – high and low – and its marketing implications need to be extended in social marketing. Social marketing frequently deals with products with which the consumer is very highly involved (complex lifestyle changes such as changing one’s diet fall into this category). While high involvement can result in a motivated and attentive con- sumer, higher involvement may be associated with feelings of anxiety, guilt and denial, which inhibit attempts to change. At the other extreme, social marketers might seek to stim- ulate change where there is very low or no involvement – for example, persuading Scots to save water. Thus, taking the example of smok- ing, involvement can be divided into at least four levels:
䊉 Very high, or hyper involvement– the smoker who can’t quit despite deep concern about the consequences of continuing, and is typically in a state of defensive denial.
䊉 High involvement– the smoker who is motivated and struggling with some success to quit.
䊉 Low involvement– the smoker who knows of the consequences of smoking but does not care enough about them to make the decision to quit.
䊉 Very low involvement– the smoker who is unaware of the health risks and has never considered quitting.
In addition, there may be an additional cate- gory of negative involvementamongst those who see the health risks and forbidden nature of tobacco as part of its attraction.
The type of campaign that will address these categories cannot be determined by sim- ply applying marketing’s rubric that ‘the greater involvement, the greater the need for factual information’. For example, very low involvement consumers may well respond well to factual information, and hyper involvement consumers to emotional messages offering reas- surance and empowerment.
More varied competition
Social marketers, like their commercial counter- parts, must be aware of their competition (Andreasen, 1995). The most obvious source of competition in social marketing is the con- sumer’s tendency to continue in his or her current behavioural patterns, especially when addiction is involved. Inertia is a very powerful competitor.
Other sources of competition involve alter- native behaviours. For example, time spent donating blood is time which the consumer could spend doing other more enjoyable, more convenient and more personally beneficial activities.
Competitive organizations include other health promoters, educators or government organizations trying to use similar methods to reach their target audiences. For example, the typical doctor’s surgery in the UK displays such a plethora of leaflets and posters that any one message or idea stands little chance of being noticed. Social marketers must then be innovative and careful not to overwhelm their target audience.
Finally, one of the most serious forms of competition comes from commercial market- ing itself, where this markets unhealthful or
unsocial behaviours. The most obvious exam- ples are the tobacco and alcohol industries.
In summary, therefore, social marketing differs in a number of ways from commercial marketing. These differences have a big impact on implementation, and the next two sections look specifically at how this is manifested in segmentation and the use of the marketing mix.
Segmentation in social marketing
The particular characteristics of social market- ing create a number of barriers to segmentation and a need for specialized segmentation criteria (see also Chapter 10). These phenomena are discussed in turn.
Barriers to segmentation in social marketing
Despite the importance of segmentation, many social marketing programmes employ ‘undif- ferentiated target marketing’ (Andreasen, 1995, p. 174), treating the target group as a relatively homogeneous mass for whom a single strategy is developed, or adopting relatively basic seg- mentation approaches based on simple demo- graphic variables such as age or gender (see Chapter 10). This limited application of seg- mentation is attributable to a number of factors:
䊉 Ambitious objectives. Social marketing is typically concerned with ambitious objectives (e.g.
reducing incidence of dental caries) which involve targeting very large populations (e.g. all parents of children under five).
䊉 The operating environment. Social marketing organizations are much more subject to political and policy demands than commercial organizations. A national body may be required by statute to deliver a programme to the whole population, or it may be local public health policy to target an initiative at a whole
population subgroup (for example, in the UK mammography screening programmes are required to target all women over 50). In this environment, it is difficult for a social
marketing organization to concentrate resources on specific market segments even where this would increase the likelihood of effectiveness.
䊉 Culture. There may be cultural and philosophical resistance to the idea of segmentation (Bloom and Novelli, 1981) – for example, it may be seen as unethical for a health professional, in offering a product to one particular market segment, to withhold it by implication from another. Alternatively, segmentation on the basis of need can lead to accusations of discrimination and
stigmatization.
䊉 Resources. Finally, social marketing organizations may lack an understanding of the potential of more sophisticated segmentation approaches, the information on which to base such approaches, or the skills and resources to implement them (Andreasen, 1995; Currence, 1997).
Some of these barriers are surmountable, par- ticularly those in the fourth category. Social marketers can acquire better understanding of the potential and uses of segmentation, and as social marketing evolves, lessons learnt will disseminate through the field, as in commer- cial marketing. Useful segmentation case stud- ies such as the 5-a-Day initiative to promote fruit and vegetable consumption (see Case 4) and the American Cancer Society’s campaign to promote mammography screening, which utilized sophisticated database information (Currence, 1997), are already contributing to this.
In addition, social marketers may have access to other valuable – and free – databases themselves. For example, in the UK, health promoters may be able to use the National Health Service patient register, either on its own or combined with additional information of the sort outlined in Case 4.
However, the other barriers to segmenta- tion are more fundamental. For example, as already discussed, because of the nature of their objectives, social marketers have less freedom than commercial marketers to choose target segments.
Ethical considerations may also prevent a social marketer from targeting a particular segment, even where this segment is identifi- able, accessible and the most in need. Case 5 illustrates how a government drugs prevention initiative using social marketing principles was unable overtly to target young drug users for fear of stigmatization. In this instance, a partial solution was found by combining blanket targeting with self-selection, whereby young people with particular interests and needs could ‘opt in’ to certain components, such as peer-led workshops (MacKintosh et al., 2001).
The assumption is that small groups with similar interests and experiences regarding drugs will naturally gravitate towards suitably tailored offerings.