The Social Ecological Model in Action in Social Marketing

1. The Social Ecological Model in Action in Social Marketing October 4, 2011 Jordan Bingham, MS Wisconsin Department of Health Services Nutrition, Physical Activity, & Obesity Program « » Chris Schellpfeffer and Jack Ferreri Knupp and Watson and Wallman (KW2)

2. Today’s Discussion Pairing the Social Ecological Model with Social Marketing in the Real World

3. Goals After this discussion, you will: - have a clear understanding of the Social Ecological Model of social marketing - be able to plan, implement and evaluate community interventions

4. “It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change.” -Institute of Medicine

5. The “Traditional” Approach Activities are: Program-driven and event-driven; not sustainable Focused on individuals Not evidence-based Planned without learning actual needs

6. Brochures, Health Fairs, Runs/Walks Great for changing knowledge Not as effective at changing attitudes and behavior

7. Individual Change Working one-on-one: • Resource-intensive • Individuals revert to old behaviors • Doesn’t address the environment where we live, work and play

8. Individual Change 4.1 Million WI Adults 2.46 million are obese or overweight 1.4 Million Kids 350,000 are overweight or at risk for it

9. Which is More Effective?(thinking about REACH) An individual-level program for 100 people with 80% success impacts 80 people A community-level environmental change in a population of 50,000 with 25% success impacts 12,500 people A statewide policy change in Wisconsin (5.5 million people) with 5% success impacts 275,000 people

10. Which is More Effective?(thinking about DOSE) Walk to School Day at one school: 1 day x 200 kids x 50% participation = 100 “doses” Walk to School Week at one school district: 5 days x 1,000 kids x 25% participation = 1,250 “doses” Walk to School Year throughout the state: 180 days x 900,000 kids x 10% participation = 1,620,000 “doses”

11. Wholesale vs. retail “Big picture” is the best way to change behavior

12. Behavior Change Triad Policy Environment Behavior

13. Social Ecological Model (SEM) PUBLIC POLICY National, state, local laws COMMUNITY Relationships among organizations ORGANIZATIONAL Organizations, social institutions INTERPERSONAL Family, friends, social networks INDIVIDUAL Attitudes, Knowledge, Skills

14. Social Marketing A step-by-step approach

15. Social Marketing in a Nutshell Develop a compelling message and efficiently get it in front of the right audience, making them change their behavior

16. Commercial vs. Social Marketing

17. What is Social Marketing? • Encourages behavior change • Establishes good role models • Promotes programs in health and safety • Announces shifts in policies or laws • Improves society with “live well” messages

18. Barriers: Immense and Subtle& Subtle • Deeply-ingrained behaviors • Loss of freedom, pleasure, comfort • Little perceived immediate personal benefit • Vaguely perceived social benefit • Asks individuals to yield to society • Difficult to measure results

19. Planning Your Intervention Step 1: What do you want to happen? Step 2: What behaviors will make that happen? Step 3: Who do you want to impact? Step 4: Select & Complete Formative Assessment

20. Planning Your Intervention Step 5: Set SMART Objectives Step 6: Select Intervention Strategies Step 7: Identify Evaluation Method(s) Step 8: Implement & Evaluate

21. Step 1: Select Health Outcome(s) Begin by defining your long-range outcome. (What do you want your program to DO?) Examples of Health Outcomes: Increase # of students participating in 60 minutes of daily physical activity Increase # of employees at a healthy weight Reduce # of WI children with diabetes Tip: Don’t jump ahead to other steps; health outcomes involve long-term change

22. Select specific behaviors that will help accomplish/achieve your health outcome This may likely be a nutrition or physical activity behavior Examples of Health Behaviors: - Get students to eat more fruits & vegetables - Increase employee physical activity Step 2: Select Health Behaviors Tip: Health behaviors are shorter-term changes than health outcomes

23. Step 3: Select Target Audience Whose behavior do you want to change? Who is most burdened OR where can we have an impact? (“low-hanging fruit”) Broad (breastfeeding mothers) or specific (young, breastfeeding WIC mothers) Examples of Target Audiences Parents of young children Workers at manufacturing companies Tweens (9-12 years olds) Healthcare patients

24. Step 3: Select Target Audience Select a secondary audience (optional) Influences the primary audience children influence parents HR directors influence employees constituents influence policymakers May need to complete Step 4 before determining a secondary audience

25. Step 4: Formative Assessment Understand your audience for accurate targeting. Review Existing Evidence/Data County Needs Assessment Data Behavioral Risk Factor Surveillance System Youth Risk Behavior Surveillance System School/Worksite Assessment Data

26. Step 4: Formative Assessment Gather Data Directly from the Audience(s) Formative Assessment Techniques: Low resource: Intercept Interviews Key Informant Interviews RAP Assessments Environmental Scan Existing Data Sources Medium resource: Community Forums Focus Groups GIS Mapping High resource Pre-Survey Pilot Testing

27. Step 4: Formative Assessment Analyze your information: Highlight common barriers, issues, themes Segment target audience Example: Common Barriers to Eating Fruits & Vegetables: Not enough time Too expensive

28. Step 5: Set SMART Objectives Specific, Measurable, Achievable, Realistic and Timeframe-oriented Select objectives that help accomplish your Health Behavior(s) Objectives define: What you hope to accomplish What your expected outcomes are What data you must collect How long it will take Tip: More effective interventions have both nutrition & physical activity objectives, but you may need to start with one area and expand

29. Step 5: Set SMART Objectives To Begin, Consider: Formative Assessment Results (Step 4) Known Science or Evidence Evaluation Measures (Step 7) When writing, Consider: Combination of Process & Outcome Objectives - Process: the amount of change expected needed to impact the outcome - Outcome: the amount of change expected to impact a health problem or issue

30. Step 5: Set SMART Objectives Examples of SMART Objectives By March 2011, a baseline nutrition environment assessment will be completed in 4 locally-owned restaurants (process) By September 2011, at least 1 of the 4 locally-owned restaurants will have made at least two environmental changes (outcome)

31. Step 6: Using Evidence-Based Strategies Think about Strategies by: Behavior Change Areas Policy Environment Individual/Behavior

32. Think about Strategies by: Key Behaviors Fruit & Vegetable Consumption Sweetened Beverage Consumption Portion Size/Portion Control Breastfeeding TV or Screen Time Physical Activity Step 6: Using Evidence-Based Strategies

33. Select strategies by setting: Worksite Home Community School/Early Childhood Healthcare Consider Evaluation Measures--Again Step 6: Using Evidence-Based Strategies

34. Sources for evidence-based strategies: CDC’s Recommended Community Strategies and Measures to Prevent Obesity in the United Stateshttp://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf MAPPS Strategies (developed for Communities Putting Prevention to Work) http://www.cdc.gov/CommunitiesPuttingPreventiontoWork/strategies/index.htm “Key Strategies” Chart on NPAO website http://www.dhs.wisconsin.gov/health/physicalactivity/Sites/Community/General/Key%20Strategies%20Table%202010.pdf “What Works” documents on NPAO website http://www.dhs.wisconsin.gov/health/physicalactivity/index.htm Step 6: Using Evidence-Based Strategies

35. Examples of evidence-based strategies: Increase support for breastfeeding in worksites Improve availability of affordable healthier food and beverage choices in public service venues Provide incentives for procurement of food from local farms Provide opportunities for 60 minutes of physical activity per day before, during and after school Step 6: Using Evidence-Based Strategies

36. Understanding Your Audience • You can only do this through research • Use your own or someone else’s • Funding agencies want evidence • Don’t trust “your gut” – you’ll be surprised

37. Developing a Message • Keep it simple and unified – 1-2 points • Key benefit – why should they change? • Language should be honest and personal • Humanize your appeal • Stats are forgotten and hard to process • What do you want the audience to do?

38. Developing a Message • Thinking things through • Name your service or campaign • What’s the call-to-action: call, write, email, visit? • Geographic area? • Can you fit your message on a business card? • Are there entities that can help?

39. The Problem with People • People don’t change for logical reasons • They must be persuaded • Even the appeal to a “noble” action can fail

40. Social Marketing Issues • Promoting ideas and actions, not products • Market could be unaware of or even hostile to your effort • Altering attitudes to lead to new behavior • The competition is the status quo

41. Delivering the Message • Where can you put your message? • Need multiple venues/vehicles • Takes time and repetition

42. Key Media Options • Print (newspapers and magazines) • Radio • Print collateral (brochures, flyers) • Transit (bus boards, bus kiosks) • Billboards • Direct mail • TV/cinema PSAs • Online advertising • Social networks • The news media

43. Delivering the Message • Public Relations • Sometimes an under-utilized message delivery option • Valuable endorsement of your message by media • Making the media’s job easier • Do some homework on who to target • Press conference when it’s really news • The media advisory & the news release • Editorial board briefings • Speakers Bureau

44. Working Together • How agencies work with public health/non-profits • RFPs • Balancing action with caution (approval process) • Localization • Breadth of partnership

45. Step 7: Determine Evaluation Measures Helps answer questions about effectiveness documenting and measuring the implementation (process) and success in achieving intended outcomes Consider existing baseline data sources Consider evaluation techniques Pre/Post Survey Retrospective Survey Observation Assessments (like NEMS)

46. Review health outcome(s), health behavior(s), objectives, & strategies to determine necessary measures Select evaluation measures for process/outcome objectives Consider the overall scope of the project: “need to know” vs. “nice to know” Step 7: Determine Evaluation Measures

47. Step 8: Implement & Evaluate Consider piloting a small part of the entire program: One segment of target audience One geographic location (school, workplace, neighborhood) Once your program is being implemented: Continually check-in with your target audience Document, evaluate, and revise as necessary

48. More on Social Marketing & Intervention Planning CDC Social Marketing Training http://www.cdc.gov/nccdphp/dnpa/socialmarketing/training/index.htm Additional resources from CDC http://www.cdc.gov/nccdphp/dnpao/socialmarketing/index.html Wisconsin NPAO Program – resources for coalition capacity and planning http://www.dhs.wisconsin.gov/health/physicalactivity/Sites/Community/General/Resources.htm