Upstream Social Marketing

Upstream Social Marketing
Policies and Laws Social Gradients Income Living Conditions Transportation Culture Discrimination Social Capital Education Social Networks Social Support Violence Staff members from all four campuses meet on certain Fridays of the month from 9:00-11:00 in one location. We call this group the “Pan Campus Wellness Workgroup” (PCWW). It was formed out of an objective in our Department of Education Grant. Because the other 3 campuses do not have specific wellness and health promotion departments, we have tried to identify key partners from those campuses to serve on this committee and aid us in providing outreach to those campuses. The 11 staff listed on the web page is our entire professional staff and all would be invited to attend this training, (even though not all of the staff members are involved in the PCWW.) As for student staff/peer educators, I am not sure about our numbers but I have ed someone and will let you know the answer. Usually student invitations to trainings would be left up to their professional staff supervisor/advisor. If you recommend that students attend this training as well, I will make sure they are invited. Individual and Community Health ASU Wellness and Health Promotion May 13, 2008 Karen Moses, MS, RD, CHES and Jim Grizzell, MBA, MA, CHES, HFI

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 ACHA Behavioral Objectives Guidelines A behavioral objective (1) is very brief and (2) states the purpose of the presentation in terms of enabling the attendee to do something that can be measured. Therefore the objective should begin with a verb, followed by a short description of what specific task an attendee could expect to perform after participating in the session. A minute session should contain no more than 2-3 behavioral objectives. Each behavioral objective should contain only one verb from the list provided below. Behavioral objectives define the expected outcome for the learner within the classroom environment. Behavioral objectives must be measurable within the time allotted to the classroom setting. Content: Content can be described as the information needed to meet each behavioral objective. An example of content appears in the sample below. VERBS TO USE Behavioral verbs used in writing objectives include: Describe, Explain, Identify, Discuss, Compare, Contrast, Recite, Define, Differentiate, List SAMPLE Title: Sleep Deprivation Behavioral Objective #1: Define sleep deprivation Content: – degrees of sleep – quantity of sleep – quality of sleep – circadian factors Behavioral Objective #2: List the consequences of sleep deprivation Content: – cognitive deficits and changes in mental status – accidents – decreased quality of life

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 CONSENSUS ON FACTORS THAT PREDICT BEHAVIOR from CDCynergy Phase 1 Step 4 In July 1993, “Behavioral and Social Sciences and the HIV/AIDS Epidemic” was published by the National Commission on AIDS. Among other things, this document suggests that for a person to perform a given behavior, one or more of the following conditions must be true: 1. the person has formed a strong positive intention (or made a commitment) to perform the behavior; 2. there are no environmental constraints that make it impossible for the behavior to occur; 3. the person has the skill(s) necessary to perform the behavior; 4. the person believes the advantages of performing the behavior outweigh the disadvantages; 5. the person perceives more social pressure to perform the behavior than not to perform it; 6. the person perceives that the behavior is consistent with their self-image and does not violate their personal standards; 7. their emotional reaction to performing the behavior is positively reinforced, and 8. they believe (have confidence) they can execute the behavior. These eight conditions or factors that represent a consensus of opinion among leading behavioral and social scientists concerning what is important to consider when developing an intervention designed to change a health-relevant behavior(s). The first three conditions (i.e., intention, environmental constraints, and ability) are considered "necessary and sufficient" for inducing a target behavior. In other words, for a behavior to occur, a person must have: a strong positive commitment orientation to perform the behavior; the skills required to implement the behavior; and live in an environment that is conducive to the behavior occurring. The remaining five conditions (i.e., anticipate outcomes, norms, self-standards, emotion, and self-efficacy) are viewed as influencing the strength or intensity and direction of the intention.

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 From CDCynergy Phase 1 Step 1 Determinants of behavior Factors, either internal or external , that influence an individual’s actions or behaviors. Behavioral science theories and models list various determinants. Just like pollution upstream lowers water quality for miles downstream, general risk factors such as a lack of educational opportunity often predict higher rates of subsequent or “downstream” health problems. The upstream causal factors are referred to as social determinants of health A social determinant may seem too big to tackle, or out of bounds because it is not specifically health-related, but there are many health problems that you really can’t understand without acknowledging such predisposing causal factors. Examples of groups that might be potential "upstream" partners: If you’re planning a diabetes intervention that encourages physical activity, recruit organizations advocating for bike trails If you want to encourage people to eat fresh fruits and vegetables, partner with grocery retailers, food coops or farmers markets If you are planning a violence prevention intervention, find partners among affordable- housing advocates (because home ownership is associated with reduced violence)

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

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.

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

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

Logic Model Click on CDCynergy Social Marketing Edition It will help if you read the pages just prior to and for each step. Enter text on logic model at the following Phases and Steps: Step 1.3: Identify potential audiences. open My Model form and “pencil in” your target audience based on what you understand about the health problem so far, then save your My Model file so that you can add to it later. You will revise and refine these decisions as you move through the planning process. Remember to think about whether new information or analysis warrants revising these major decisions. Examples of completed My Model forms can be accessed in the My Model window. Step 1.4: Identify models of behavior change and best practices. Complete My Model: Then go to My Model and fill in the blanks for the behavior you think you want to change and the major determinants of that behavior that you know about so far. Step 3.1: Select your target audience segment(s). Update My Model Open the My Model form and update your target audience segments based on your latest decision-making. Examples of completed My Model forms can be accessed in the My Model window. Step 3.2: Define current and desired behaviors for each audience segment. Update My Model Open the My Model form and enter the final target audiences and behaviors to be changed. Examples of completed My Model forms can be accessed in the My Model window. Step 3.3: Describe the benefits you will offer. Complete My Model Go to My Model and record the benefits portion of your exchange. Examples of completed My Model forms can be accessed in the My Model window. Step 3.4: Write your behavior change goal(s). Complete My Plan Go to your My Plan file and enter your benefit exchange statements in Step Go to My Model and enter your target audience and the behavior you have decided to try to change. Get ready to select the interventions that will make up your social marketing program! Step 3.5: Select the intervention(s) you will develop for your program. Complete My Model Go to My Model and record your interventions in the Activities and Tactics Box. You can also begin to complete the box that refers to addressing the “P’s.” You will add to that analysis when you plan intervention details in the next phase. Step 4.2: Write specific, measurable objectives for each intervention activity. Complete My Model Enter your outcome objectives in the appropriate column of My Model.

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 Objectives State participant’s health or safety problem and the groups it affects Identify the major causes of the problem Draft a list of possible audiences for participants program Learn about and describe previous efforts to address the problem List potential members who would form a strategy team Identify issues and aspects of participants situation that could affect the program’s success * These are Logic Model items

Phase 2: Market Research
Define your research questions Develop a market research plan Conduct and analyze market research Summarize research results Objectives Spell out your market research questions Select research methods to answer those questions Take full advantage of data that were collected for other purposes Collect supplementary data Summarize your research results

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 Objectives Select your target audience segment(s) Define the current and desired behavior for each segment – increasing levels of the desired behavior is your program goal Identify the benefits of the desired behavior to “doers” in each segment Clarify the exchange you will offer and encourage Apply a marketing mix analysis to select the interventions you will develop for your program Write subgoals for each intervention that will add up to your overall program goal

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 Objectives Assemble your planning team and assign roles Plan your interventions in detail Test and revise your interventions At the end of this phase, you’ll know What your services and products will actually look like How your program will phrase its messages How your various offerings will be tied together into a cohesive, mutually reinforcing whole

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 Objectives Determine which program components should be monitored and/or evaluated Decide how to gather the information Decide how to analyze and report the data Get IRB approval for research with human subjects if necessary

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 Objectives Execute intervention plans Initiate monitoring and evaluation activities Modify program components based on feedback Share evaluation findings and lessons learned

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

Extra Slides

Resources

Moving to a Health Agenda
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 1. Consciousness Raising: Becoming more aware of a problem and potential solutions; 2. Dramatic Relief: Emotional arousal, such as fear about failures to change and inspiration for successful change; 3. Self-Reevaluation: Appreciating that the change is important to one’s identity, happiness, and success; 4. Self-Liberation: Believing that a change can succeed and making a firm commitment to the change; 5. Environmental Reevaluation: Appreciating that the change will have a positive impact on the social and work environment; 6. Reinforcement Management: Finding intrinsic and extrinsic rewards for new ways of working; 7. Counter-Conditioning: Substituting new behaviors and cognitions for the old ways of working; 8. Helping Relationships: Seeking and using social support to facilitate change; 9. Stimulus Control: Restructuring the environment to elicit new behaviors and inhibit old habits; and 10. Social Liberation: Empowering individuals by providing more choices and resources. Stages of Organizational Change in Which Particular Processes of Change are Emphasized Precontemplation Contemplation Preparation Action Maintenance Dramatic Relief Self-Reevaluation Thinking about Commitment Teams Consciousness Raising Commitment Counter-Conditioning Stimulus Control Helping Relationship Reinforcement Management Moving to a Health Agenda

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

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

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 Health, in its broadest sense, serves to support students and create learning environments. A wide range of college and university professionals work in higher education to promote health. Programs and policies surrounding issues such as alcohol and other drug use, sexual misconduct, and mental health are increasingly viewed as campus wide issues that affect the health of students and academic progress. Advancing the health of college students influences the quality and productivity of their lives in the workplace and in the community. But 17.5 million students (18,000,000 expected in next year or two) 421 HP Section Members (250 professionally prepared but most may be entry level with bachelors degrees without experience in comprehensive HP program planning, 70 CHES) 980 HHEKC members - ~2,600 doing HP? (1:6,701) 2,200 members of First Year Experience listserv doing some health education - ~4,800 total doing HP? (1:3,646) 1,156 CHES in higher ed (.edu or .cc addresses), likely faculty. 4,300 CHES have .com or .net addresses - ~6,000 (1:3,000) 4,200 universities with Health / PE depart – assume each has 3 faculty. Therefore, 13,000 - 19,000 (1:947) 250 professionally prepared ACHA health educators (1:70,000) 52,000 students at ASU 15 doing HP (1:3,467) 10 HEs (1:5,200) 4 CHES Required academic semester long health coureses : Pearman JACH 1997 article, Becher J Gen Ed in print There are 2,200 on First Year Experience listserv. Health education has been a topic for their classes. With topics thought to be important as exercise, nutrition and no mention of stress. * See notes section

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 Theme for the presentation Work on upstream social marketing strategies to influence the behavior of decision makers and other stakeholders: Academic department heads and their key faculty - they currently do not have department specific HP programs) 3 PCWW campus’ clinical staff (nurses and mental health professionals - relied upon to conduct HP which appears to mostly be traditional methods of awareness activities, written information, pamphlets, outreach tables, presentations)). Possible goal is to cause behavior change to using evidence-based interventions (EBI) and cost-effective interventions (CEI). Therefore, policy change to require EBI and CEI which might eventually make using EBI CEI the social norm. At the ASU social marketing training objectives for which we might consider developing marketing strategies are to: Create dissonance about non-EBI/CEI Increase responsibility for health outcomes by non-health stakeholders (instead of relying on SHS staff) Increase perception of effectiveness of EBI/CEI Create a consensus that current non-EBI/ECI interventions are costly and ineffectively Thoughts: Cost-effectiveness of Paul Jones’ (Bipolar Boy) presentations could be $750, $3,000 to $7,000 to change the behavior (impact) of one students, and cost per student attending his presentation could be $1.50 ($750/500 students) to as high as $280 ($7,000/25 students). Of course these programs are likely not evaluated so we'll never know. The challenge seems to be to find EBIs I think are out there likely to have impacts of $3 to $8 to change a single student's behavior.

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 Thoughts about disseminating not only program ideas on listserv but also what the outcomes measures are and evaluation plans. From to Jim Matthews at Merrimac U The reason to disseminate how we would evaluate is that the problem the vast majority of SHS/college health staff don't have that dissonance about non-EBI as an HP option. The marketing offering may have to be marketing communication (the P, promotion of the 4Ps) to disseminate drawbacks of awareness activities, written information, didactic/entertaining presentations (non-EBI), demonstrate the costs to the campus of doing them, the role of alternatives (EBI). Don’t just tell what programs to use, also share the process and outcome measures they will use and how data will be collected. The objective is to influence the behavior of the >90% of the ~2,200 SHS listserv members who are clinically trained. It seems our problem in college health is that there are so few trained health educators. The HP section has 421 members but Paula Swinford estimates that only about 200 are trained and about 70 are CHES. The ratio of qualified HEs to students is likely around 1:6,000. The evidence-based tools and resources we have created in ACHA are have only been available for 3 to 7 years (created and implemented since 2001, SPHPHE, NCHA, HC2010, plus CAS standards and NASPA's HELP & HHEKC) so hardly a blip on the radar screen of the majority of SHS staff.

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 First bullet is Safe Schools / Healthy Students Initiative Program Announcements and Application Instructions March 14, Definitions and Other Terms page 54: Evidence-based—Evidence-based practices or interventions (also called EBIs) are approaches to prevention, behavioral intervention, and treatment that are validated by some form of documented scientific evidence to indicate their effectiveness. Evidence-based programs have met high standards of safety, efficacy, and effectiveness, based on the strength of the study design, magnitude of the beneficial effects of the intervention, sustainability of the effects over time, and replications of the benefits across different settings and populations. Equally important is the availability of information on programs that do not work and can have potentially harmful effects. Practices and interventions that are based on tradition, convention, belief, or anecdotal evidence are not evidence based. Next four bullets are from a presentation titled “Eight Key Questions in Understanding Social Marketing” by Patrick Ladbury from the National Social Marketing Centre. “We know that some programmes and campaigns are window dressing but we still do them. Information giving is often the default option when issues are hard to deal with Why: Pressure to be seen to be acting The desire to help Poorly developed skills and understanding in population behaviour change Short term policy planning budgeting and review”

Evolution of College Wellness & Health
1850s s s ~ 1st Generation nd Generation rd Generation Healthy Campus Objectives Graphic idea from history of corporate health promotion programs. For college health use History and Practice of College Health -So what’s brought us to where we are today? In the latest worksite HP book published last year by ACSM through Human Kinetics (hold book up), Joe Leutzinger from Union Pacific provides a good view of the generations of worksite programs. - I started in the 70’s, so have experienced three of these generations. - National Cash Register started it in the 1800’s with recreation programs for their employees. Back then those lucky kids who had a parent who worked for National Cash Register pretty well had their summer fun assured. Those of us who didn't curried the favor of friends who did so we too could be among the thousands beating the heat in the two-acre swimming pool or canoeing through the peaceful waters of the 1.5-mile lagoon. - Ken Cooper brought on the Fitness craze in the 70’s with his Aerobic books, and this started a whole slew of “executive fitness programs”, and in the late 70’s questions were being raised about why not for all employees. - The Tenneco program was started in 1981 and was one of the first large programs that initiated a wave of programs designed for all employees and focused not just on fitness, but on health and wellness issues, but most surrounded fitness centers. -In the early 90’s programs started to mature and little data had been collected, companies started to ask tough questions and the industry started to make some tough choices that brought on a model that got them closer to company needs. Instruction, Treatment, Exercise Health Education/Promotion EB/CE-HP* * Evidence-based / Cost Effective Health Promotion

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 Evolution model from CHAPMAN, Larry S. Do we need a "virtual" program infrastructure for worksite and population health promotion efforts? American Journal of Health Promotion The Art of Health Promotion Volume 21, Issue 2 - November/December 2006: A 1-7 Health Promotion Section Proposed ACHA Document - Guidelines for Hiring Health Promotion Professionals in Higher Education (Draft) A common misconception is that health promotion professionals should spend a significant amount of time coordinating and delivering events, activities, health fairs and presentations. On the contrary, this guideline recommends that health promotion professionals should focus on creating well-planned, theory- and evidence-based interventions using thorough needs assessments, market research, and objective setting to guide the development process. The interventions are then monitored and evaluated, and outcomes are reported to stakeholders. All health promotion professionals, regardless of the type of position, will increase their effectiveness by having the academic degrees, training and preparation to complete these more complex tasks. Inaccurate terminology: Health Promotions: “Health promotions” is not a term used by any legitimate organization that conducts evidence-based health promotion activities, curricula, programs and services. Example: Office of Disease Prevention and Health Promotion in the US Department of Health Services. Use of promotions with an "s" at the end implies that the department’s primary responsibility is to run specials on the health topic of the day, week or month without following standard health promotion planning processes. Morale Oriented Activity Oriented Results / Outcome Oriented Primary Focus Moving to a Health Agenda * Health Cost Management

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 Evolution model from CHAPMAN, Larry S. Do we need a "virtual" program infrastructure for worksite and population health promotion efforts? American Journal of Health Promotion The Art of Health Promotion Volume 21, Issue 2 - November/December 2006: A 1-7 Health Promotion Section Proposed ACHA Document - Guidelines for Hiring Health Promotion Professionals in Higher Education (Draft) A common misconception is that health promotion professionals should spend a significant amount of time coordinating and delivering events, activities, health fairs and presentations. On the contrary, this guideline recommends that health promotion professionals should focus on creating well- planned, theory- and evidence-based interventions using thorough needs assessments, market research, and objective setting to guide the development process. The interventions are then monitored and evaluated, and outcomes are reported to stakeholders. All health promotion professionals, regardless of the type of position, will increase their effectiveness by having the academic degrees, training and preparation to complete these more complex tasks. Inaccurate terminology: Health Promotions: “Health promotions” is not a term used by any legitimate organization that conducts evidence-based health promotion activities, curricula, programs and services. Example: Office of Disease Prevention and Health Promotion in the US Department of Health Services. Use of promotions with an "s" at the end implies that the department’s primary responsibility is to run specials on the health topic of the day, week or month without following standard health promotion planning processes. Morale Oriented Activity Oriented Results / Outcome Oriented Primary Focus Moving to a Health Agenda * Health Cost Management

Social Marketing Commercial 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 From CDCynergy: Susan Middlestadt on "Role of Behavioral Theory“ text from videio The way I see it is there are a bundle of theories out there -- in psychology, anthropology, social psychology, sociology -- and they all address issues like why do people do what they do? How does behavior change happen? How do systems change? How do people get meanings of things? So it's a bundle of theories in the behavioral and social sciences that can be useful in social marketing. And I'm not quite sure where the boundaries between behavioral and the other social sciences lie. Can we call it communication sciences, decision theories? There are a whole bunch of them out there. But what, from a social marketing point of view, what you need to know is those theories spend a lot of time -- people that study those things spend a lot of time trying to understand behavior. And since behavior is one of the central constructs of social marketing, then why not learn from those scientists? I see social marketing as an applied science, and these other things are like basic science. So I see social marketers as applied scientists are drawing on all these other kinds of scientists -- behavioral science being one of them. And they're using it for a particular reason, so the social marketers are the appliers and the behavioral scientists are the people that spend all their time trying to understand things. So one's applied and one's basic, so why not learn from that in doing social marketing? ...a theory is a concept plus a way to measure it. And the scientists spend a lot of time defining the concepts and figuring out how to measure it. It's a good theory when we capture something that marketers are doing naturally. We just help them define it better, help them figure out how to measure it better, help them differentiate it from some other concept. It's a good theory if we have a construct or a concept that works. That social marketers actually use. .when you're thinking about the process of social marketing, in the beginning the social marketer needs to define the behavior. Behavioral scientists spend a lot of time thinking of that. Well, what is a behavior? Is that a behavior or not? Is that an outcome? Is that an action? Is it observable? So we can help inform the process of deciding the behavior. Once you have the behavior, then you need to understand what are the factors that cause that behavior to happen. Continued on next slide

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? Continued from previous slide. We need to figure out which factor you have to address by any one social marketing campaign. Is it a consequence? Is it an attitude? Is it a norm? Is it a skill? Is it accessibility? So the behavioral scientist can tell you, these are the determinants or the factors to think about. And, at the same time, they can help you do formative research to help you figure out which one is the one we need in this situation, this context, for this target audience. So they help you figure out what to ask about, how to ask the questions, and if they're good, about how to analyze the data because there are different ways to analyze the data. The set of theories that I find most useful are the theories that try to say, “This is how people behave.” And they look at attitudes and beliefs, and there are a bunch of them: the theory of reasoned action, the theory of planned behavior, social cognitive theory, the health belief model. They all have some of the same concepts in them. I don't use any one of them; I use that bundle of concepts, that bundle of determinates, that bundle of factors. behavioral scientists are out there developing new theories -- so sometimes they're developing theories around things that address their new challenges. So you can go to those other theories and pick up a new concept. “You know I heard about social capital. How does that help me?” And so sometimes it enriches our thinking and allows us to be more creative because there's a new concept that comes in. So concept wherever you can get it. I don't believe in being strict about a theory. I think it needs to be informed by theory, but you're not testing a theory. You're using a theory. So you should just use the theory that works best in your context. Have somebody on your team who wears the behavioral scientist hat, who asks, “Is that a behavior?” Or, “What are the determinates of that behavior?” Or, “How shall we ask folks about their behavior?” How shall we analyze it? So have somebody on your team that can be there to ask those questions -- and there usually will be someone who is a behavioral scientist. They may or may not be formally trained --but there are enough resources around with consultants and technical assistants and manuals and things that people have written that they can represent that viewpoint. I think that's my best advice is to make sure there's somebody in the room wearing that hat when you're making decisions.

Keys to Effective Use of the Ecological Perspective
College Health: Stretch Your Definition of the Core Concepts, Assumptions and Practices 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 NASPA - Health in Higher Education Knowledge Community and American College Health Association - Contact Person: Jim Grizzell, MBA, MA, CHES

Intervention Pyramid Cost Reach Low Specialty Care Primary Care
High Low Cost Reach Policies Health Communication, Social Ecological Model & Social Marketing Activities no feedback Health Systems Activities w/ Health Education Specialty Care Community & Neighborhood Collaboration Primary Care Policy Community Assets (IDS/CAIB) Squadrons Traditional Tobacco Cessation Classes Low Intensity Interventions Primary Care Health Systems level may include (in terms of cost vs. reach): A health system comprises all organizations, institutions and resources devoted to producing actions whose primary intent is to improve health. Most national health systems include public, private, traditional and informal sectors. The four essential functions of a health system have been defined as service provision, resource generation, financing and stewardship. Just above this level - activities such presentations and health fairs without feedback and follow-up Health systems includes insurance, HMOs, hospitals Just below this level – activities such classes, presentations, health fairs with screenings and assessments with feedback and follow-up

Business Case Levels of Interventions & Wellness Program ROIs
Program Levels Intervention Levels Quality of Life Traditional Health & Productivity I. Awareness Information, no feedback <1:1 IIa. Behavior Change Health education w follow-up 3:1 IIb. Behavior Change Targeted priority health issues with Social Marketing 6:1 to >15:1 III. Supportive Environment Ecological Approach, Policies >15:1 Awareness: Health fairs, commissary tours, outreach tables and displays, literature and pamphlets. Organizations are doing wellness activities to let employees know that they are cared about by the employer. Organizations at this level want to improve employee quality of life by running programs that are fun, enjoyable, and that allow employees to interact with each other during the workday. Programming is basic, meaning organizations simply offer a variety of programs and let employees choose which ones they like. This level is the least likely to produce a return on investment, and employers might invest $10 to $50 per person per year. Traditional: Organizations still offering a variety of programs, hoping the right people will go, but they’re also putting some effort into reaching the at-risk population, too. Organizations may spend between $50 and $100 per employee per year at this level. About half of employees will use one or more programs over a two-to-five-year period. But here’s the trouble. It’s typically the other half of the employee population that needs the programs the most. So at the Traditional level, it’s very difficult for us to evaluate the entire population because we don’t have data on the entire population (low, medium and high risk populations). For this reason, Traditional programs present challenges when evaluating behavior change and economic return because we simply have people using one program here, one program there, and there’s no good way to track anything or pin anything down for the purposes of evaluation. Health and Productivity Management: Efforts from Traditional program design are targeted and tailored to specific audiences and 80% to 90% can recall the marketing, social marketing and media messages specifically designed for them. The marketing messages are based on focus groups and surveys of their needs, aspirations, wants and desired (the real “products” the want). Date is epidemiologically sound. Wellness is linked to benefits and incentives the audience wants and short-term interventions are designed to improve attitude, comprehension, aspirations, knowledge, stage of change, behavior, practices, decision making, policies, social and community action. The productivity dimension is added to your process and evaluation — a dimension that accounts for work effectiveness as well as direct medical costs. At this level, organizations begin to put stronger incentives in place and link wellness more powerfully to the health plan. This is the level where organizations can expect to see a significant economic return. At this level, organizations may spend $100 to $300 per employee per year. The most innovative companies are going this way. $100 - $300 per employee. Moving to a Health Agenda

Continuum of Services Intensive Early Intervention
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

Health in Higher Education
College Health: Stretch Your Definition of the Core Concepts, Assumptions and Practices 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 NASPA - Health in Higher Education Knowledge Community and American College Health Association - Contact Person: Jim Grizzell, MBA, MA, CHES

The Ecological Perspective
College Health: Stretch Your Definition of the Core Concepts, Assumptions and Practices 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) NASPA - Health in Higher Education Knowledge Community and American College Health Association - Contact Person: Jim Grizzell, MBA, MA, CHES

A New Paradigm: The Ecological Approach to Campus Health
College Health: Stretch Your Definition of the Core Concepts, Assumptions and Practices 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 NASPA - Health in Higher Education Knowledge Community and American College Health Association - Contact Person: Jim Grizzell, MBA, MA, CHES

Using the Ecological Perspective on Campus
College Health: Stretch Your Definition of the Core Concepts, Assumptions and Practices 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 NASPA - Health in Higher Education Knowledge Community and American College Health Association - Contact Person: Jim Grizzell, MBA, MA, CHES

Influencing Factors Individual Community Place Organization People
College Health: Stretch Your Definition of the Core Concepts, Assumptions and Practices Influencing Factors Characteristics of the: Individual Community Place Notes: Comprehensive, multifaceted, HOLISTIC, concerned with the environment and its relationship to people at individual, interpersonal, organizational and community levels. Recognizes that these interactions INFLUENCE behavior and well being. Organization People NASPA - Health in Higher Education Knowledge Community and American College Health Association - Contact Person: Jim Grizzell, MBA, MA, CHES

Environmental Influences
College Health: Stretch Your Definition of the Core Concepts, Assumptions and Practices 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. Organization Organizational Structure Policies Organizational Climate Community Political Climate Conservative/liberal Pro education? Reinforcement and Rewards For healthy org & indiv behaviors NASPA - Health in Higher Education Knowledge Community and American College Health Association - Contact Person: Jim Grizzell, MBA, MA, CHES

Stress: Environmental Influences
College Health: Stretch Your Definition of the Core Concepts, Assumptions and Practices Stress: Environmental Influences Place Warm climate Lack of parking High traffic Campus size—distances Crowding—long lines People Financial concerns ISO – global troubles Relationships w/friends Lack of friends/commuters Irresponsible drinkers Uninvolved students Institution Services--lack of info Depts disconnected Too many steps Weak policy enforcement Inconsistent messages Community State budget crisis Increase in tuition/fees Rewards for over commitment Culture of stress NASPA - Health in Higher Education Knowledge Community and American College Health Association - Contact Person: Jim Grizzell, MBA, MA, CHES

Ecological / Environmental Approach Neighborhood Collaboration
Social Marketing’s Fit Intervention Pyramid Policies Health Communication, Ecological / Environmental Approach Activities no feedback Health Systems Activities w/ Health Education Specialty Care Community & Neighborhood Collaboration Primary Care Social Marketing Social Marketing Social Marketing Ways to affect behavior Social Marketing can be used to affect each level – downstream to those having the health/behavior problem, sidestream to others who can influence the persons with the problem and upstream to those who can set policy. Social Marketing in Health Promotion

Moving to a Health Agenda
Historical Snapshot: Think Health Agenda & Business Case Corporate & College Health & Wellness 1st Generation nd Generation 3rd Generation 4th Generation Recreation Fitness Health Education > Promotion HPM* 1850s s s ~ 1st Generation nd Generation rd Generation -So what’s brought us to where we are today? In the latest worksite HP book published last year by ACSM through Human Kinetics (hold book up), Joe Leutzinger from Union Pacific provides a good view of the generations of worksite programs. -I started in the 70’s, so have experienced three of these generations. -National Cash Register started it in the 1800’s with recreation programs for their employees. Back then those lucky kids who had a parent who worked for National Cash Register pretty well had their summer fun assured. Those of us who didn't curried the favor of friends who did so we too could be among the thousands beating the heat in the two-acre swimming pool or canoeing through the peaceful waters of the 1.5-mile lagoon. -Ken Cooper brought on the Fitness craze in the 70’s with his Aerobic books, and this started a whole slew of “executive fitness programs”, and in the late 70’s questions were being raised about why not for all employees. -The Tenneco program was started in 1981 and was one of the first large programs that initiated a wave of programs designed for all employees and focused not just on fitness, but on health and wellness issues, but most surrounded fitness centers. -In the early 90’s programs started to mature and little data had been collected, companies started to ask tough questions and the industry started to make some tough choices that brought on a model that got them closer to company needs. Instruction, Treatment, Exercise Health Education > Promotion HAPM* * Health & Productivity Management, Health & Academic Performance Management Moving to a Health Agenda

Upstream Social Marketing

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