Upstream Social Marketing

1. Policies and Laws Social Gradients Income Living Conditions Transportation Culture Upstream Social Marketing Discrimination Social Capital Education Social Networks Social Support Violence ASU Wellness and Health Promotion May 13, 2008 Karen Moses, MS, RD, CHES and Jim Grizzell, MBA, MA, CHES, HFI Individual and Community Health

2. 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

3. 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

4. Why Use Upstream Social Marketing • A social determinant may seem • Too big to tackle • Out of bounds because it is not specifically health-related • Can’t understand many health problems without acknowledging predisposing causal factors

5. 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

6. 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.

7. Alan Andreasen’s 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

8. 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 CDCynergy Social Marketing Edition Green text are common tasks left out of social marketing programs.

9. Logic Model

10. Phase 1: Problem Description • Write a problem statement • List and map the causes of the health problem • Identify potential audiences* • Identify the models of behavior change and best practices* • Form your strategy team • Conduct a SWOT analysis * These are Logic Model items

11. Phase 2: Market Research • Define your research questions • Develop a market research plan • Conduct and analyze market research • Summarize research results

12. Phase 3: Market Strategy • Select your target audience segments* • Define current and desired behaviors for each audience segment* • Describe the benefits you will offer* • Write your behavior change goal(s)* • Select the intervention(s) you will develop for your program • Write the goal for each intervention

13. Phase 4: Interventions • Select members and assign roles for your planning team • Write specific, measurable objectives for each intervention activity* • Write a program plan, including timeline and budget, for each intervention • Pretest, pilot test, and revise as needed • Summarize your program plan and review the factors that can affect it • Confirm plans with stakeholders

14. Phase 5: Evaluation • Identify program elements to monitor • Select the key evaluation questions • Determine how the information will be gathered • Develop a data analysis and reporting plan

15. Phase 6: Implementation • Prepare for launch • Execute and manage intervention components • Execute and manage the monitoring and evaluation plans • Modify intervention activities, as feedback indicates

16. 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

17. Extra Slides

18. Resources

19. Resources

20. 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-Reevaluation: Appreciating that the change is important to one’s 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 Moving to a Health Agenda

21. 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 people’s everyday lives

22. 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

23. 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 - 1:72,000* • 19,000 faculty and staff – 1:947 • Health problems • Campus wide • Specific to college or major • Influences quality and productivity * See notes section

24. 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

25. 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

26. 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

27. Evolution of College Wellness & Health 1850s 1970s 1980s ~1995 2010 1st Generation 2nd Generation 3rd Generation Healthy Campus Objectives Instruction, Treatment, ExerciseHealth Education/Promotion EB/CE-HP* * Evidence-based / Cost Effective Health Promotion

28. Evolution of College Wellness & Health Traditional Medical Model and Health Education Traditional Medical and Health Promotion 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 Mostly health focus Some risk reduction Little risk reduction Limited HCM oriented All voluntary Site-based only Weak personalization Modest incentives Few sig. others served Weak assess/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 Main Features Morale Oriented Activity Oriented Results / Outcome Oriented Primary Focus Moving to a Health Agenda * Health Cost Management

29. Social MarketingCommercial vs. Social • Marketing is about behavior change • The bottom line • ROI and CEA • If your intervention won’t change behavior • Don’t do it!!!! • Theory • Distillation of previous work • Simplify complex phenomena

30. 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?

31. 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

32. Intervention Pyramid Low High Specialty Care Reach Cost Primary Care Activities no feedback Health Systems Activities w/ Health Education Community & Neighborhood Collaboration Health Communication, Social Ecological Model & Social Marketing Policies High Low

33. Business CaseLevels of Interventions & Wellness Program ROIs Moving to a Health Agenda

34. 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

35. 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

36. 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. O’Donnell, American Journal of Health Promotion (1986)

37. 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

38. 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

39. Influencing Factors Characteristics of the: Individual Community Place Organization People

40. Environmental Influences Place People The location of the campus The weather The constructed designs Landscapes Behavior settings: Rituals, student organizations Cultural Influences: Customs, traditions, values Economic Forces: Student financial stability, budget Inhabitants: Diversity, Athletics, Greek, campus communities, etc. Organizational Structure Policies Organizational Climate Organization Community Political Climate Conservative/liberal Pro education? Reinforcement and Rewards For healthy org & indiv behaviors

41. Stress: Environmental Influences Warm climate Lack of parking High traffic Campus size—distances Crowding—long 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 Institution State budget crisis Increase in tuition/fees Rewards for over commitment Culture of stress Community

42. Social Marketing Social Marketing Social Marketing Specialty Care Primary Care Activities no feedback Health Systems Activities w/ Health Education Community & Neighborhood Collaboration Health Communication, Ecological / Environmental Approach Policies Social Marketing’s FitIntervention Pyramid Social Marketing in Health Promotion

43. Historical Snapshot: Think Health Agenda & Business Case Corporate & College Health & Wellness 1st Generation 2nd Generation 3rd Generation 4th Generation RecreationFitnessHealth Education > Promotion HPM* 1850s 1970s 1980s ~1995 2010 1st Generation 2nd Generation 3rd Generation Instruction, Treatment, ExerciseHealth Education > Promotion HAPM* * Health & Productivity Management, Health & Academic Performance Management Moving to a Health Agenda