Social Marketing Research:

1
Social Marketing Research

• Recommendations for Delivering Nutrition and
  Physical Activity Messages to Low-Income
  Care-givers of Children Aged 2-12 Years
• March 1999
• Elisabeth Schafer and Diane Nelson

2
Target audience

• Low-income parents of children aged 2-12 years
• mothers
• fathers
• child-care providers

3
Behavioral objectives

• Increase consumption of a variety of foods
• Increase consumption of fruits and vegetables
• Decrease consumption of total fat
• Increase physical activity

4
The problem Children dont eat a variety of
foods

• According to the 1996 CSFII (2-day record)
• Children aged 2-11 eat
• 1/2 the total vegetables eaten are white potatoes
• 1/4 the total vegetables eaten are french fries

5
The problem Children dont eat a variety of
foods

• According to a 1998 study of preschoolers
• 40 had never been offered 42 of a list of 196
  commonly eaten foods
• Foods never tasted included winter squash, navy
  beans, grapefruit juice, plain yogurt, spinach,
  cabbage, shredded wheat, and tomato juice

6
The problem Children dont eat a diet moderate
in fat

• According to 1996 CSFII
• 74 and 71 of 6-11 year old boys and girls
  exceed recommendations for total and saturated fat

7
The problem Children dont eat enough fruits
and vegetables

• According to 1996 CSFII
• Boys and girls aged 2-11 years eat 2.2-2.3
  servings of vegetables/day
• 1/4 of the boys eat
• 1/5 of the girls eat

8
The problem Children dont get enough physical
activity

• 1/2 of 12-21 year-olds are not physically active
• 1/3 of 14-18 year-olds are not physically active
• 14 of US children are overweight
• Hours spent watching TV are associated with
  higher BMI and body fat content

9
The problem Low income is associated with poor
health behaviors

• Physical activity in middle and high school
  students is lowest among low-income children
• Low-income adults eat fewer servings of fruits
  and vegetables

10
The problem Hispanic children have dietary risks

• Fruit and vegetable intake is only
• 26-38 of recommended amounts.
• Compared to Anglo children
• Percent energy from fat is higher.
• Physical activity is lower.
• Percent body fat is higher.

11
The problem Iowans do not meet health
recommendations

• According to the 1995 Iowa BRFSS
• 15 of adults eat 5-A-Day
• (national average is 23)
• According to the 1996 Iowa BRFSS
• 58 of adults do not engage in regular physical
  activity
• (MN 48 IL 54 NE 54 MO 58)

12
What is Social Marketing?

• formal definition
• Social marketing is the application of commercial
  marketing technologies to the analysis, planning,
  execution, and evaluation of programs designed to
  influence the voluntary behavior of target
  audiences in order to improve their personal
  welfare and that of society.

13
Why use social marketing?

• immensely powerful tool for affecting massive
  behavior change
• one of the fastest-growing sectors of nonprofit
  marketing
• first used with health behaviors and health
  applications still dominate

14
Social marketing similarities to commercial
marketing

• final objective influence target audience
  behavior
• target behaviors compete with comfortable/known
  behaviors
• community pressure can work against behavior
  change even if target audience finds change
  attractive

15
Social marketing similarities to commercial
marketing (cont.)

• supporting agencies must help if behavior change
  program is to be successful

16
Social marketing differences from commercial
marketing

• targeted behavior change benefits the audience or
  society not the marketer
• influencing customer behavior is the bottom line
• customer is key everything starts from customer
  perspective

17
Social marketing differences from commercial
marketing (cont.)

• often deals with more limited budget, more
  diverse tasks, more diverse and harder to reach
  audiences
• often must be accountable to government agencies

18
Social marketing is

• more than social advertising
• a way of thinking about behavior change process
• a process for planning and carrying out
  strategies to change behavior
• a set of tools

19
Social marketing tools

• education approach
• give facts (no focus on behavior)
• facts alone can have a boomerang effect
• social marketing focuses on behavior and uses
  education to influence behavior change

20
Social marketing tools

• persuasion approach
• action takes place only if people are
  sufficiently motivated
• social marketing recognizes that change occurs
  only when start with customers reality

21
Social marketing tools

• behavior modification approach
• people do what they do because they learn the
  necessary techniques and find the outcomes
  rewarding
• most effective with individuals so costly
• social marketing looks for ways to use this
  approach with audience segments who share
  similarities

22
Social marketing focus audience

• consider environmental influences
• cultural
• personal
• family
• situational

23
Social marketing focus audience

• consider personal influences
• resources
• knowledge
• skills

24
Social marketing focus behavior

• consider type of behavior change is it
• new to world or new to individual?
• in competition with another desirable alternative
  or with the status quo?
• offering a personal benefit or a third-party
  benefit?
• emotional?

25
Social marketing focus behavior change

• How does the proposed behavior fit audiences
  image of itself?

26
Social marketing summary

• Learning is a two-way thing you cant influence
  someone if youre not learning from them at the
  same time.
  Charlotte Zolotow

27
What can we learn from other states?
28
California program

• Large budget 4.9 million many partners
• Research multiple methods used multiple times
  mostly with women
• Similar behavior changes sought for similar
  audience subset
• Various themes tested

29
California sample findings

• Fruit/vegetable use dropped 1989-1997
• Women determine what families eat
• Build on other campaigns
• Barriers to eating healthy
• cost, eating out, TV, lack of knowledge
• Desirable methods
• in-store education, taste tests, coupons

30
Connecticut program

• Very successful cooperative effort with Hispanic
  Health Council
• www.hispanichealth.com/pana.htm
• Using several channels

31
Georgia program

• Audience low-income men and women
• Goals
• Eat at least 5 servings of fruits/vegetables
  daily
• Reduce dietary fat intake
• Increase level of physical activity
• Extensive research on message concepts
• Theme Take Charge of Your Health

32
Georgia sample findings

• Women eat more fruits/vegetables than do men
• Half of men and women said trying to eat more
  fruits and vegetables
• Most think theyre getting enough physical
  activity from work or by choice
• Prefer messages that depict a family

33
Michigan program

• Goal Improve nutritional health of
• low-income families
• Theme Eat Healthy. Your Kids Are Watching
• Tested in one pilot county Aug.-Sept. 1998
• Involved more than 60 agencies/companies

34
Minnesota program

• Audience Low-income African American and
  Caucasian women ages 18-54 with children under
  age 12 at home
• Theme The power of healthy eating Growth,
  Energy, Learning
• Pilot test in Minneapolis/St. Paul in
  Feb.-March 1999

35
Minnesota focus groups Caucasian mothers

• Less control over familys dietary habits
• Less likely to have learned how to cook
• More likely to prefer fast food meals
• Evening meal likely to revolve around convenience
  and childrens wishes
• Want to take care of their children and be happy
  with their families

36
Minnesota focus groups Hispanic mothers

• Family unit is very significant
• Families more likely to prepare and eat meals
  together
• Have most control over familys dietary habits
  conscious of nutritional value
• Want to change their eating habits
• Want Spanish recipes for American foods

37
Minnesota focus groups African American mothers

• More control over familys dietary habits more
  knowledge about nutritional needs more likely to
  have cooking skills
• Want children to have a balanced evening meal
  cooking is considered necessary even if not
  enjoyed
• Want to take care of their children

38
Missouri program

• Audience Food stamp families
• Goals Increase the number of families who are
  fixing healthy meals and snacks
• Research Focus groups and interviews with low
  income women, children, and nutrition-related
  professionals
• Possible slogan Energize Your Life

39
Missouri sample findings

• Substantial variation in audience readiness to
  change nutrition behaviors
• Children are the most important thing in lives of
  most single mothers who receive food stamps
• Nutrition behavior changes need to be quick,
  easy, low-cost

40
Missouri sample findings (cont.)

• Nutrition behavior changes need to be compatible
  with existing family responsibilities
• Recommended foods for children must be compatible
  with childrens preferences
• Printed materials are best for low income mothers
  who are contemplating change in nutrition behavior

41
Oklahoma program

• Audience Families with children age 13 and
  younger in home
• Research Focus groups with 4 ethnic groups in
  rural and urban areas
• Used a software program on transcripts
• Market testing slogans and logos decision
  expected Sept. 1999

42
Oklahoma focus groups

• Benefits of eating healthy foods
• children are in good mood, have greater attention
  span, are healthier
• mothers cited weight control and energy
• Obstacles to adoption of healthier eating habits
• limited food budget, convenience, taste, habit,
  childrens preferences

43
Oklahoma focus groups (cont.)

• Mothers want children to eat more fruits and
  vegetables and less junk food and sweets
• Nutrition information sources friends, family,
  WIC/EFNEP, job, school,
• TV news
• Frustrated by contradictory information
• Preferences for information vary

44
Virginia program

• Primary audience food stamp recipient families
  (children aged 2-12)
• Short-term objective Increase awareness of
  importance/benefits of healthier food choices
  and motivate audience to seek information
• Research Focus groups
• Campaign suggested for May 97-Feb. 98

45
Virginia focus groups nutrition message should

• Suit current perceived needs
• Be targeted to who has the most influence on food
  purchases (children have a major influence in
  younger families)
• Recognize that recipients may not want to change
  current eating habits

46
Washington program

• Audience food stamp recipients (or eligible)
  with children at home
• Research Focus groups
• Theme Making the most of it Eating together,
  eating better
• example channel four 12-panel mailers in 8
  languages

47
Washington focus groups

• Screened for belief that shared family meals are
  important
• Said campaign should encourage families to eat
  more nutritious meals together
• Said campaign should target parents with
  components for children and teens
• Positive reaction to suggested weekly postcard
  mailing

48
Gaps What dont we know?
49
Gaps Audience Low-income parents

• Much food information from mothers
• Less information about physical activity
• Little information about other behaviors
• Are Iowa mothers similar or different?
• Little information from fathers

50
Gaps Audience Who influences parents?

• Agency staff
• Some information from other states
• Childcare providers
• No information from other states
• School teachers/nurses/counselors
• No information from other states
• Family and friends

51
Gaps Audience Family interaction

• Know some children influence some family food
  patterns
• Suspect influence is stronger toward negative
  behaviors
• What are Iowa patterns?
• Can childs influence be directed toward desired
  behavior changes?

52
Gaps Behavior

• Considerable information about fruit vegetable
  use from other states
• Some information about physical activity
• Less information about other target behaviors
• Does it apply to Iowa audiences?

53
Gaps Channels

• Have some information about audience preferences
  in other states
• Where do Iowa target audiences get information
  about target behaviors?
• Where do Iowans want to get information?

54
Gaps Messages

• Know what audiences in other states say they want
• What do Iowa target audiences want?
• How do Iowans react to other state messages?

55
Theory Health Belief Model
Benefits
Self-efficacy
Behavior change
Barriers
56
Purpose of focus groups

• Identify motivations
• Identify perceived benefits
• Identify perceived barriers
• Identify preferred channels of information
• Evaluate potential campaign themes, logos, etc.

57
County selection criteria

• Has a Team Nutrition program in the schools
• Has a BASICS for child nutrition grant
• Has an EFNEP program

58
County selection criteria (cont.)

• Has a high proportion of children
• aged 2-12
• Has a high proportion of families living in
  poverty
• Represents diverse geographical and demographic
  areas of the state
• Has media channels that can use the campaign to
  be developed

59
(No Transcript)
60
Focus group plan

• 3 focus groups/county
• --2 with low-income parents of
• young children
• --1 with day-care providers
• In Woodbury county
• --1 in Spanish

61
Focus group participants

• Total 77
• Mothers 45 (7 groups)
• Fathers 8 (3 groups)
• Child care providers 24 (5 groups)

62
Focus group participants
63
Income
64
Employment status
65
Participation in Food Programs
66
Thea

• Blended family
• 6 children,
• aged 4 to 12
• Lives in small town

67
Frank

• Single parent
• 3-year-old twin boys
• Black
• Born and raised in Mississippi
• Lives in large urban area

68
Focus Group Dynamics

• Interaction of participants
• Networking
• Enjoyed being the experts
• Didnt want to leave

69
Perceptions of Good Health and Healthful Living
Dominant Themes

• Value is here and now - not delayed
• Healthy person
• has energy
• eats right
• feels happy, vibrant
• is clean
• is active - in family, community, personally

70
Perceptions of Good Health and Healthful Living
Dominant Themes - Mothers

• Good health is time-consuming
• See immediate value of good health and have clear
  image of healthy person, but dont see themselves
  as capable of doing what it takes to be healthy

71
Perceptions of Good Health and Healthful Living
Dominant Themes - Fathers

• Good health is a matter of attitude
• Money is not necessary for health

72
Perceptions of Good Health and Healthful Living
Dominant Themes - Providers

• Good health arises from a balanced, organized
  life.
• Time is the barrier.

73
Perceptions of Fruits and Vegetables
74
Paired adjective attitude scale

• Expensive 1 2 3 4 5 6 7
  Inexpensive
• Convenient 1 2 3 4 5 6 7
  Inconvenient
• Good tasting 1 2 3 4 5 6 7 Bad tasting
• Satisfying 1 2 3 4 5 6 7 Not
  satisfying
• Appealing 1 2 3 4 5 6 7 Not
  appealing
• Pleasant 1 2 3 4 5 6 7
  Unpleasant
• Easy to buy 1 2 3 4 5 6 7 Hard to buy

75
Attitudes toward vegetables
76
Perceptions of Fruits and Vegetables Dominant
Themes

• Eating fruits and vegetables
• makes you feel healthier
• makes you feel energetic
• makes you feel good about yourself
• does not describe me or the people
• I know

77
Perceptions of Fruits and Vegetables Dominant
Themes

• Strong positive attitude toward fr/veg
• Strong belief in the benefits of fr/veg

78
Perceptions of Fruits and Vegetables Dominant
Themes

• Children
• prefer fruits to vegetables
• love fruits of all kinds
• are highly variable in vegetable preferences
• are strongly influenced in vegetable preference
  by adult example
• more readily accept foods with which they have
  personal involvement

79
Fruit preferences

• Preferred apples, bananas, oranges, kiwi,
  grapes
• Also mentioned melons, strawberries, pears,
  peaches (mango, fresh pineapple)
• Not mentioned orange juice, other fruit juices

80
Vegetable preferences

• Preferred baby carrots, celery, corn, potato
• Also mentioned broccoli, tomato, peas, green
  beans, lettuce, sweet potato, squash, tofu,
  cucumber, cauliflower, spinach, green pepper,
  onion, avocado

81
Vegetable preferences

• Definite dislikes Brussels sprouts, cauliflower
• Never mentioned juices, cabbage, radishes, and
  a host of others
• Fresh strongly preferred
• Frozen and canned often mentioned and used

82
Ethnic difference in preferences

• Hispanic
• fresh, natural
• perhaps due to type of vegetables used
• viewed canned tomatoes as a convenience food

83
Perceptions of Fruits and Vegetables Dominant
Themes

• Major barriers to increased use
• Inconvenience
• Access to quality and variety
• Cost - seasonality
• Problems with storage and waste
• Lack of knowledge about how to use

84
Perceptions of Fruits and Vegetables Dominant
Themes

• Other
• Confusion on classification
• Confusion on meaning of 5-A-Day
• Providers more strongly positive than either
  mothers or fathers

85
Perceptions of Physical Activity Dominant Themes
86
Perceptions of Physical Activity Dominant Themes

• Exercise requires equipment or a membership
• Exercise requires a separate, dedicated time
• Exercise requires organization, structure,
  scheduling

87
Perceptions of Physical Activity Barriers

• Lack of time
• Lack of access - place, equipment
• Weather
• What to do with children
• Being too tired

88
Perceptions of Physical Activity Hispanic
Mothers

• Attitude, laziness
• TV, nintendo

89
Perceptions of Physical Activity Fathers

• Focus more on attitude
• Less focus on time
• External vs. internal locus of control

90
?PERSONALITY?
?KNOWLEDGE?
91
Communication

• Sources
• Preferences
• Messages Themes

92
Communication sources mothers

• relatives
• television
• medical and educational professionals
• nutrition programs
• cooking classes recipes
• other media

93
Communication sources fathers

• Strongest from my kids
• More likely to mention mass media sooner than
  others
• Hard to be specific

94
Communication sources childcare providers

• health professionals
• education professionals
• personal network
• media

95
Communication preferences mothers

• Bold, simple, colorful, bright
• Show happiness be cheerful, encouraging
• Show parents and children preparing food together
• Recipe cards and coupons
• Posters in places where people have to wait and
  have time to read
• Teach cooking and nutrition

96
Communication preferences fathers

• Convenience
• Need recipes and ideas on how to prepare and
  store foods
• Advertise to kids because they influence parents

97
Communication preferences childcare providers

• Strong interest in learning
• Recognize their role as teacher

98
Themes

• Eat Healthy. Your Kids Are Watching
• The power of healthy eatingGrowth, Energy,
  Learning
• Take Charge of Your Health

99
Georgia approach

• 1995 focus groups explored needs
• Message criteria defined message created
• 1997 focus groups reacted to 3 alternatives
• 1997 intercept interviews used to test 2 versions
  of revision

100
Georgia criteria Message should . . .

• Clearly suggest benefits that appeal to the
  target audience
• Be positive and upbeat
• Be clear, concrete, unambiguous
• Be catchy both verbally and visually thus easy
  to remember

101
Georgia criteriaMessage should . . .

• Offer clear idea of what to do
  and how to do it (call to action)
• Convey a you can do it feeling
• Include images with relevance and appeal to a
  wide array of target audience

102
Georgia testingDo participants . . .

• Understand the message as intended?
• Find the concepts attention-getting and
  appealing?
• Find the concepts personally relevant?
• Find the concepts motivating?

103
Georgia testing (cont.)

• Do different types of participants respond
  differently to concepts?

104
Iowa reactions to themes mothers

• Eyes  mostly strong agreement with message and
  visual
• Power overall, more positive than negative
• Take charge all agreed good concept and message

105
Iowa reactions to themes fathers

• Eyes strong agreement that adults influence
  kids
• Power modest reaction
• Take charge doesnt evoke strong reactions

106
Iowa reactions to themes childcare providers

• Eyes Comments consistent with mothers and
  strongly positive
• Power Comments consistent with mothers
• Take charge Most variable responses

107
Other Observations
108
Recommendations

• Learning is a two-way thing you cant
  influence someone if youre not learning from
  them at the same time.
• --Charlotte Zolotow

109
What does the target audience need to know?

• How to incorporate vegetables into meals and
  snacks easily
• How to make fruits and vegetables convenient to
  use
• How to manage time, set priorities, work toward
  goals
• How to incorporate physical activity into daily
  life

110
What does the target audience need to know? (cont)

• How to store fruits and vegetables so they dont
  spoil
• What 5-A-Day means
• How fresh produce can be low cost
• Sense of being capable of targeted behaviors
• Positive attitude toward variety of vegetables

111
What does the target audience already have that
we can capitalize on?

• Belief that targeted behaviors will increase
  energy for daily living
• Belief in importance of adult example for
  children
• Commitment to healthy children and doing whats
  best for children
• Belief that targeted behaviors are good for
  adults and children

112
How should we get messages to the target audience?

• Recipes, menus, and shopping lists People need
  ideas.
• Large posters at community sites such as
  billboards, movie theatre screens, courthouse,
  health clinics, doctors offices, WIC office (for
  fathers and mothers but NOT necessarily for
  providers)

113
How should we get messages to the target
audience? (cont)

• Small posters for refrigerator (for providers)
• Flyers or newsletters for child care providers
• Flyers that child care providers can distribute
  to parents

114
How should we get messages to the target
audience? (cont)

• School or after-school interventions with
  children theyll carry the message into the
  family
• Food preparation workshops (for fathers and
  mothers but NOT for providers)
• Coupons for fruits/vegetables

115
What theme will appeal most strongly to the
target audience?

• Must be short, simple, few words
• Should be positive, upbeat
• Should suggest family
• All three themes tested had and - responses,
  both for visual and for content
• Eyes has strong emotional appeal, less strong
  visual appeal

116
Two final thoughts on theme selection

• Be clear on the purpose of the theme--advertising?
  logo?
• Test the theme selected

117
What else should we think about for a
community-based social marketing campaign?

• The theme is only the attention-getter. The
  theme must be supported with other programmatic
  components.
• Keep the audience at the center of the campaign.
• The target audience has subsets and can be
  focused even more tightly.

118
What else should we think about for a
community-based social marketing campaign? (cont.)

• Which target audience has the potential for the
  greatest impact -- total numbers in the target
  audience, readiness to change, ease of reaching,
  need for change?
• How will we evaluate outcome of the campaign?

119
What else should we think about for a
community-based social marketing campaign? (cont.)

• Consider incorporating parenting skills and child
  development information into the program.
• Find a way to involve children in food
  acquisition and preparation activities, for
  example through establishment of community
  gardens.

120
What else should we think about for a
community-based social marketing campaign? (cont.)

• Recognize the power of coalition work to
  reinforce the message and to reach different
  members of the target audience.
• Involve grocery stores and farmers markets.