What are some of the best papers published in social marketing this past year? This list of 10 represent the best work I came across in journals outside of the social marketing journals – Journal of Social Marketing and Social Marketing Quarterly. Hopefully these papers will expand your awareness of what is happening in social marketing theory, research and practice. The papers are selected from journals outside of social marketing to remind us that social marketing is indeed a multi-disciplinary and far-reaching enterprise. The articles present a breath of interests (feeding programs for infants and young children; reducing obesity among youth; health disparities; global health concerns of HIV, reproductive health, child survival, malaria and tuberculosis; physical activity), insights and processes for improving social marketing programs (see Longfield et al and Venturini); different levels of intervention focus (macro-level social marketing programs and mobile health apps); and a critique of the ‘upstream-downstream’ metaphor (one that I believe since its use as a wake-up call to social marketers to focus on more than “blaming the victim’ has outlived it usefulness for social marketing theory and practice). For those new to these reviews, here are the links to the 2011, 2012, 2013 and 2014 selections – yes, I missed 2015.

Each of the papers is presented in an extended format that draws from their abstracts as well as details in the papers. I’m interested in your feedback, especially if you have other papers you would like to recommend (use the Comments box or email me). Happy 2017 and I hope that you find inspiration for your work in one or more of these papers.

Aaron et al. (2016). Assessing program coverage of two approaches to distributing a complementary feeding supplement to infants and young children in Ghana. PLoS One; Oct 18;11(10):e0162462. doi: 10.1371/journal.pone.0162462

Two strategies were evaluated for distribution of a food supplement to infants and young children in Ghana. The supplement was designed for point-of-use (home fortification) as a micronutrient powder added to children’s food. Each approach was designed to reach different populations: Delivery Model 1 for the rural poor and Delivery Model 2 for more affluent and more populous urban and peri-urban populations, with the aim of developing programming models suited for use as context-specific components of a scaled-up program. Delivery Model 1 was conducted in the Northern Region of Ghana and used a mixture of health extension workers (delivering behavior change communications and demand creation activities at primary healthcare centers and in the community) and petty traders recruited from among beneficiaries of a local microfinance initiative (responsible for the sale of the complementary food supplement at market stalls and house to house). Delivery Model 2 was conducted in the Eastern Region of Ghana and used a market-based approach, with the product being sold through micro-retail routes (i.e., small shops and roadside stalls) in three districts supported by behavior change communications and demand creation activities led by a local social marketing company. Both delivery models were implemented sub-nationally as 1-year pilot programs, with the aim of informing the design of a scaled-up program. Behavior change communication and demand creation activities included promotion of generic infant and young child feeding practices by Ghana Health Services (both models), cookery demonstrations and tastings (both models), billboards and posters (both models), house-to-house sales (specifically in model 1 as door-to-door hawkers were not targeted by model 2), songs-based and street-theatre based messaging (model 1 only), nutrition and health education (model 1 only), distribution of free samples to beneficiaries at health facilities and at points of sale (model 2 only), distribution of free samples to potential sales outlets (model 2 only), radio news and talk-shows (model 2 only), product placement in radio soap operas (model 2 only), community discussions with consumer groups (model 2 only), and mobile public address system (model 2 only). A series of cross-sectional coverage surveys was implemented in each program area. Results from these surveys show that Delivery Model 1 was successful in achieving and sustaining high (i.e., 86%) effective coverage (i.e., the child had been given the product at least once in the previous 7 days) during implementation. Effective coverage fell to 62% within 3 months of the behavior change communications and demand creation activities stopping. Delivery Model 2 was successful in raising awareness of the product (i.e., 90% message coverage), but effective coverage was low (i.e., 9.4% of children had been given the product in the past 7 days).The work reported here indicates that product availability and brand recognition, while necessary, are not sufficient to deliver effective coverage and impact. Future programming efforts should use the health extension / microfinance / petty trader approach in rural settings and consider adapting this approach for use in urban and peri-urban settings. Ongoing behavior change communications and demand creation activities are likely to be essential to the continued success of such programming.

Aceves-Martins, et al. (2016). Effectiveness of social marketing strategies to reduce youth obesity in European school-based interventions: A systematic review and meta-analysis. Nutrition Reviews; 74(5):337-351.

Thirty-eight publications were included in the systematic review and 18 of these studies were randomized controlled trials (RCTs) that were included in the meta-analysis. All RCTs reported using four social marketing benchmark criteria (SMBC): participant orientation, behavior, segmentation, and methods mix. All but one of the 12 RCTs included the competition domain, four based their intervention on a theoretical framework, two included the insight domain in their design, and five included the exchange of the intervention. Overall, the inclusion of at least 5 SMBC in the school-based interventions resulted in a reduction in the prevalence of overweight and obesity of approximately 28%. The inclusion of SMBC when designing interventions represents a valuable methodological tool that may increase the quality and effectiveness of school-based interventions aimed at improving healthy habits, ultimately resulting in positive changes in outcomes such as weight, BMI, or prevalence of overweight and obesity. The current evidence is sufficient to support the notion that at least 5 SMBC domains, regardless of which domains are chosen, must be included in the design of school-based interventions so that these interventions can benefit weight-related measures in young people.

Firestone, R., Rowe, C.J., Modi, S.N. & Sievers, D. (2016). The effectiveness of social marketing in global health: A systematic review. Health Policy and Planning. doi: 10.1093/heapol/czw088

Social marketing is a commonly used strategy in global health. Social marketing programmes may sell subsidized products through commercial sector outlets, distribute appropriately priced products, deliver health services through social franchises and promote behaviours not dependent upon a product or service. We aimed to review evidence of the effectiveness of social marketing in low- and middle-income countries, focusing on major areas of investment in global health: HIV, reproductive health, child survival, malaria and tuberculosis. We searched PubMed, PsycInfo and ProQuest, using search terms linking social marketing and health outcomes for studies published from 1995 to 2013. Eligible studies used experimental or quasi-experimental designs to measure outcomes of behavioural factors, health behaviours and/or health outcomes in each health area. Studies were analysed by effect estimates and for application of social marketing benchmark criteria. After reviewing 18,974 records, 125 studies met inclusion criteria. Across health areas, 81 studies reported on changes in behavioural factors, 97 studies reported on changes in behaviour and 42 studies reported on health outcomes. The greatest number of studies focused on HIV outcomes (n=45) and took place in sub-Saharan Africa (n=67). Most studies used quasi-experimental designs and reported mixed results. Almost one-half of studies reported positive, statistically significant results.. Much of the evidence on the effectiveness of social marketing was concentrated in HIV/AIDS, with 45 included studies. Most of these studies focused on the ability of social marketing interventions to influence condom use and other sexual behaviours. Child survival had proportionately the greatest number of studies using experimental designs, reporting health outcomes, and reporting positive, statistically significant results. Most programmes used a range of methods to promote behaviour change. Programmes with positive, statistically significant findings were more likely to apply audience insights and cost-benefit analyses to motivate behaviour change. Key evidence gaps were found in voluntary medical male circumcision and childhood pneumonia. Social marketing can influence health behaviours and health outcomes in global health; however evaluations assessing health outcomes remain comparatively limited. Global health investments are needed to (i) fill evidence gaps, (ii) strengthen evaluation rigour and (iii) expand effective social marketing approaches.

Longfield, K., Moorsmith, R., Peterson, K., Fortin, I., Ayers, J., & Lupu, O. (2016). Qualitative Research for Social Marketing: One Organization’s Journey to Improved Consumer Insight. The Qualitative Report, 21(1), 71-86. http://nsuworks.nova.edu/tqr/vol21/iss1/7

The authors describe a 10-year journey by their organization to improve their ‘traditional’ qualitative research program through the use of more appropriate data collection methods to develop insight into the emotional barriers and motivators driving consumer behavior (methods fit for purpose). These methods allow marketers to shape new brands and campaigns that resonate with consumers and to reposition concepts to connect with new consumers. They moved away from ‘thin’ interviews and focus groups to more ‘deep’ methods of narratives of consumers’ personal histories of behaving and not behaving, embedded in a relatable context. They began to emphasize data collection methods, like spoken and photo narratives, where researchers could develop a rapport with consumers and focus on story-telling rather than interview guides. Using photos and oral histories to learn about consumers’ lives, behaviors, hopes, fears, and decision-making within the given context yielded deeper consumer insight than asking consumers what they think usually happens in their community, as they had done in focus groups. They also found that using peer interviewers allows them to gain an insider’s perspective on risk behavior and factors associated with that behavior. Peer interviewers was especially helpful for studies about family planning needs among indigenous and ethnic minority couples; concurrent sexual partnerships among young women; condom use among clandestine groups of men who have sex with men, transgendered women, and female sex workers; and use of reproductive health services among young women who had experienced abortion. Small group discussions, like dyads and triads, were helpful when consumers felt nervous or unsafe meeting interviewers and they would benefit from the company of a friend, such as people who inject drugs and youth. Direct observation techniques are useful with caregivers of children and medical providers. In other cases, documenting experiences through life histories, sexual histories, and diary keeping were appropriate; one study in Kenya explored multiple concurrent partnerships through life histories and relationship maps. The authors also describe the formal interaction between researchers and marketers during an interpretation workshop. Researchers typically lead these workshops, which last approximately two days and are an opportunity to explore the data together and become immersed in the consumer’s experience. The marketing planning process then became one of understanding the consumer together rather than researchers simply presenting their data analysis to marketers. These workshops give marketers the opportunity to process consumers’ own words, images, and other inputs, and challenge any pre-conceived notions they had about consumers’ behavior and motivations. The final phase of the workshop is to synthesize descriptive information as well as data about consumers’ values, needs, and aspirations to create an archetype or persona, the “typical” consumer on which to anchor findings. The research and marketing teams then generate a short document (dashboard) that contain the archetype’s beliefs to change; beliefs to reinforce; strategies previously used to behave; perceptions of the product/service/behavior’s current position and personality; their frames of reference or competition; and the archetype’s opportunity, ability, and motivation to process communications. This information fed into the audience profile, positioning statement, marketing strategy, and eventually the program design. Marketing teams reported that FoQus helped them in several ways. The primary benefit of this process for the marketing team was the development of the archetype and dashboard. Consumers now came alive as people; they were no longer just demographic groups, like women of reproductive age. With this simple but clear window into consumers’ lives, marketing teams were able to find new ways of speaking with consumers that were more relevant and emotionally engaging. They were also able to design brands that spoke to consumers on a deeper level, promising emotional benefits rather than just functional ones.

Newton, J.D., Newton, F.J. & Rep, S. (2016). Evaluating social marketing’s upstream metaphor: does it capture the flows of behavioural influence between ‘upstream’ and ‘downstream’ actors? Journal of Marketing Management; 32(11-12):1103-1122.

The ‘upstream/downstream’ metaphor has been used to disparage the tendency for social marketers to focus their efforts on modifying the behaviour of ‘downstream’ consumers without first considering whether the actions of ‘upstream’ actors placed such behaviours beyond consumers’ volitional control. Such discussions would be relatively uncontentious if the metaphor was simply being used to focus attention on the fact that ‘upstream’ forces may impede ‘downstream’ consumers in their pursuit of healthy, sustainable lifestyles. However, many social marketing textbooks extend the metaphor beyond this relatively circumscribed use, applying it instead to justify the targeting of social marketing interventions at these ‘upstream’ forces. For example, many social marketers advocate with varying levels of intensity the targeting of regulators and legislators who can compel firms to act in ways more consistent with supporting the health and sustainability of ‘downstream’ consumers. To use an untested metaphor to guide the strategic direction of social marketing interventions may unnecessarily limit or constrain the types of interventions being proposed. Using a case study, the authors demonstrate how ‘downstream’ actors do exert control over ‘upstream’ actors and that the relationship between the two is often bi-directional. The authors also note how different ‘upstream’ actors influence each other’s actions. “We believe that the upstream/downstream metaphor has reached the end of its usefulness in that the assumptions underlying the metaphor may restrict how social marketers conceptualise or approach efforts to change the structural impediments to behaviour. What is needed instead are new frameworks that can explicate the multidirectional relationships that give rise to the ill-defined problems facing society and provide guidance as to how these problems could be addressed.”

Singh et al. (2016). Many mobile health apps target high-need, high-cost populations, but gaps remain. Health Affairs; 35(12):2310-2318.

The authors evaluated 137 patient-facing mHealth apps—those intended for use by patients to manage their health—that were highly rated by consumers and recommended by experts and that targeted high-need, high-cost populations. They found that few apps address the needs of the patients who could benefit the most. Patient engagement functionalities were limited; many apps provided educational information and reminders or alerts while very few apps focused on providing guidance based on user-entered information or support through social networks, or on rewarding behavior change. The authors also found that consumers’ ratings were poor indications of apps’ clinical utility or usability, and that most apps did not respond appropriately when a user entered potentially dangerous health information.

Thornton et al. (2016). Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Affairs; 35(8):1416-1423.

The opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. The authors review scientific evidence from promising interventions focused on the social determinants of health and discuss how such interventions can improve population health and reduce health disparities. They found sufficient evidence of successful outcomes to support disparity-reducing policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. The complex interplay of factors that has resulted in persistent health disparities cannot be reversed with short-term investments. Interventions focused on the health sector are insufficient to address population level health disparities. Social determinant–related interventions designed to create structural changes must be coordinated with long-term efforts to change social and cultural norms, build on existing community strengths, and change the opportunity costs associated with healthy behaviors to make the healthy choice the default choice. For such interventions to have sustained, intergenerational positive health impacts, they must be coupled with attention to social marketing, behavioral economics, social services, and other supports.

Truong, V.D. (2016). Government-led macro-social marketing programs in Vietnam: Outcomes, challenges, and implications. Journal of Macro-Marketing; 1-17. DOI: 10.1177/0276146716660833

Although social marketing is regarded as an effective consumer-oriented approach to promoting behavioral change and improved well-being for individuals and communities, its potential for generating societal change is still under-researched. The use of social marketing by governments and other upstream actors within a systemic approach to engender social change is referred to as macro-social marketing. This article examines government-led macro-social marketing in Vietnam, a country where the national government is interested in using social marketing to engender societal change. The author identified four macro-social marketing programs that target smoking cessation (since 2002), helmet use (since 2001), drunk driving prevention (since 2008), and nutrition (2011-2015). Delivery of these interventions includes a wide variety of interventions. Education campaigns raise public awareness of the harmful impacts of smoking, drunk driving, driving motorcycles without helmets, and micronutrient deficiencies on the health of individuals and social development as a whole. Education activities include tailored training programs (e.g. workshops, community meetings) and documents (e.g. toolkits, guidebooks, posters) for individuals, health professionals, community health workers, media professionals, leaders and staff of state- and private-owned organizations. Dissemination of program messages is through national and provincial television channels, radio, print and online newspapers and magazines, social media, brochures and posters. Community health workers, loudspeakers, and members of community-based civil organizations (e.g. youth unions, women’s unions) are more popular in rural areas, particularly remote and mountainous ones. All four programs also have adopted measures to restructure marketing systems to avoid the undesirable consequences of commercial marketing practices on society, either by restricting marketing practices that are detrimental to public health (such as with tobacco) or supporting marketing practices that are beneficial (tax reductions for producers of quality bicycle helmets and prioritized advertising schedules – prime hour spots are reserved for them on national television and radio). The author cites data showing steady declines in tobacco use and deaths and injuries from road traffic accidents, increases in the use of bicycle helmets (over 95%), and the participation of 10 leading food producers in the micronutrient food fortification program. the author concludes that an effective combination of different interventions involving many stakeholders and agencies and targeting multiple layers of long-term behavior change is required if such problems are to be eliminated or ameliorated on a macro level. Education, community engagement and mobilization, and policy and legislative initiatives are complimentary rather than mutually exclusive strategies.

Venturini, R. (2016): Social marketing and big social change: Personal social marketing insights from a complex system obesity prevention intervention. Journal of Marketing Management; 32(11-12): 1190-1199. DOI: 10.1080/0267257X.2016.1191240

The author presents insights into using social marketing within a systems approach that is described as ‘A strategy to tackle obesity needs a comprehensive portfolio of interventions targeting a broad set of variables and different levels within the obesity system. Although, alone, each component part of the strategy may not create significant impact, their complementary and reinforcing action is critical to achieving the significant shift required in population obesity trends if the strategy is not to fail.’ His five insights include (1) positioning social marketing to stakeholders as a critical decision-making tool that could be used to innovate and support evidence-informed business decisions in a way that would drive big social change; (2) using behavioural data and insight, mapped against traditionally available data sets, to gain a better understanding of the viewpoint of the citizen and a deeper understanding of the problem – what influences individuals to act, what may motivate them to change their behaviour and ultimately what can be used to drive population health change; (3) creating a brand aligned with the need to create a systems intervention that groups of people could relate to and trust, something that could inspire action, something that multiple stakeholders across a range of interests could see value in and something they could be inspired to be a part of; (4) using ‘sociall marketing’ to attract stakeholders’ curiosity, we created opportunities for stakeholders to reflect and challenge their role and consider how they could best contribute to the overall obesity prevention effort; (5) focusing on knowledge capture – the development of a number of key resources that included a behavioural segmentation model, various strategies and implementation plans, literature reviews, guides on how to conduct research, guides on developing messages and narratives, guides on managing the brand and case studies. Individually these resources did not hold the key to success. However when they were brought together as part of other tools and resources that supported the delivery of Healthy Together Victoria, they proved to be powerful assets. They were powerful in the way that these assets represented a tangible means of translating theory into practice. They became tools that nurtured talent, enabled a workforce to take action, and supported stakeholders and broader networks to deliver efforts that ultimately contribute to the common goal of creating a healthier Victoria.

Xia, Y., Deshpande, S. & Bonates, T. (2016). Effectiveness of social marketing interventions to promote physical activity among adults: A systematic review. Journal of Physical Activity, 2016; 13(11):1263-1274. doi: http://dx.doi.org/10.1123/jpah.2015-0189

The authors proposed benchmarks, modified from those found in the literature, that would match important concepts of the social marketing framework and the inclusion of which would ensure behavior change effectiveness. In addition, they analyzed behavior change interventions on a social marketing continuum to assess whether the number of benchmarks and the role of specific benchmarks influence the effectiveness of physical activity promotion efforts. To avoid becoming embroiled in the debate on the appropriateness or inappropriateness of social marketing labels, they decided to examine the effectiveness of all types of physical activity promotion interventions that displayed at least one of the marketing mix benchmarks. A systematic review of social marketing interventions available in academic studies published between 1997 and 2013 revealed 173 conditions in 92 interventions. A Logical Analysis of Data (LAD-WEKA) revealed that when more than 6.5 benchmarks were used, 81.82% of the interventions were successful, while all interventions were successful when more than 7.5 benchmarks were employed. Through several statistical analyses and modeling, six benchmarks emerged as predictors of program success in improving levels of physical activity: primary formative research (e.g., identify the target group’s attitudes, beliefs, barriers, and enablers regarding physical activity), core product (e.g., highlight that participating in physical activity strengthens work performance), actual product (e.g., offer a gym facility), augmented product (e.g., offer consulting sessions), promotion (e.g., “Get Firefighters Moving”), and behavioral competition ((e.g., watching TV at home, identify and address social-ecological factors competing with physical activity). The authors note that other benchmarks that did not predict success may have been due to their low use among all of the interventions under study.



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