I.     Introduction

Social marketing is generally defined as the design and implementation of programs that introduce and promote a social idea or cause. Diffusion of innovations, health communications, and media advocacy are related disciplines with application to ATOD problem prevention. Media campaigns and health message and materials development are integral to the development of comprehensive multilevel, multistrategy approaches and to the dissemination of prevention interventions (National Cancer Institute, 1989; Rogers, 1983). Each of these related topics is briefly reviewed here. The reader is also referred to Section IIIG of the CD-ROM which contains four communication training programs developed specifically for preventionists whose role involves media and public relations.
 

A.     Diffusion of Innovation

Diffusion of innovation is a process outlined by Rogers (1983) by which an innovation (e.g., new idea, approach, strategy) is communicated through certain channels over time among members of a social system. In other words, diffusion is concerned with spreading new ideas. The characteristics of an innovation as perceived by members of a social system determine its rate of adoption.

Certain patterns of adoption, both in time and in the response of receivers of the message, must be considered when initiating an innovation. The social system acts as a kind of collective learning system in which early adopters of an innovation transmit their experiences through interpersonal networks. Opinion leaders play a significant role in the ultimate acceptance of an innovation. Another crucial factor is readiness for change (e.g., the readiness of individuals, groups, and/or systems). Schinke and Orlandi (1991) describe work of various researchers on innovation and change and their diffusion. Five phases of programmatic implementation for social and health education efforts are outlined: mobilization, adoption, implementation, maintenance, and evolution. This work builds on the work of Rogers (1983) and is intimately related to the transfer of learning and technology.
 

B.     Health Communications

Communications campaigns work better when expectations are more realistic for their outcomes, when useful strategies are borrowed from social learning and social marketing, and when entertainment strategies from mass communications have been incorporated (Backer and Rogers, 1992). As we seek to alter human behavior, for example, by trying to promote smoking cessation or drug abuse prevention, we are using a communication process that relies upon social systems and their functioning. Customs, norms, values, and leadership patterns must be considered in formulating social change strategies targeted on society as a whole or on a single community.

Furthermore, a single marketing message limits potential response. When planning educational campaigns as part of a comprehensive prevention intervention, it is essential to understand the audience and to test the message being used. Messages of antidrug campaigns of the past have tended to focus on negative consequences of drug behavior to deter use. As we move from an individual behavior-change focus to a multilevel, multistrategy approach to prevention, the full range of human needs should be taken into consideration to enlarge the possibility of reaching the intended audience with an appropriate and effective message (McGuire, 1991).

In addition, further research is needed to assess the importance of the messenger. A study of the use of lay health educators to promote smoking cessation in a hard-to-reach urban community (Lacey et al., 1991) raised an often overlooked question in prevention practice: does the messenger matter as much as the message? Research in health communications is exploring this and other issues.
William McGuire (1991) lists the following steps individuals must go through to assimilate a desired behavior:

• Exposure to the message
• Attention to the message
• Interest in or personal relevance of the message
• Understanding of the message
• Personalizing the behavior to fit one’s life
• Accepting the change
• Remembering the message and continuing to agree with it
• Being able to think of it
• Making decisions based on bringing the message to mind
• Behaving as decided
• Receiving positive reinforcement for the behavior
• Accepting the behavior into one’s life.

• Predisposing factors—knowledge, attitudes, behavior, beliefs, and values prior to intervention that affect their willingness to change
• Enabling factors—the structure of the environment or community and the individual’s situation that facilitate or present obstacles to change
• Reinforcing factors—the positive or negative effects of adopting the behavior that influences continuing the behavior.

C.     Media Advocacy

Media advocacy involves understanding and working with the news media to turn public attention to an issue and pressure policy makers to act. Furthermore, media advocates craft a story to focus on specific solutions involving change through policy development. They focus on the news media as a far-reaching channel of communication (Berkeley Media Studies Group, 1994). Whereas social marketing tries to influence individual behavior change, media advocacy aims to improve health by influencing the social and political environment in which decisions are made. Wallack (1990) states the following:

...media advocacy reflects a progressive approach to health promotion in that it explicitly recognizes the importance of the environment and defines health problems as matters of public policy and not just of individual behavior. It tries to empower individuals by providing the knowledge and skills necessary for participation in efforts to change the social and political factors that influence health status. The health of the community, not necessarily that of the individual, is the main concern.

II.     How Social Marketing Works

Social marketing uses commercial marketing tools to “sell” products and ideas for the public good. The key to a successful social marketing campaign is learning what will work with the target population. This is far more effective than simply telling people what they “should do.” The target population is more likely to adopt a desired behavior if we assess and subsequently try to change their attitudes toward the behavior, their perceptions of benefits of the new behavior, and their perceptions of how they think their peers will view their behavior. In the substance abuse prevention arena,
 

A.     The Four “P’s” of Social Marketing

With each social marketing program, the concept of a target population is constant. The variables are the product being promoted, the price, the promotion, and the place or channel whereby the information reaches the consumer.

• Product is the knowledge, attitudes, or behavior you want the target audience to adopt. The product can be an idea such as not using alcohol, tobacco, or other drugs. The product could also be an actual related commodity such as seeds for a substitute cash crop such as wheat or corn, or a nicotine substitute to help smokers quit.

• Price is what audience members must give up to receive the program’s benefits. This price is usually something more abstract than money. It might be the psychological cost of separating oneself from friends or the peer group that continues to use drugs, or the psychological and physical trauma of fighting an addiction.

• Place, or the channel, refers to how the message is disseminated. Channels could include mass media, schools, churches, or workplaces. Keep in mind that place affects price. For instance, if the message is promoted by an organized youth group, the price of peer pressure may be reduced. Choose the channel which is most appropriate for the target audience.

• Promotion is the means for persuading the target audience that the product is worth this price. It may include a publicity campaign through the mass media but it can also involve teaching life skills or community activities. (Bureau of International Narcotics Matters, 1988)

 
B.     Eight Specific Components In the Social Marketing Process

Lefebure and Flora (1988) suggest that there are eight components in the social marketing process. They are

Consumer orientation

Voluntary exchange

Audience analysis and segmentation

Formative research

Channel analysis

Marketing mix

Process tracking

Management

The Center for Substance Abuse Prevention has taken these concepts and outlined a detailed process for developing prevention programs, using social marketing principles.

 
C.     CSAP’s Eight Guidelines for Social Marketing Program Development

The Center for Substance Abuse recommends that prevention programs follow specific guidelines during the development of a social marketing program.

Guideline 1: Follow a Six-Stage Social Marketing Process that provides multiple opportunities for improvement and refinement.

The six stages include

Stage One:  Plan your approach.
Stage Two:  Define your messages and channels.
Stage Three: Develop and pretest your materials.
Stage Four:  Implement the program.
Stage Five:  Evaluate the program.
Stage Six:  Use feedback to refine the program.

1. Research the scope of the problem.
2. Review the research literature.
3. Define your audience.
4. Develop your concept.
5. Set goals and objectives.

A social marketing program may need to address more than one audience to accomplish its objectives. Planners often differentiate among primary, secondary, and tertiary audiences:

• Primary audience—the group of people that the program is designed to influence, for example, young adolescent males.
• Secondary audience—those individuals who influence the primary audience, for example, the peers, parents, teachers, and employers of young adolescent males.
• Tertiary audience—the decisionmakers, the community’s gatekeepers. These are the individuals who influence policy and offer financial and logistical support to community-based prevention programs. The support of this group is critical to any prevention program. In some social marketing programs, these individuals may be the primary audience.

Stage Two: Define your messages and channels.

1. Identify the message(s) you want to send.
2. Choose appropriate and effective channels of communications.

 

What message will work? The message has to be meaningful and appealing to the target audience. If the message is that substance abuse is directly linked to violent crime, give an example appropriate for the target audience. For instance, car hijackings might be more appropriate for an urban than a rural audience. The message should get your audience to think about and discuss the issues. Try to generate action. Convey clear, concrete suggestions. For example, show alternative behavior or ways of resisting pressure to use drugs. The message should be based on facts and tied to the present, not the distant future. Our society has a tendency to live primarily in the here and now with an emphasis on instant gratification. The outcome of “cirrhosis of the liver in 20 years” poses little threat to an 18-year-old. CSAP cautions that messages that may do more harm than good—e.g., “scare tactics”—should be avoided.
The program’s or campaign’s ultimate outcome should be to establish social norms that promote and sustain healthy, safe behaviors. Change does happen—it just may take a while. Product positioning refers to the niche that a product occupies in people’s minds. In commercial marketing, this niche is created by packaging and promotion. In social marketing, the niche is the cultural and psychological appeal of a product. For instance, it’s okay not to belong to a gang, or community service can help put your problems in perspective, or running and other vigorous exercise produce a natural high. The message should highlight this appeal.

What is the cost? The message should minimize the psychological or physical cost of the product. For example, if an adolescent thinks that giving up drugs will cost him or her status among peers, the message might minimize this cost by emphasizing well-known male and female athletes, musicians, or movie stars who don’t use illegal drugs or abuse alcohol.
 

Choose effective channels of communications.

These include television, radio, newspapers and other print media, and bulletin boards throughout the community such as those found in supermarkets, churches, neighborhood centers, and other places where people congregate. According to the Bureau of International Narcotics Matters (1988), the following factors should be considered in choosing a channel or channels:

Reach—The number of people or households exposed to a specific media message during a specific period of time. These data may be available from previous studies or the target population can be surveyed to see what stations or shows they prefer, what newspapers or magazines they read, and what their literacy/educational levels are.

Frequency—The average number of times an audience is exposed to a specific message. Remember that repetition helps to convey a message.

Impact—What effect will the use of each channel have on the target audience? Keep in mind the characteristics of each type of media. For example, television and radio have mass appeal but are costly, so messages will probably be short. Print media can give instructions or more detailed information.

Credibility—How credible do members of the target audience find the channel? Some people find television believable while others find newspaper articles more convincing.

Cost effectiveness—Is the cost offset by the benefits? For example, during the 1996 Olympics, advertisers paid approximately $500,000 for a 30-second spot during prime time and reached an estimated 21 to 22 million viewers.

Stage Three: Develop and pretest your materials.

1. Develop message statements and concepts.
2. Test materials with target audience(s) and important community gatekeepers.

– Determine whether the target audience responds to the product(s) and the message is clear.
– Revise the product(s) based on pretests.

Apply the message statement.

The message statement outlines information critical to the development of accurate materials that are successfully received by the target audience. It keeps the development of the materials on target. Further, the message statement provides a common knowledge base for everyone involved, and can be used in presentations which need to be made in advance of the campaign.

The message statement includes

• Statement of the problem
• Goals of the campaign or other social marketing activity
• Definition of the target audience
• What has been learned about the target audience’s needs, values, and perceptions
• Channels to be used
• The idea/message to be communicated.

Develop the message concepts.

Message concepts are the preliminary ideas which eventually become draft materials after they are tested and refined. Message concepts are verbal descriptions that convey the basic form and appeal of the message including its presentation style, the spokesperson or source, and the slogan or other essential words or symbols.

Keep in mind as you develop your program’s message that we live in a society bombarded on all fronts by diverse messages. Your message must compete with many others for attention. Appeal, style, personal relevance, and the spokesperson or source of information will influence how well a message attracts and holds the target audience’s attention.
 

Appeal to reason and emotion.

A message can appeal to a variety of emotions and perceptions such as logic and reason, self-esteem, fear, and patriotism. Design the message to appeal to a variety of emotions and perceptions. Keep in mind that a moderate amount of emotional appeal works better than none, especially with people who are indifferent to a problem to begin with. “Scare tactics” are not as effective as appeals to more positive emotions. However, fear of social disapproval may be an exception. Appeals to fear have been most effective when anxiety can easily be reduced. If the message explains how to reduce the fear, it will give a sense of control back to the audience. Appeals to fear are more likely to work when the person hearing the message does not feel vulnerable. Ironically, the most vulnerable people appear least likely to respond to appeals to fear. Appeals to fear are more successful when delivered by a highly credible source.

A factual approach is most successful with people who are already highly motivated. A sophisticated audience of opinion leaders is more likely to respond to this sort of appeal. Humor works best when the message has become familiar. Keep in mind that people, even within the same target audience, have very different senses of humor and some humor can offend (Bureau of International Narcotics Matters, 1988).
 

Use an engaging style.

Broadcast messages can employ various techniques, e.g., a spokesperson’s testimonial about a personal experience; the portrayal of a common, everyday situation; a demonstration of a skill such as saying no to a drug dealer; or a series of vignettes portraying situations with a common theme. Printed materials can be primarily visual with little text or primarily text. Printed materials frequently use cartoons, charts, photographs, and graphics to present the message. Common formats for printed brochures and factsheets include questions and answers, newsletter format, or report format. Be sure that the format used is appropriate for the age, educational, and literacy levels of the audience. For example, second graders would probably respond more favorably than eighth graders to a coloring book.

Vocabulary, tone, and appeal should make the target audience feel that this message is meant for them.

Consider the spokesperson or source. The choice of spokesperson should reflect the interests of the target audience and be seen by the audience as credible. A basketball star may appeal to adolescents but their parents may react more favorably to a well-known medical personality.

Test message

If funding is available, professionals can be hired to complete the pretesting evaluation process. Alternatives include using faculty and staff of a local university or college or using community volunteers. Materials should also be reviewed by community gatekeepers including program funders and key people in the community’s prevention program.

Pretesting assesses the audience’s response to the campaign. It measures recall, comprehension, reaction—Is the message believable? It is relevant? Acceptable? What are the strong points? The weak points?

Pretesting methods include:

• Focus groups—Small groups of 8 to 12 people who meet with a moderator to discuss ideas and materials. Focus groups are especially helpful in the early stages of materials development to test themes, images, and general issues.
• Interviews—In-depth interviews can be used to gauge an individual’s reactions to a sensitive issue and/or specific materials.
• Central-location-intercept interviews—These interviews are held in public areas where members of the target population congregate. These areas include shopping malls, movie theaters, schools, and churches. Questions are designed for quick answers that are easily tabulated.
• Theater testing—Many people in the same location view messages (such as public service announcements) embedded in other programming.
• Self-administered questionnaires—(mailed or delivered) This method provides access to people in rural areas or those who are not likely to attend focus groups or to be in areas for central-location- intercept interviews.
• Readability testing—Used to gauge the reading levels of materials. One widely used formula uses both sentence length and syllable counts to estimate reading levels.

Stage Four: Implement the program.

1. Promote and distribute through all channels chosen.
2. Review activities and track audience reactions.
3. Review as necessary.

Evaluate the effectiveness of your media materials. Monitor which pieces were published/broadcast and which were not selected. How many times were public service announcements (PSAs) aired? Inventory the materials on hand. Did the press release get published, but not the op-eds or letters? The problem may simply be column space: newspapers can publish event information throughout the paper, whereas guest editorial space may be very limited or reserved weeks in advance. Mail materials well in advance of when you want the information to be published.

Controversy can inhibit publication, especially in smaller communities. Present your prevention information in terms that evoke sympathy and agreement. Use positive language. Avoid sarcasm and blame.

Look for communications problems within the pieces that did not get printed or broadcast. Stick to one subject and don’t ramble. Present a single issue, back it up with facts, and state the results you would like to achieve. The more focused you are, the more effectively your message comes across.

Stage Five: Evaluate the program.

1. Determine what has worked well based on the goals and objectives established at the beginning of your program.
2. Assess how the program affected the beliefs, attitudes, and behaviors of the target population.

Four types of evaluation are generally used in health communications:

• Formative evaluation includes pretesting of materials and is designed to test for program strengths and weaknesses before implementation. It is used in stages one  through three.
• Process evaluation reviews the tasks of implementing the program. It tracks program activities. It answers questions such as What did we do well? What do we need to improve? How do we improve?
• Outcome evaluation describes the program’s immediate effects. It answers such questions as, Did the target population show any measurable changes in behavior, attitude, knowledge, or perception? Did their awareness of alcohol and other drug problems increase?
• Impact evaluation focuses on the long-term outcomes of the program. It answers such questions as, What effect has the program had on the community? How have the beliefs and behaviors of the target populations been influenced? What changes have occurred in how community members think about the use of alcohol, tobacco, and other drugs?

Stage Six: Use Feedback to refine the program

1. Revise the community’s prevention program to maximize its effectiveness.
2. Receive feedback.

Provide feedback.

Most people respond well to positive feedback. And many of us like to be thanked when we’ve made an effort to follow through with a request. Be sure to thank

• Members of the program’s media and/or campaign committee(s)
• Funders and other sponsors
• Community members who helped with the campaign
• Campaign spokespersons
• Members of the media who participated in and/or supported the campaign.

 

Guideline 2:     Understand what social marketing and communications can do.

A strong community-based prevention program includes activities that support the six prevention strategies and comprehensive communication efforts. The program will target a specific audience with a prevention message and increase the general public’s awareness of prevention-related issues. Raising of public awareness ultimately results in a change in social policies and practices.

Effective social marketing/communications can

• Raise awareness
• Increase knowledge
• Influence attitudes
• Show benefits of behavior change
• Reinforce knowledge, attitudes, and behavior
• Demonstrate skills
• Prompt an immediate action
• Increase demand for services
• Refute myths and misconceptions
• Influence norms
• Raise the volume of the public health voice.

Guideline 3: Use a public health approach to prevention.

The public health model stresses that problems arise through the interaction of a host(s), agent, and environment. Prevention programs that focus totally on the host may overlook the influences in the environment or community that promote substance abuse. Effective programs take a comprehensive approach. They look not only at individual risk and resiliency factors, but also at community norms, local laws such as those relating to drinking age, availability of alcohol, and other factors.
 

Guideline 4: Reflect and respond to cultural diversity.

Cultural changes are constant in all societies, especially today with the ease of travel and the high rate of immigration. Some people rush to accept new ideas, technologies, and values. Others, in the face of rapid change, turn to traditional values for support. Understanding how people respond to change is a critical component to understand when designing educational messages. Other issues to be addressed include assimilation, immigration, and discrimination issues.

In minority communities, successful prevention programs also deal with the dynamics of drug use specific to their differing cultures. These programs promote cultural understanding and pride in a shared heritage while confronting whatever problems of alcoholism or other drug abuse are most common to their particular community (Office of National Drug Control Policy, 1993). (See also Section I E, Cultural Diversity.)
 

Guideline 5: Involve the audience at all stages.

• Use focus groups and theater testing to learn about needs and preferences.
• Involve members of the target audience in the preparation of materials. This involvement not only helps to ensure that materials will be appropriate for the target audience, but helps to create ownership. At the same time, these individuals are acquiring knowledge, new skills, and self-esteem.

Guideline 6: Explore innovative strategies.

These include

• Developing online computer databases
• Helping communities plan live, call-in supplements to nationwide television
• Using computer-generated animation in combination with live action
• Using computer-generated art and desktop publishing to create inexpensive professional posters, flyers, and other printed materials
• Music videos.

Guideline 7: Use multiple channels and methods.

This ensures more coverage of the issues as well as better chances of reaching the target population. Channels and methods include posters, radio spots, brochures, satellite networking, small groups, take-home projects, music and visual arts programs. A multiple-outlet or a limited-outlet approach may be used.

• Multiple outlet—a total social marketing program that uses as many available resources as possible including television and radio stations, newspapers, and billboards. The community is inundated with information from these multiple outlets.
• Limited outlet—a concentrated effort by one or two outlets. Each makes a more significant commitment of time and resources than in a multiple outlet effort. The benefit to these two outlets is that the campaign becomes closely tied and related to each.

Guideline 8: Learn from successful programs.

Don’t reinvent the wheel. Many communities have been through the process you are now beginning, and a little research can get you information on why they started their program, what they did, what worked, and what didn’t. A number of information sources are listed below.

Center for Alcohol Advertising
2140 Shattuck Avenue, Suite 1206
Berkeley, CA 94704

Center for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
404/639-3824
http://www.cdc.gov/cdc.htm

Center for Media Literacy
4727 Wilshire Boulevard, Suite 403
Los Angeles, CA 90010
213/931-4177
1/800/226-9494
http://websites.earthlink.net/~cml

CSAP’s National Clearinghouse of Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847-2345
1/800/729-6686
TDD Number: 1/800/729-6686
Web site: http://ncadi.samhsa.gov
E-mail address: ncadi-web@samhsa.hhs.gov

Indiana Prevention Resource Center
http://www.drugs.indiana.edu

Partnership for a Drug-Free America
(Develops Public Service Announcements)
405 Lexington Avenue, 16th Floor
New York, NY 10174-0002
212/922-1560

Policy and Media Center on Alcohol and Other Drug Issues
Institute for Health Advocacy
1717 Kettner Boulevard, Suite 200
San Diego, CA 92101
619/238-9210

The Web of Addictions
http://www.well.com/user/woa

Join Together
(Publishes monthly media action kits)
441 Stuart Street, 6th Floor
Boston, MA 02116
617/437-1500
Website: http://www.jointogether.org/

National Institute of Health
gopher://gopher.nih.gov
National Institute on Drug Abuse/NIH
5600 Fishers Lane
10A-54 Parklawn Building
Rockville, MD 20857
1/800/662-HELP

National Association of State Alcohol and Drug Abuse Directors
Arts and Sciences Outreach Office
University of Wisconsin-Eau Claire
Eau Claire, WI 54702-4004
715/836-2031

Office of National Drug Control Policy
gopher://ncjrs.aspensys.com:71/11/drugs

III.     Summary

Social marketing uses commercial marketing tools to “sell” products and ideas for the public good. The key to a successful social marketing campaign is learning what will work with the target population.

In terms of substance abuse prevention

• Product is the knowledge, attitudes, or behavior you want the target audience to adopt.
• Price is what audience members must give up to receive the program’s benefits.
• Place, or the channel, refers to how the message is disseminated.
• Promotion is the means for persuading the target audience that the product is worth this price.

Follow the Six-Stage Health Communication Process

1. Understand what communications can do
2. Use a public health approach to prevention
3. Reflect and respond to cultural diversity
4. Involve the audience at all stages
5. Explore innovative strategies
6. Use multiple channels
7. Learn from successful programs

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