Upstream Social Marketing

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Upstream Social Marketing
Policies and Laws
Social Gradients
Income
Living Conditions
Culture
Transportation
Discrimination
Social Capital
Education
Social Networks
Social Support
Violence
Individual and Community Health

• ASU Wellness and Health Promotion
• May 13, 2008
• Karen Moses, MS, RD, CHES and Jim Grizzell, MBA,
  MA, CHES, HFI

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Learning Objectives

• Explain importance of moving upstream
• Social determinants of health
• Policy makers, decision makers, implementers,
  regulators, funders, police, other influencers
• Describe upstream social marketing approaches
• Apply upstream social marketing to ASU health
  problems

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Why Move Upstream

• It is unfair to expect individuals to use healthy
  behaviors
• Even if motivated because barriers make it
  difficult
• Social environment in which we live has a marked
  impact on our choices
• Our behavior is only partially under our own
  control

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Why Use Upstream Social Marketing

• A social determinant may seem
• Too big to tackle
• Out of bounds because it is not specifically
  health-related
• Cant understand many health problems without
  acknowledging predisposing causal factors

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Why Use Upstream Social Marketing

• Social marketing is appropriate
• whenever you have a behavior to influence
• for motivating a bureaucrat to implement new or
  existing laws or regulations that would
  contribute to increase social welfare

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Benchmarks

• Customer orientation
• Behavior
• Theory
• Insight
• Exchanges
• Competition

• Audience segmentation and targeting
• Marketing mix
• Continuous and strategic formative process
  research, monitoring and evaluating

Green text are common tasks left out of social
marketing programs.
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Alan Andreasens Approach

• Process
• Listening
• Planning
• Pretesting
• Implementing
• Monitoring
• Revising

• Concepts and tools
• Stages of change
• BCOS
• Benefits, Costs, Others, Self-assurance
• Competition
• Others concepts
• Segmentation, 4Ps, Branding

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CDCynergy Social Marketing Edition

• CDCynergy's Competitive Advantage
• Extremely pre/post tested
• Distills comprehensive best practices
• Vetted by major players in social marketing
• Over 700 resources
• CDC originated
• Use CDCynergy for funding requests
• Looked on very favorably!!
• Recognized nationally and internationally

• Phases
• Problem description
• Market research
• Market strategy
• Interventions
• Evaluation
• Implementation

Green text are common tasks left out of social
marketing programs.
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Logic Model
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Phase 1 Problem Description

1. Write a problem statement
2. List and map the causes of the health problem
3. Identify potential audiences
4. Identify the models of behavior change and best
   practices
5. Form your strategy team
6. Conduct a SWOT analysis

These are Logic Model items
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Phase 2 Market Research

1. Define your research questions
2. Develop a market research plan
3. Conduct and analyze market research
4. Summarize research results

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Phase 3 Market Strategy

1. Select your target audience segments
2. Define current and desired behaviors for each
   audience segment
3. Describe the benefits you will offer
4. Write your behavior change goal(s)
5. Select the intervention(s) you will develop for
   your program
6. Write the goal for each intervention

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Phase 4 Interventions

1. Select members and assign roles for your planning
   team
2. Write specific, measurable objectives for each
   intervention activity
3. Write a program plan, including timeline and
   budget, for each intervention
4. Pretest, pilot test, and revise as needed
5. Summarize your program plan and review the
   factors that can affect it
6. Confirm plans with stakeholders

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Phase 5 Evaluation

1. Identify program elements to monitor
2. Select the key evaluation questions
3. Determine how the information will be gathered
4. Develop a data analysis and reporting plan

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Phase 6 Implementation

1. Prepare for launch
2. Execute and manage intervention components
3. Execute and manage the monitoring and evaluation
   plans
4. Modify intervention activities, as feedback
   indicates

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Learning Objectives

• Explain importance of moving upstream
• Social determinants of health
• Policy makers, decision makers, implementers,
  regulators, funders, other influencers
• Describe upstream social marketing approaches
• Apply upstream social marketing to ASU health
  problems

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Extra Slides
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Resources
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Resources
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Processes of Change
Positive outcomes and ROI Reduced
utilization Reinforcement Management
Finding intrinsic and extrinsic rewards
for new ways of working Environmental
Reevaluation Appreciating that the
change will have a positive impact on the
social and work environment Self-Liberation
Believing that a change can succeed and making
a firm commitment to the change Self-Reevaluatio
n Appreciating that the change is important to
ones identity, happiness, and
success Dramatic Relief Emotional arousal, such
as fear about failures to change and inspiration
for successful change Consciousness Raising
Becoming more aware of a problem and potential
solutions
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Customer Orientation

• Customer in the round Develops a robust
  understanding of the audience, based on good
  market and consumer research, combining data from
  different sources
• A broad and robust understanding of the customer
  is developed, which focuses on understanding
  their lives in the round, avoiding potential to
  only focus on a single aspect or features
• Formative consumer / market research used to
  identify audience characteristics and needs,
  incorporating key stakeholder understanding
• Range of different research analysis, combining
  data (using synthesis and fusion approaches) and
  where possible drawing from public and commercial
  sector sources, to inform understanding of
  peoples everyday lives

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Insight

• Based on developing a deeper insight approach
  focusing on what moves and motivates
• Focus is clearly on gaining a deep understanding
  and insight into what moves and motivates the
  customer
• Drills down from a wider understanding of the
  customer to focus on identifying key factors and
  issues relevant to positively influencing
  particular behaviour
• Approach based on identifying and developing
  actionable insights using considered judgement,
  rather than just generating data and intelligence
  

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Health in Higher Education

• Health in higher education supports 18 million
  students in 4,200 IHEs
• Many college and university professionals work in
  higher education to promote health
• 250 professionally prepared ACHA HEs - 172,000
• 19,000 faculty and staff 1947
• Health problems
• Campus wide
• Specific to college or major
• Influences quality and productivity

See notes section
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Traditional Health Programs

• Use the Medical Model
• Health services has primary responsibility
• Staff trained in clinical practice
• Health care agenda focus is on the physical
• Healing sickness/injury
• Wellness for physical health
• Methods focus on the individual
• Awareness activities, written information,
  didactic presentations

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The Traditional Approach

• Limits our understanding of health
• Physical health is what counts most
• Ignores role of environment/community on health
• Lacks prevention focus
• Financially costly and ineffective
• Lacks cost-effectiveness, positive ROI, reach,
  impact
• Removes responsibility for health outcomes by
  non-health entities
• Gives medical systems a lot of power

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Traditional Health Programs

• Based on tradition, convention, belief, anecdotal
  evidence
• Pressure to be seen as acting
• Desire to help
• Poorly developed skills and understanding of
  population behaviour change
• Short term policy planning, budgeting and review

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Evolution of College Wellness Health
1850s 1970s
1980s 1995
2010
1st Generation
2nd Generation
3rd Generation
Healthy Campus Objectives
Instruction, Treatment, Exercise Health
Education/Promotion EB/CE-HP
Evidence-based / Cost Effective Health Promotion
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Evolution of College Wellness Health
Traditional Medical and Health Promotion
Traditional Medical Model and Health Education
Evidence-Based Cost-Effective Health Promotion
Name of Model
Fun activity focus No risk reduction No high risk
focus Not HCM oriented All voluntary Site-based
only No personalization Minimal incentives No
sig. others served No assessment/eval
Focus on student learning Strong risk
reduction Strong high risk focus Some required
activity Site and virtual Environmental
changes Strongly personal Major incentives Sig.
others served Rigorous assess/eval
Mostly health focus Some risk reduction Little
risk reduction Limited HCM oriented All
voluntary Site-based only Weak personalization Mod
est incentives Few sig. others served Weak
assess/eval
Main Features
Activity Oriented
Morale Oriented
Results / Outcome Oriented
Primary Focus
Health Cost Management
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Evolution of College Wellness Health
Traditional Medical and Health Promotion
Traditional Medical Model and Health Education
Evidence-Based Cost-Effective Health Promotion
Name of Model
Fun activity focus No risk reduction No high risk
focus Not HCM oriented All voluntary Site-based
only No personalization Minimal incentives No
sig. others served No assessment/eval
Focus on student learning Strong risk
reduction Strong high risk focus Some required
activity Site and virtual Environmental
Changes Strongly personal Major incentives Sig.
others served Rigorous assess/eval
Mostly health focus Some risk reduction Little
risk reduction Limited HCM oriented All
voluntary Site-based only Weak personalization Mod
est incentives Few sig. others served Weak
assess/eval
Main Features
Activity Oriented
Morale Oriented
Results / Outcome Oriented
Primary Focus
Health Cost Management
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Social MarketingCommercial vs. Social

• Marketing is about behavior change
• The bottom line
• ROI and CEA
• If your intervention wont change behavior
• Dont do it!!!!
• Theory
• Distillation of previous work
• Simplify complex phenomena

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Some Questions to Guide Theory Selection

• Where are people in relation to a particular
  behavior?
• What factors cause this position?
• How can they be moved in the desired direction?

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Keys to Effective Use of the Ecological
Perspective

• Expand the focus beyond health information and
  programming
• Integrate responsibility for health across
  student affairs and academic units
• Provide supportive environments and reduce
  barriers to optimal outcomes
• Promote leadership and involvement by multiple
  partners

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Intervention Pyramid
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Business CaseLevels of Interventions Wellness
Program ROIs
Program Levels Intervention Levels Quality of Life Traditional Health Productivity
I. Awareness Information, no feedback lt11
IIa. Behavior Change Health education w follow-up 31
IIb. Behavior Change Targeted priority health issues with Social Marketing 61 to gt151
III. Supportive Environment Ecological Approach, Policies gt151 gt151 gt151
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Continuum of Services
For students at highest risk of engaging in high
behaviors or already having a health problem
For students at risk of engaging in high
behaviors or already having the health problem
Intensive
For all students, regardless of risk to delay or
prevent health problems
Early Intervention
Universal Prevention
From Dept of Education Safe Schools / Healthy
Students Grant Guidelines
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Health in Higher Education
Karen S. Moses, MS, RD, CHES Director, Wellness
and Health Promotion Arizona State
University Chair, NASPA Health in Higher
Education Knowledge Community Member at Large,
ACHA Board of Directors Deputy Coordinator,
Coalition of National Health Education
Organizations
Certified Health Education Specialist
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The Ecological Perspective

• The science and art of helping people change
  their lifestyle to move toward a state of optimal
  health.Lifestyle change can be facilitated
  through a combination of efforts to enhance
  awareness, change behavior, and create
  environments that support good health practices.
  Of the three, supportive environments will
  probably have the greatest impact in producing
  lasting changes.
• M. P. ODonnell, American Journal of Health
  Promotion (1986)

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A New Paradigm The Ecological Approach to
Campus Health

• Views the connections among health, learning, and
  the campus structure
• Explores relationships between and among
  individuals and the learning communities that
  comprise the campus environment

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Using the Ecological Perspective on Campus

• Establish a Working Group
• Identify Campus Values
• Assess Student Health Data
• Analyze Campus Health Concerns Through an
  Ecological Lens
• Environmental influences
• Individual influences
• Develop a Plan

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Influencing Factors
Characteristics of the
Individual
Community
Place
Organization
People
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Environmental Influences
Place
People
Behavior settings Rituals, student
organizations Cultural Influences Customs,
traditions, values Economic Forces Student
financial stability, budget Inhabitants
Diversity, Athletics, Greek, campus communities,
etc.
The location of the campus The weather The
constructed designs Landscapes
Organizational Structure Policies Organizational
Climate
Organization
Community
Political Climate Conservative/liberal Pro
education? Reinforcement and Rewards For healthy
org indiv behaviors
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Stress Environmental Influences
Warm climate Lack of parking High traffic Campus
sizedistances Crowdinglong lines
Place
People
Financial concerns ISO global
troubles Relationships w/friends Lack of
friends/commuters Irresponsible
drinkers Uninvolved students
Services--lack of info Depts disconnected Too
many steps Weak policy enforcement Inconsistent
messages
State budget crisis Increase in
tuition/fees Rewards for over commitment Culture
of stress
Institution
Community
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Social Marketings FitIntervention Pyramid
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Historical Snapshot Think Health Agenda
Business Case Corporate College Health
Wellness
1st Generation 2nd Generation 3rd
Generation 4th Generation
Recreation Fitness Health
Education gt Promotion HPM
1850s 1970s
1980s 1995
2010
1st Generation
2nd Generation
3rd Generation
Instruction, Treatment, Exercise Health
Education gt Promotion HAPM
Health Productivity Management, Health
Academic Performance Management