The Challenges of Social Marketing of Health Issues in Culturally

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The Challenges of Social Marketing of Health
Issues in Culturally Socially Diverse 
Populations - The Case of Israel Nurit
GuttmanDepartment of CommunicationTel-Aviv
University
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What is social marketing?
Conventional approach A cross-disciplinary
theory-based activity that applies and adapts
commercial marketing strategies to advance social
issues, for the purpose of making desired changes
through changes in knowledge, attitudes, beliefs
and behaviors of individuals, communities and
society and related policies
The Intended Population at the center
Participative approach A cross-disciplinary
theory-based activity that draws on the needs and
perspective of the intended population and
engages them as partners in the process to
advance social issues through changes in
knowledge, attitudes, beliefs and behaviors of
individuals, communities and society and related
policies
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Some issues from The Marketing Mix Product,
Price, Place, and Promotion
What are the various channels we can use to get
to the populations we want to involve in our
program? What is the price they have to pay
for adopting the recommended practices? What
about the competition? The importance of
segmentation
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Focus on 7 Challenges of Social Marketing of
Health Issues in Culturally Socially Diverse 
Populations

• Diversity within the minority groups themselves
• Avoiding stigmatization
• Commercial competition
• Choosing behavior-change theories that go beyond
  individual-change models
• Using new media channels
• Moral relativism and harm reduction
• Adopting both a culturally-sensitive and
  culturally-centered approach

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Diversity within Minority, Cultural and
Linguistic Populations The challenges of
segmentation and tailoring
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Diversity among the Ultra-Orthodox Hassidic Jews

• Nearly 200 communities led by Rabbi who has a
  court and administration Each has code of
  dress and rules

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Diversity within the Immigrants from the former
Soviet Union

• The Disconnected (24) from Israeli society
• The Proud (31) connected to own culture but
  also to Israeli, use Israeli media but prefer
  Russian channels
• The Split (19) Consider themselves assimilated
  but connected to heritage
• The assimilated (26) Feel completely
  assimilated (typically higher income)

Source Brandman Research, 2006
Similarly diversity within other minority and
immigrant populations
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Media use and Immigrant populations from the
former Soviet Union
About 70 of Russian immigrants did not watch a
very popular Prime-time Israeli news spoof show
that has a highly-visible Russian character
Former soviet union immigrants, regardless of
Hebrew proficiency prefer Russian language
television programs, but those whose Hebrew
skills are better, will also watch Hebrew shows
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Media Use Among Minority Populations According
to Language
Majority Language Media Use
Minority Language Media Use
High
Low
High
Low
Adoni, H. Caspi, D. and Cohen, A. 2006. Media,
Minorities and Hybrid identities The Arab and
Russian communities in Israel. Hampton Press.
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Media Use Among Minority Populations According to
Language
Majority Language Media Use
High
Low
Minority Language Media Use
High
Low
Adoni, H. Caspi, D. and Cohen, A. 2006. Media,
Minorities and Hybrid identities The Arab and
Russian communities in Israel. Hampton Press.
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Media Use Among Immigrants from the former
Soviet Union
High Hebrew
Low Hebrew
High Russian
Low Russian
Adoni, H. Caspi, D. and Cohen, A. 2006. Media,
Minorities and Hybrid identities The Arab and
Russian communities in Israel. Hampton Press.
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What about Israeli Arab populations and media
use?
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Israeli Arab populations and the media

• Most tend to watch Arab language media,
  regardless of Hebrew language proficiency
• Strong Arab identity among second generation
• Israeli media does not provide sufficient
  channels, relevant programs and characters for
  Arabs to identify with
• Tune to local Pirate Arab radio and regional
  television stations
• Tune to Israeli channels for education and health

Sources Avraham et al., 2006 Jamal, 2006
Cohen and Tulchinsky, 2007
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Media use among Israeli Arabs according to
language
High Hebrew
Low Hebrew
High Arabic
Low Arabic
Adoni, H. Caspi, D. and Cohen, A. 2006. Media,
Minorities and Hybrid identities The Arab and
Russian communities in Israel. Hampton Press.
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Israeli Arabs and Media Use

• Read both Hebrew and Arabic newspapers mainly
  Hebrew dailies (54) and Arab weekly magazines
  (73)
• 1/3 who do not use media in Hebrew mentioned lack
  of sufficient linguistic fluency
• Highly value Israeli newspapers published in
  Arabic by members of their own community
  surpassing radio TV in Arabic produced by
  Israeli Jewish media
• Choice of language of media use correlated with
  identity
• The Arab community suffers from a relative
  paucity of media compared with Israeli majority
  and Russian minority

Adoni, H. Caspi, D. and Cohen, A. 2006. Media,
Minorities and Hybrid identities The Arab and
Russian communities in Israel. Hampton Press.
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The Challenges of Avoiding Stigmatization
The challenge of avoiding stigmatization when
addressing sensitive issues that are relatively
more prevalent in certain minority populations
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The challenges of commercial competition
Commercial influences on populations that are in
a process of acculturation products that are
not necessarily health-promoting
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The challenges of choosing behavior-change
theories that go beyond individual-change models
When little spiders spin their webs together -
the communal web is strong enough to catch even
the biggest of lions Ethiopian Proverb From the
Tene Briut Program
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The challenges of using new and conventional
media channels in diverse population

• What is preferred?
• What is available?
• What is not available and why?

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Ultra-Orthodox (Haredi) Populations
Posters (Pashkvallim are highly popular and
considered an effective communication channel.
Advertisers suggest that for maximum effect it
is recommended to post them before the start of
the Sabbath.
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radio
Radio used to be outlawed but now is considered
a high-impact channel in the Haredi community
many programs are related to health
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Haredi women created a phone-based information
center for womens health at Bnei-Brak, support
by the municipality
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The Internet and the Haredim?
The danger of the computer
Prohibition of having computers at the home or
allow ones sons and daughters to go to a home
that has a computer
Kosher phone that does now allow for SMS or
internet connection
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Research Findings Haredim use the internet,
beyond work-related issues, despite rabbinical
prohibitions
About 17,000 Haredim work in the hi-tech industry
(including women)
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Hevre Haredi Site
Report on Mumps occurrence in the Haredi
community Doctors need to immunize children who
have not yet been immunized
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Internet site of Channel 7 BESHEVA - for
religious populations claims to be the most
distributed paper Article on parents who do not
want to vaccinate their children
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News about Haredi town that is going to join the
Smoke Free Town project of Israels Healthy
Cities
Competition of religious essays on prevention of
smoking
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Internet site of HAZOFE for religious
populations Health Section
Opportunities to use new media to reach
populations to provide information and help
address sensitive issues
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Hebrew speaking Russian immigrants tend to prefer
Russian sites, forums and Blogs
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Israeli Arabs and internet
Individuals who use the internet will use Hebrew
sites, but mostly turn to Arab sites, both
international and local
Yahala network
As in television, Arabs feel that there is rarely
coverage of issues that pertain to them in
Israeli sites, including official ones
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To effectively reach diverse populations need
media channels and content that address Identity
Issues and are linguistically and culturally
accessible
?
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The Challenges of Moral Relativism and Harm
Reduction
To contest or preserve current cultural customs
to effectively reach intended populations?
Cultural tradition VS change
An opportunity to advance the issue of gender
equality or jeopardize the acceptability of the
material?
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Smoking among Arab Men in Israel
Arab Men
Jewish men
Jerusalem
Nazereth
Data from Israel Cancer Association Report
published in Ynet, Oct. 7, 2007
Tel Aviv-Jaffa
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The challenge of taking away something that is
culturally and socially meaningful, especially to
underprivileged populations
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The challenge of the adopting a
culturally-sensitive andculturally-centered
approach
Whose goals and perspective are prioritized?
Are we being culturally sensitive in order to
get OUR messages across? Do we aim to be
culturally- centered and focus on the very
needs and perspectives, as they are defined by
the members of the community?
Adapted from Dutta (2007)
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Bedouins in Israel North and South
What are the goals of the program?
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An organization conducted workshops for Ethiopian
immigrant population on health rights It found
out it had to add sessions to address specific
issues that were raised by participants..
Health Rights information to diverse population
Beyond mere translation Need to address what
the people are actually concerned about, what is
relevant to them, and their sense of individual
and collective efficacy
A study we conducted on health rights among Arab
women they knew they had certain rights but did
not feel they could ask..
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The challenge to learn what is the real cost
for the population to adopt the recommendations
Beyond conventional techniques - Need a cultural
perspective

• In what way do the recommended behaviors require
  that the people need to give up something very
  that has a cultural meaning
• What may be embarrassing?
• What may require changes in self-concept or
  identity that is culturally related?

The challenge to adopt a participatory approach
Storytelling PHOTOVOICE Group discussions
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Reach the Population with Media that is
Accessible and Culturally Relevant, including
Entertainment Media

• Radio and television programs/ talk shows,
  drama, Reality shows, Dance, Music, Theater,
  Photonovella, Games..

Can address relevant issues Can raise
dilemmas Model behaviors Create identification
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Social marketing approaches can use various media
Instead of an advertising model it aims to

• reach diverse populations in media that relates
  to their culture and values
• raise issues to the personal and collective
  agenda
• address sensitive issues
• elicit identification
• illustrate the dilemmas involved
• offer culturally-relevant suggestions and tips
• model ways to address issues

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The challenges of social marketing in culturally
diverse populations are to address what is really
important to peoples

• Values
• Norms
• Identity
• Social and Economic Issues
• Sense of Efficacy
• and Empowerment